Managing Medicine

Hospitals Preserved Patient Safety Amid Pandemic

By Jay Gonzales

Even though the Tucson region wasn’t experiencing the chaos that COVID-19 brought to other communities, healthcare here was still stressed by the arduous task of preparing for and dealing with the virus while conducting the usual medical business.

And it was anything but business as usual.

The pandemic’s arrival didn’t put an end to broken bones, heart problems and babies coming into the world. What it did do was make processes related to COVID-19 part of the routine for hospitals to ensure every patient’s safety during treatment and visits to medical facilities where COVID-19 might be present.

At the same time, the community had to be prepared for a potential surge in COVID-19 patients. That meant making sure there were enough hospital beds to go around and medical staff available  – all while not knowing if they would be needed. The anticipated surge never materialized and there was no shortage of hospital space or medical services.

The public, meanwhile, responded by thinking that the last place they wanted to be was near anyone who might have the virus  – therefore people stayed away from medical facilities in droves, resulting in a huge financial impact on the entire healthcare industry.

Safety first

The safety issue was first and foremost at every medical facility and hospital.

At Tucson Medical Center, CEO Judy Rich said medical care at the hospital was separated into two tracks  –  dealing with those who might be coming in with coronavirus and dealing with those who weren’t.

“Every work stream that we have had to be separated into a virus and a non-virus work stream,” Rich said. “Patients who were suspected of having the virus were separated from everybody else.

“We chose the parts of the hospital that were the farthest away from everything else and made those our COVID-19 units. We separated our two intensive care units into a COVID unit and a non-COVID unit. A lot of things changed very quickly. But once we settled into our understanding of the new processes, things actually worked remarkably well.”

Medical staff working in the COVID-19 units knew the risk they were taking in having direct contact. Everything possible was being done to protect them. However, staff who were working with the more “day-to-day” patients faced a risk just by being in places where COVID-19 might be, said Chad Whelan, CEO at Banner – University Medicine Tucson.

“I just can’t emphasize enough that while we were doing this complete redesign of how we deliver care with all the uncertainties, we also had to reassure our colleagues who were placing themselves literally in harm’s way to care for our community that we were doing everything we could to minimize that risk so that they would feel comfortable and confident to keep coming back,” Whelan said.

‘People are fearful’

The perception that the hospitals and clinics were overwhelmed and lacked space was a national perception brought on by the haunting images of patients in tents outside hospitals where the virus surged to epidemic proportions.

In Tucson, medical facilities emptied out except for those staff and patients caught in the pandemic. People weren’t visiting their doctors unless they absolutely had to. There was a moratorium on elective surgeries. Like most other businesses, the medical industry was immediately thrown into financial distress because of a lack of business.

For example, on a normal day, 500 patients are seen at TMC. During an April 20 economic impact webinar conducted by Sun Corridor Inc., Rich reported the number of daily patients was down to 300 to 350.  The hospital also was seeing about half the normal number of patients in the emergency room. At El Rio Health, a large local primary care provider, the face-to-face patient volume dropped by 50%, said Nancy Johnson, CEO at El Rio Health.

“We’re finding people are fearful of coming to the hospital,” TMC’s Rich said at the time.

The new way

Out of necessity, the medical industry began developing or, in some cases, accelerating plans for new ways of doing business to not only generate revenue, but to ensure the patients they had been taking care of were still getting the needed care.

At primary care providers El Rio Health and MHC Healthcare, doing what they do during the normal course of business, which is to provide primary care, was actually part of the pandemic response.

“We’ve always seen our place as kind of the frontline to keep people out of hospitals, to keep people out of ERs,” said Clinton Kuntz, CEO of MHC Healthcare. “We are the primary contact for most of our patients. When they’re feeling sick or have questions or want testing, we’re the first place they go to.

“The more services we provide and the more support to patients we can provide, the less strain it’s going to put on the hospitals on the back end who need to deal with the really sick patients.”

Almost immediately, all healthcare companies turned to “telemedicine” or “telehealth” –  the practice of conducting doctor visits virtually – on a computer or mobile device from a patient’s home or somewhere other than a doctor’s office. This was something they all had dabbled in and saw as part of their future. However, out of necessity, it was accelerated to become a staple of treatment.

“We’re doing about 1,000 telehealth visits a day with patients because we want them to stay home,” Johnson said in early May, during the stay-at-home order issued throughout Arizona. “The first step up is a telehealth visit for someone who is sick. We can determine if they need to come in and be seen. And if they need to come in and be seen, we’re going to keep them safe.

“Our health centers don’t have a lot of people in them because they’re staying at home. So we’re able to really protect patients that need to come in because some of them do need to come in and be listened to and have a physical assessment so we can determine how ill they are.”

Kuntz said: “We really had to flip our whole model on its head overnight. We did about six month’s worth of work in less than two weeks to change our approach to how we’re taking care of our patients.”

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