BY LISA EISENHAUER
March 25, 2020
Providence St. Joseph Health's hospitals have had the misfortune of being among the first in the nation to grapple with the pandemic caused by the novel coronavirus. The system operates in seven western states including two with the highest number of COVID-19 cases, Washington and California.
Dr. Rhonda Medows, president of population health at Providence St. Joseph, shared some of the challenges the health system faces during a CHA webinar called "Lessons from Ground Zero." Medows is on CHA's board of trustees and chairs its advocacy committee.
On March 25, the date of the webinar, the total number of cases across the nation was nearing 62,000 with 859 deaths. Medows said Washington, where she is based and where the first U.S. patient with COVID-19 was treated in January at Providence Regional Medical Center in Everett, had "2,662 cases and growing." Providence St. Joseph facilities had treated about 850 patients with confirmed or suspected cases of the virus when Medows made the webinar presentation.
Medows said based on predictive models the system is bracing for a surge of COVID-19 patients in coming weeks.
Anticipating ventilator shortages
In order to add to its inventory of ventilators that by some projections is now only a third of what could eventually be needed by its hospitals to care for patients with life-threatening cases of COVID-19, Providence St. Joseph has moved well beyond its typical supply chain.
"We have gone so far as to reach out to a very unusual partner, the American Veterinary Medicine Association," Medows said, because some veterinarians have ventilators for large animals that are made by the same manufacturers that make the machines for people.
In response to Providence St. Joseph's plea for equipment, the veterinarian advocacy group put out a call to all its members, chapters and veterinary schools for ventilators they could donate or loan. Medows didn't know exactly how many ventilators the veterinarians will be able to provide, but she said the appeal has brought in offers of help from almost every state.
"Even still, we need more ventilators manufactured and made available," Medows said.
She said the system's hospitals have enough ventilators to meet their current needs, but there are grave concerns about potential demand ahead that are based on how quickly COVID-19 is spreading. To prepare for the worst-case scenario where there are too few ventilators, she said teams with clinicians, ethicists and mission leaders are meeting to discern "whether there is a rationing process that can be put in place consistently."
The health system also is struggling to acquire test kits and personal protective gear for clinicians. Masks needed to protect clinicians from patient/clinician infection are scarce, Medows said. (To reduce the risk of staff-to-patient and staff-to-staff transmission, the system requires all staff members to have their temperatures taken when they arrive at work.)
Providence St. Joseph launched a 100 Million Masks campaign to raise money to buy masks, and, since masks are in short supply internationally, to get more made based on a prototype it created. At first, individual volunteers were making the surgical masks and face shields from patterns and materials the system supplied. More recently, the effort has been taken over by local companies. Nationally, storied brands including Hanes are gearing up to manufacture protective masks.
N95 respirator masks that are believed to be the best protection against the deadly virus are in particularly short supply. The system is allocating them to protect doctors, nurses and bedside respiratory therapists treating patients with COVID-19 and the housekeeping staff who clean and disinfect the rooms of patients with the infectious virus, Medows said. In some cases, the masks are being sanitized and reused provided they do not have any obvious stains or contaminant. "That is not our first choice but that is the realistic choice while we have shortages," Medows said.
Extra assistance for staff
The system is providing extra services such as childcare and it has added 80 hours of emergency time-off for each caregiver to use, if necessary, through May 31, Medows said in response to a follow-up question after the webinar. For all its employees, the system is providing extra resources, such as access to mental health counseling beyond the typical employee assistance programs.
All of the system's workers who aren't providing direct patient care or hospital maintenance are telecommuting. Many services, including care for patients exhibiting less severe symptoms of novel coronavirus, also have been shifted over to the virtual world. Medows said the system at first thought those patients could be treated at ambulatory care sites, but the shortages of test kits and protective gear made it pivot to telehealth care.
Boom to telehealth
The health emergency has prompted the system to expand its telehealth care services to the point that it has 7,000 physicians who can see patients through virtual means.
"Virtual care and telehealth services have taken off and is skyrocketing," Medows said. "I think that initially we thought of it as an adjunct to the care we could provide in person with our doctors, nurses, clinics and hospitals. It has begun to play this huge role and will only grow bigger."
The system is also using web-based tools such as webinars, teleconferences and websites to educate its staff on topics including best practices to prevent the spread of the virus and proper use of protective gear. Online tools also are being employed to help the public do self-assessments of potential coronavirus symptoms and to share information about who can be tested and where.
Making use of new spaces
In its coronavirus efforts, the system is also using drive-up testing and setting up triage centers in tents. For patients with symptoms that warrant hospitalization, Medows said hospitals are keeping patients until they test negative for the virus.
She said Providence St. Joseph executives have identified available facilities in each region where the system operates that could be converted to clinical facilities if needed, but so far that had not been necessary.
Watch the webinar
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