All non-essential care halted as county case numbers grow
Those two words have become a national rally cry as federal, state and local health authorities have looked to communities as the front-line defense in stopping the spread of COVID-19 through social distancing. Klickitat Valley Health reinforced that directive locally and halted all non-essential clinic visits, suspended surgeries, reduced physical therapy, and enacted limited diagnostic imaging this past week.
“We want you to be safe, and if you aren’t sick, the safest place for you to be right now is at home,” advised KVH Chief of Staff Dr. Nathan Armerding, DO.
Since Klickitat County confirmed its first case on March 14, 2020, positive cases have continued to rise. Nationally, that trend has followed suit and in the case of a highly infectious virus that transmits easiest through human contact or interaction, health authorities have looked to communities to band together and halt all non-essential activities to stop the spread.
“If we could wave a magic wand and freeze everyone in America for 14 days, the virus would have nowhere to go and it would eventually die. That is why it is of utmost importance that we don’t put ourselves in situations where we can spread the virus or become infected” said Armerding.
KVH operations transition to Incident Command System
While the majority of COVID-19 cases are being seen in large cities, the rapid rise of confirmed cases will continue to appear in smaller, rural communities. Like the other 1,365 critical access hospitals that care for rural health in America, KVH has been actively preparing to protect its staff and convert resources to handle a potential surge.
Four weeks ago, KVH instituted the Hospital Incident Command System (HICS) to guide operations. The incident command system is a national model that allows multiple agencies to cohesively operate and communicate as one unit to ensure safety for their region. The KVH HICS team has met daily to track and prepare the facility for changes and protocol as guided by the State Health Department and the University of Washington.
“Last Thursday, Governor Inslee ordered a temporary halt on non-urgent medical and dental procedures to preserve protective equipment. The order, in effect until May 18, applies to any non-urgent procedure that requires medical professionals to don such gear,” said Leslie Hiebert, CEO of Klickitat Valley Health. “In most major catastrophes, such as earthquakes, hurricanes or floods, the national disaster management system is designed to pour resources into the effected region, including equipment and people, from other parts of the country.’
This time, with the virus affecting every state, Hiebert isn’t sure what will be available. The ICS team has moved quickly to conserve and inventory all PPE to insure staff protection in the event of a surge.
“There’s definitely more to do,” said Hiebert. “It’s a big challenge and things are changing day by day. KVH has been monitoring PPE and essential supplies for weeks. We review numbers daily to ensure staff has access to necessary protection.”
KVH prepares for large upswing in COVID-19 patients
KVH operates independently without the resources available in larger health systems. This is the case for most critical access hospitals. To adequately prepare, KVH has focused its efforts on protecting all resources including its most importance resource – the staff needed to provide care.
“Not just here, but everywhere, health care workers are in short supply,” said Employee Health and Infection Control manager Paula Riley, RN . “Demand is high, so we want to keep everyone as healthy as possible so that we can continue to care for people as they get sick.”
All entrances, except the main entrance to the hospital and clinic, are now locked. KVH has implanted the highest level of infection control policies, including using other controlled entrances to bring suspected COVID-19 patients into the facility that isolates them from other patients and staff.
“Any single person who walks into the facility, which includes staff, patients and vendors, all have to be screened,” said Riley “It’s a series of questions and then we triage appropriately.”
“Staff is briefed and trained as care protocol recommendations change. We already have year-round infectious disease protocols, and the novel coronavirus will be treated accordingly.”
The entire facility, including logistics, staffing and housing, has been converted to prepare for a surge of patients needing COVID-19 care. The operating rooms and former ICU have been equipped for respiratory care. Former patient care areas have been identified and prepped for potential patients.
“We looked within the walls of the hospital to say, ‘Are there places that we can stand up essentially patient rooms or patient beds where there aren’t any today?,” said Hiebert. “We expanded the capacity within the hospital preparing for what we can do, how many people we can take care of, how we take care of people even if they are very sick.”
