For several months, leaders and employees at CaroMont Health have been
working with local health officials and emergency management leaders to
prepare for a highly contagious respiratory pathogen like COVID-19. Once
the virus took hold in cities across the country, the health system convened
a task force of health system leaders, including medical and nursing leadership,
infection prevention specialists and experts from across all operational
disciplines to plan CaroMont Health’s response to a local outbreak
of COVID-19.
“We met with Gaston County DHHS, Emergency Management, GEMS, and
many others in January to coordinate plans and drill response procedures,”
explained Todd Davis, MD, Chief Medical Officer at CaroMont Health. “Around
that time, the novel (new) Coronavirus was exploding in Wuhan but was
not yet a global health concern. Given the sheer number of communicable
diseases that exist, we knew we needed to prepare, but no one knew the
virus would move so quickly. I’m glad we have community partners
who understand the importance of preparedness.”
In the days since COVID-19 began to spread domestically, leaders at CaroMont
Health have been working around the clock to plan logistics, medical and
clinical resources, staffing, financial planning and technology needed
for the health system to deal with the virus now and well into the future.
They have also maintained daily contact with community partners and health
systems across the state to coordinate response at the local and regional level.
“We have spent many hours preparing for what we believe would be
the worst-case scenario – an extraordinarily large number of very
sick patients,” said Chris Peek, President and Chief Executive Officer
at CaroMont Health. “Like hospitals across the country, we are planning
for all eventualities, but we are seeing hopeful signs the proactive ‘Stay
at Home’ measures put in place by leaders in Gaston County and then
at the state level are helping limit the spread of COVID-19. We are certainly
not out of the woods, but there are signs of progress.”
Indeed, recent studies released by the University of Washington and a state
collaborative with Blue Cross and Blue Shield of North Carolina, NoviSci,
RTI International, and scientists at Duke University and the University
of North Carolina at Chapel Hill, suggest that efforts to “flatten
the curve” in North Carolina will reduce the number of individuals
affected by the virus. While the studies do not agree on exact numbers,
they both show the “Stay at Home” measures are working.
“While there is certainly an economic impact related to the measures
in place, the protection they provide to the public, our most vulnerable
citizens and our healthcare workers is absolutely critical,” said
Dr. Davis. “Current research suggests this virus may be more easily
spread than the flu, so it’s frightening to consider where we would
be if people were still going to public places and large gatherings.”
Health System Preparations Help Patients and Visitors Access Care Safely
Facility closings and visitor restrictions
Over the last month, CaroMont Health has postponed non-essential services,
like elective surgeries and non-urgent procedures, and significantly limited
visitors in all facilities. These measures were taken to help reduce the
number of people in facilities who may inadvertently expose patients and
staff or may become exposed themselves. Those who are allowed to enter,
patients and visitors alike, must be screened for symptoms of respiratory
illness. Along with this protocol, based on CDC guidelines, visitors and
patients are encouraged to wear a mask when they are in a CaroMont facility.
“The goal is to minimize the chance of COVID-19 exposures to patients
and employees,” said Dr. Davis. “In the absence of an urgent
need for medical care or the responsibility to provide that care, now
is not the time to be in a healthcare facility. Many COVID-19 cases are
asymptomatic, so it is difficult to determine which visitors are safe
to be around patients and employees and which could expose them. We must
take all precautions to minimize that risk.”
Telehealth Appointments at CaroMont Medical Group Clinics
To accommodate “Stay at Home” orders and visitor restrictions,
CaroMont Health recently launched telehealth and virtual visits in primary
care, urgent care and specialist offices in their physician practice network.
This technology is allowing doctors and providers to stay connected with
their patients for more routine visits and well-checks.
“Telehealth and virtual visits were a high priority for our doctors
and providers because so much of their work is focused on keeping patients
well,” said Peek. “Allowing them to efficiently care for patients
who are sick, either in the office or through a virtual visit, is critical
right now, but they didn’t want to postpone well-checks and follow-up
visits with all patients.”
