Preparedness and Planning Readied Evangelical Community Hospital for COVID-19May 01, 2020 11:14AM ● By Erica Shames
During the COVID-19 response, several rooms inside of the hospital were converted to negative pressure rooms. Negative pressure rooms help prevent airborne diseases from escaping the room and infecting other people. A machine pulls air into the room. Then it filters the air before moving it outside.
When it comes to emergency planning and preparedness, Evangelical Community Hospital is ready on any given day for a myriad of situations that may arise. The same was true when COVID-19 made its first appearance at the Hospital.
“We have a basic outline for any pandemic response,” said Kendra Aucker, President and CEO. “Starting in December and January, we took the basic pandemic framework and created a COVID-19 specific appendix to our plan that included all areas of operation as it would relate to the virus.”
The Hospital put specific tools in place that would keep COVID-19 patients and non-COVID-19 patients separated for the safest response.
Testing and Exam
An alternative test site for COVID-19 was setup off the Hospital campus at the Plaza 15 shopping center. This drive-through testing site allowed individuals to remain in their vehicles while staff in personal protective equipment (PPE) completed testing on those who met the necessary criteria. This site continues to keep those seeking tests outside of the Hospital.
The Emergency Department created four treatment rooms for possible COVID-19 patients separate and apart from others seeking medical care for other reasons. They also established an exam site for patients in the ambulance bay/garage area with access from the Emergency Department to allow for separation from general population patients.
A tent has been set up outside of the Hospital and treatment areas have been created in the event that the garage area filled to capacity. The tent has not been used to-date but is waiting in the wings in the event a second wave hits and surge capacity is needed.
Patients who test positive are asked to isolate themselves at home for 14 days. Only patients who are severely ill are hospitalized.
Intensive Care and Stepdown Units
The Hospital’s Intensive Care Unit (ICU) was converted into a full COVID-19 ICU. The 12 ICU rooms were converted into five isolation rooms with connected ante rooms. Ante rooms are essential for infection prevention and control and are the rooms where medical staff don and doff PPE. In the current pandemic, they serve as the only access in and out of the isolation room. These five rooms joined two existing isolation rooms for a total of seven COVID-19 ICU beds.
For non-COVID-19 patients who need critical care, the Hospital’s Post Anesthesia Care Unit was transformed into the new ICU for the Hospital. With both ICUs in place, the Hospital can care for 23 critical care patients.
The Hospital’s 17 Stepdown beds were converted into a COVID-19 unit as well and were available at any given time for COVID-19 patients requiring hospitalization but not critical care.
The Hospital’s Orthopaedic Unit, which was unused due to the restriction on elective surgeries, were turned into the non-COVID-19 stepdown unit, making it possible for 39 beds to be available as stepdown beds.
The moves provide distinctly separated space to care for COVID-19 positive or suspected positive patients away from areas to care for patients who are not positive but require treatment for other reasons. The separation also affords the Hospital the ability to segregate staff, further minimizing potential exposure for everyone.
Negative Pressure Rooms
Negative pressure rooms use lower air pressure to draw outside air into the segregated environment. This traps and keeps potentially harmful particles within the negative pressure room by preventing internal air from leaving the space. Negative pressure rooms isolate patients with infectious conditions and protect people outside the room from exposure.
“Operating the Hospital during the COVID-19 response required everyone to step-up and think outside of the box,” said Aucker. “Our staff use innovation, ingenuity, and creativity to create new spaces or methods within the current Hospital structure. The negative pressure rooms are just one example of how we used creativity and ingenuity to create a space our medical staff needed.”
Prior to COVID-19, the Hospital had three negative pressure rooms in place, one each on ICU, Stepdown, and the Emergency Department. As part of the COVID-19 plan, an additional eight negative pressure rooms were created within the ICU and Stepdown and another two were created in the Emergency Department. These rooms are used for the treatment of COVID-19 positive patients.
The Family Place
The Family Place, the Hospital’s obstetrics unit, had no isolation units in place before the COVID-19 response. One isolation room of the 16 available was converted to treat positive obstetric patients.
One measure in the preparedness plan for COVID-19 was to take assessment of the number of ventilators on hand to manage care for patients impacted by respiratory illness. The Hospital currently has 23 traditional ventilators in-house with an addition eight anesthesia machines that were repurposed as ventilators during the pandemic response. This gives the Hospital the capability of handling 31 patients on ventilators at any given moment.
Consolidation of Services
Part of the plan was to gear down Hospital services to limit the number of individuals in the Hospital or outlying practices as much as possible for infection control. Due to a state mandate, elective surgeries were put on hold and only emergent or urgent, time-sensitive procedures were being conducted. Outlying family practice offices were consolidated into just a few in operation to handle primary care needs. Urgent Care remained open for patients to create additional access for patients seeking care for non-COVID-19 related illnesses. Specialty services, such as orthopaedics, physical therapy, heart and vascular, and Palliative Medicine continued to see patients but on a modified schedule to limit the number of people in the clinic at a time.
More Than Care Preparation
That’s not all, emergency preparedness means addressing supplies—making sure there are enough of them and the proper use of them. The Hospital’s supply of PPE was analyzed on a daily, sometimes hourly basis to ensure the staff had the tools they needed to carry out their jobs safely.
The Hospital also had to look at the safest cleaning methods and what proper agents to be using.
Some of the most difficult and talked about decisions centered around visitation restrictions, masking, and screening for the safety of patients and staff.
“We’ve worked very hard to do right by our patients and those who may need care. We are the community’s hospital and that means making sure we’re focused on safety and following the science to keep people seeking care and our staff safe,” said Aucker.
As of May 4, 2020, the Hospital will begin ramping up some of the services that were closed down. The opening is being completed in phases with a methodical approach to the expansion of operations.
Of the systematic and measured return to some services, Aucker added, “We have to maintain our ability to address the continued presence of COVID-19 in the community and remain nimble enough to respond to a possible surge.”