“We have put a call out to take inventory of qualified personnel we could bring in and made a three-phase plan to shuffle doctors and nurses who normally practice in other areas to help in the emergency department or in acute care.”
Members of KVH’s staff are being cross trained to take on additional duties, Hiebert said. Many employees are volunteering to work extra shifts. “We want to bolster the workforce with the skill set necessary to provide the health care required now.”
The state health department is providing guidance on how to preserve and allocate resources, reducing barriers to bringing in emergency workers, such as retirees, medical students and others that might provide hospitals relief and searching for additional ventilators and the pharmaceuticals required for their use and the staff to administer them.
The KVH Memorial Foundation has led a donation campaign to gather furniture needed to outfit rooms in the former assisted living facility to house additional staff KVH might have to bring in for patient care. The Goldendale Mask Mission has gathered a local group of seamstresses who are creating masks. Other Gorge companies have stepped in to create plastic masks and gowns to help hospitals keep staff protected.
“Everybody is rallying together,” Hiebert said. “It’s heartwarming. We all want to take care of our community.”
Drive-up testing, Virtual Visits continue care, mitigate exposure
Managing the flow of COVID-19 care also became a top priority at the hospital and clinic. A KVH COVID Nurse Hotline, 509-773-4029, has been established to triage all patient calls. The helpline is open seven days a week from 7 am to 7 pm. Anyone who feels they are displaying symptoms, or knows of exposure, is asked to call this helpline. The nurse will review the information, and based on current testing criteria, will schedule a test or an appointment with a provider.
A drive-up testing station has been set up outside Family Medicine to keep anyone possibly infected outside of the facility. If directed by the State Health Authority, the drive-up testing site has been designed to be easily converted to a drive through test site. KVH is equipped with testing kits to handle this directive. Currently, all testing is being scheduled.
With non-essential visits and services
halted, KVH Virtual Health was launched on Monday, March 30th, 2020.
will be able to schedule a secure appointment with their provider and use their
phone, mobile device or computer to meet virtually with the provider.
“As we continue to do everything we can to flatten the curve and stop the spread of COVID-19, Virtual Visits will allow patients to receive the same quality care as they do when visiting the clinic, without risking potential exposure,” said Family Medicine Director Annie Stone, ARNP “Every part of a face-to-face visit, except the physical exam, can be addressed during a Virtual Visit. Labs, x-rays and other tests may be ordered, but non-essential exams will be pushed out at least 2 – 3 weeks and possibly longer. Medication refills can be sent electronically.”
Patients can schedule a Virtual Visit just as they would a clinic visit by call 509-773-4017. Staff will assist in helping set up your mobile device or computer.
Community response timing is critical to flatten the curve, and slow the spread
As KVH has consolidated resources and suspended non-essential services in preparation for a surge in COVID-19 patients, it also means losing out on revenue that keeps the hospital running in normal times. Elective procedures, surgeries, non-critical physical therapy and diagnostic imaging, represent a large part of operating revenue at KVH.
“While Congress works on a third COVID-19 response bill, a bill is in front of the state legislature to direct emergency funding. We also received new information on emergency funding through FEMA where we can forecast expenses and submit for immediate funding based on that forecast,” said Hiebert.
“We are in a unique position of having to track financing at the same as we prepare for a global pandemic.”
“There’s no way to describe the effect of this pandemic,” said Hiebert “These next one to three weeks are going to be incredibly important. The timing of everyone’s response is critical to flatten the curve and slow the spread of the disease.
“We all remain emphatic in urging people to stay at home and avoid contact with others. Keeping the infection rate as low as possible will free up critical resources for those who need it most and will ultimately save lives.
“The real unknown is how well all of the efforts that we have begun around social distancing, around hand hygiene and around staying home are going to help flatten the curve. It’s also hard to predict when a surge could happen. That’s why we have gone to such great lengths to prepare. We have taken this seriously and have prepared every resource accordingly.”
KVH asks that anyone believing they may have the virus to please call the facility prior to arrival, if possible. Staff will meet you outside and assist you.