Major health systems around Oklahoma have been rocked by the COVID-19 outbreak. Representatives from INTEGRIS Health System, Ascension St. John, OU Medicine and Cancer Treatment Centers of America have answers to important questions about their day-to-day changes, safety and how Oklahomans can help to slow the spread.
INTEGRIS: Becky Lewis – System Director of Infection Prevention
Ascension St. John: Mike McBride – Regional President and COO
OU Medicine: Kris Gose, RN – President, OU Medical Center
Cancer Treatment Centers of America: Dr. Jeffrey Metts – Chief of Medicine
Q: How are health systems working together during this pandemic, either locally or nationally?
INTEGRIS:In Oklahoma, there is a healthcare system Incident Command Center call, pulling multiple healthcare leaders together to identify challenges, resources and opportunities. In true Oklahoma fashion, the communities find ways to step up to support. Nationally, healthcare systems who are farther along in their pandemic response have been generous to share their processes and experiences, allowing our organization and others to learn from their “I wish we had done X-Y-Z” moments. What a blessing.
Ascension St. John:We are lucky that Ascension St. John is a part of a national system. So, working with our colleagues at that national level, it helps us in having the best expertise and a strong supply chain. On a state-wide level, we’re working with the Oklahoma Hospital Association and talking with our colleagues there on a three-times-a-week basis. We also consult with local hospitals and the local health department on a regular basis.
OU Medicine: We are working together as CEOs through the Oklahoma Hospital Association, working with the state leadership on surge plans for the state, and the tertiary hospitals in Oklahoma City and Tulsa are having their incident commanders meet several times a week to share updates and best practices. Infectious disease providers, intensive care unit providers, emergency department teams as well as supply chain, ethic teams, legal and bio medicine are also working together to plan and implement consistently best practices for our community.
CTCA:We have made offers to city and state officials to welcome cancer patients from other hospitals during the pandemic as they make more room for COVID-19 patient needs. This also brings cancer patients to a non-treating COVID-19 facility, which is important for immunocompromised patients.
Q: How are you, in general, keeping workers on your front lines safe during this pandemic?
INTEGRIS: Looking at the multiple settings in which we provide care, we provide a variety of safety measures, including: Pre-appointment calls with patients to identify if they are symptomatic and if there are any appropriate precautions to take before they can come in for a visit; Visitor and staff screening stations – we require temperature checks upon entry, and those with a fever will not be allowed to enter; Deployment of face shields for patient care areas to reduce risk of exposure; Internal manufacturing of critical supplies, including face shields and face masks; Placing COVID patients in cohort units to isolate them from other patient populations; And development of evidence-based clinical guidelines.
Ascension St. John:First is providing people with the appropriate personal protective gear, or PPE. Secondly, we’re putting an emphasis on self-care, so people do the things necessary personally to do their best at work. Third, we have hoteling options for associates in certain categories that are concerned about taking infection home with them. We’re creating all kinds of measures to provide people with safety and mental peace during this time.
OU Medicine:Our team members wish this was not occurring, but this is what we are trained for and they are focused, brave, caring and prepared.
CTCA:We have implemented screening protocols and safety measures recommended by the CDC at each of our locations. As an added measure, we are taking these safety precautions: CTCA clinical teams are reaching out to our patients prior to their visit to check on their health and see that they have a plan for getting to our facilities; CTCA clinical teams are reaching out to our patients to determine if a tele-health visit is a better option; Each of our facilities has a single point of entry, with 24-hour, mandatory screening of all patients, caregivers, visitors, physicians and employees; We have updated our visitor policy to do all that we can to protect patients where they are most susceptible; All CTCA employees are being screened for symptoms twice a day; We are providing masks for all patients and caregivers to wear throughout their time in any of our facilities and until they get back home; All CTCA physicians, clinicians, other employees and official visitors will be provided the appropriate mask based on their patient responsibilities as outlined in the CTCA COVID-19 Preparedness Personal Protective Equipment policy; All CTCA employees who are not required to be onsite are working remotely to reduce person-to-person contact.
Q: Did you have a contingency plan for this type of event, or is unprecedented?
INTEGRIS:The scope is extraordinary; however, hospitals are required to have a plan and to drill for such events. What is different is that drills only last a limited time, while the length of this event is unknown. Contingency plans also have unknowns. This situation has provided reinforcement of good practices and preparation, along with new learnings.
Ascension St. John:Hospitals everywhere have well-developed disaster plans, but this particular situation didn’t exactly fit any of those plans, so we used them as a basis for our approach. It has been a mixture of both enacting plans and using a learn-on-the-job approach.
OU Medicine:We do have typical surge plans, processes and PPE for contagious diseases, but the possible scope of this pandemic is unprecedented and focused on a particular population of patient and needs.
CTCA: Yes, we have a company wide Incident Command Center that is planning for all scenarios, including potential surges.