Telehealth is available for both new and existing patients by calling the
physician’s office and requesting a telehealth appointment. Patients
will need their insurance information when calling to schedule the visit,
and will need access to a smart phone, tablet or computer with a camera,
as well as an internet connection, to complete the virtual visit. Most
insurance companies have expanded coverage for telehealth visits; however,
patients should check with their provider to understand the costs associated
with the visit.
Preparations and Response at Hospital Focused on Critical Supplies and
Care Resources
Patient Triage and Care Capacity
In preparation for an influx of patients with signs and symptoms of COVID-19,
CaroMont Regional Medical Center has established a four-tiered triage
process to manage patients who present to the hospital. The process, based
on the prevalence of confirmed COVID-19 cases in the community, proactively
isolates individuals with suspected COVID-19, both for initial screening
in the Emergency Department and admission to the hospital.
“The measures taken to postpone elective surgeries and non-urgent
procedures have reduced the daily census in the hospital anywhere from
5% to 25%, depending upon the day,” said Peek. “That adjustment
in volume has allowed teams to transition several units to care exclusively
for patients with suspected or confirmed cases of COVID-19.”
In North Carolina, the allocation of acute care beds is managed through
the North Carolina Department of Health and Human Services’ Division
of Health Service Regulation. CaroMont Regional Medical Center is licensed
to operate 372 acute care beds. Recently, NCDHHS has allowed hospitals
to apply for additional beds using an expedited application process. Thus
far, CaroMont Health requested and received approval for 10 additional
beds to expand inpatient capacity.
“The hospital is licensed for the operation of 25 ICU beds,”
said Peek. “Our current estimates suggest we have flexibility to
double or triple the total ICU bed count. We will work with NC DHHS to
covert other inpatient beds to ICU beds should the need arise.”
Critical Supplies and Personal Protective Equipment (PPE)
In response to the global shortage of personal protective equipment (PPE),
CaroMont Health has been monitoring inventory of critical supplies to
ensure the system remains well prepared to protect employees and patients.
In the face of product allocations from manufacturers and distributors,
procurement and logistics units are continuously working to source and
purchase personal protective equipment (PPE) from new and existing vendors.
“The efforts of our logistics and procurement teams have put us in
a far better position than many hospitals,” said Peek. “However,
with the uncertainty of the situation and the current fragility of the
supply chain, we are being vigilant in our conservation efforts. We continue
to source critical supplies such as masks and N95 respirators, isolation
gowns, cleaning products and disinfecting wipes, and hand soap and sanitizer
from vendors and local businesses. All efforts are focused on building
inventories to plan for future volume changes.”
The hospital has also received several offers of hand-sewn surgical masks.
The CDC recommends the use of hand-sewn or fabric masks only when appropriate
PPE is not available, so those offers have not yet been accepted. However,
they are being tracked and will be activated should there be a need in
the future.
As another protective measure, the health system has elected to exceed
CDC recommendations for PPE and provide masks for all employees working
in a CaroMont Health facility. That includes providing N95 respirators
to every employee providing care directly to patients and surgical masks
for employees who are not interacting with patients directly (including
business and administrative functions).
“Given the circumstances, we must do everything possible to protect
our employees and medical staff,” said Peek. “The health and
safety of our employees and patients is our priority and providing this
level of personal protection is important.”
While all work being done in the healthcare setting will be critical in
the coming weeks, the community plays a huge role in reducing the spread
of COVID-19 and supporting the healthcare system on a regional level.
“The processes and protocols CaroMont Health has put in place to
protect our patients and employees does not eliminate their risk of contracting
COVID-19 in the community,” said Dr. Davis. “That’s
why it is absolutely imperative people who can stay home, stay home. We
need every doctor, nurse, clinician and support staff member to remain
healthy, so they can care for patients who are not.”
In closing, Peek shared appreciation for those working to manage COVID-19
and those offering support during this time.
“Our employees and medical staff have been incredible in their willingness
to do what needs to be done to prepare for and respond to this situation,”
said Peek. “I am continually amazed by their courage and compassion.
Our Board of Directors has solidly supported the operational changes needed
to address this situation. And our community – we have felt such
huge support from county and city leaders, business owners and private
citizens. We are incredibly fortunate to be surrounded by people who care
so much for each other.”