As Covid-19 Progresses, CaroMont Health Prepares and Responds
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.”