Q: How are you faring in regard to PPE (personal protective equipment): masks, gloves, goggles, gowns, head covers?
INTEGRIS:This is difficult as there is much unknown (including length of the event and more); however, we are following up on all leads to not only improve our access to supplies, but preserve as well. As of today, we feel confident we will have an adequate supply for the safety of our caregivers.
Ascension St. John:We monitor our PPE supplies and use something called a burn rate on a daily basis. Today, we have an adequate supply to take us forward through any anticipated surge. However, if conditions change with either supply or demand, we could be put in a pinch.
OU Medicine:We are successfully obtaining many of these supplies. We have initiated a Million Mask Challenge (accessed here). We are also working with our academic partners and community partners in unique ways to preserve PPE, and we’re creating unique tools for additional support – testing tents, oxygen helmets, cloth masks, etc.
Q: How about ventilators and other equipment necessary for severe COVID cases?
INTEGRIS:Our organization is monitoring critical equipment and supplies on a daily basis. As the nation sees different regions impacted by surges of infectious patients, we continue to secure what we can for when our communities are in need.
Ascension St. John:Same answer as above – we’re monitoring the situation daily. Today, we have an adequate supply to take us forward through any anticipated surge.
OU Medicine:We currently have ventilators on standby to support additional volume and have placed requests with the state supply to meet needs of prediction models, which exceed our current supply.
Q: How are you faring in regard to hospital beds?
INTEGRIS: As the healthcare community in Oklahoma has asked the community to reduce visits for safety purposes, we have seen our hospital bed capacity increase. That is a fluid measure, as day to day it can change based on community needs.
Ascension St. John:We are faring well. Our general volumes are down by 40 percent, so there is plenty of room in case of a surge.
OU Medicine: With elective volumes down due to state guidelines and social distancing, we currently have physical bed capacity, but would have to use alternative bed sites if the peak is as high as predicted.
Q: Do you think Oklahomans are taking the severity of this pandemic seriously?
INTEGRIS:Oklahomans have overall done decently as it relates to taking this pandemic seriously. There will always be individuals, groups or theories suggesting that the pandemic is overblown. Interventions that our communities have taken have made positive impacts in outcomes. It is always easy to look back and identify things we could do better, but with the information we know at this moment, we are doing decently well.
Ascension St. John:I do think we are doing well. From my observations here in Tulsa, people seem to be taking physical distancing carefully, and certainly people are moderating their use of healthcare supplies.
OU Medicine:In general, the community is being successful with social distancing and universal masking. We strongly encourage everyone to keep practicing these behaviors, as they are helping to flatten the curve – but that can change if we stop utilizing the best prevention practices.
Q: Who are some of the forgotten heroes of your organization?
INTEGRIS:Respiratory therapists are critical heroes, along with our environmental services workers. RTs are essential to managing ventilators and respiratory procedures to assist patients to heal. EVS is front-line in providing a safe, clean environment. So many others, including facilities workers who keep the lights on and the water flowing, to dietary, to therapies and more. Our volunteers have been essential also. There are numerous people battling this virus behind the scenes.
Ascension St. John:The community often thinks about doctors and nurses in these situations, and they are important. But there are so many others, like respiratory therapists, housekeepers, infection control specialists, radiologists, food services, lab technicians … it’s a long list of people that make the hospital operate effectively.
OU Medicine:Supply chain services are working around the clock to find resources. Environmental services are critical to successful care every day, but especially in this kind of situation. And, infection prevention and planning operations teams are critical to our success.
Q: How can Oklahomans generally help to make your life easier?
INTEGRIS:Be kind to one another. Kindness always helps. Beyond that, we will all benefit from basic healthy habits, including hand washing. Assume the best intentions of people; sometimes when we don’t have all the information or are given wrong information, and it is easy to assume the worst. But healthcare organizations across the state are making difficult decisions related to our community members – assume that there are good intentions behind the decisions made.
Ascension St. John:Be patient. Continue social distancing. I understand that people are getting weary, but this method is working. We don’t want to suspend social distancing too quickly, or we will have the chance of a second surge. Continue the good things you’re doing for a bit longer.
On another note, our ER volumes are down significantly. People are using the ER only when it’s absolutely needed, and that’s a good thing. But we also have a blossoming fear that people are waiting too long to seek treatment during medical emergencies. I want to make it clear that we are well-equipped to safely and effectively take care of patients in the emergency room.
OU Medicine:Practice social distancing, support healthcare team members and take care of yourself to stay safe.
CTCA:Touched by the giving spirit of volunteers who want to help prevent shortfalls in necessary safety equipment for healthcare workers, we are embracing generous offers to make hand-sewn surgical masks. We have developed careful, detailed instructions on how to make the masks, to ensure that your time is well spent and the masks will provide proper protection. Once the masks arrive at our hospitals, we follow a thorough process to inspect, prepare and sterilize them for use. (Directions here and video here.)