Question: David, thank you for finding the time to speak with me during these chaotic times—and while adjusting to a new role within Ochsner Health.
David Grimes: Yes, it's been quite the first few weeks. I previously was the Director of Perioperative services at Ochsner's academic medical center, and moved into my current role at West Bank, which is more of a community hospital, about three to four weeks before the outbreak. So I'm kind of learning how to manage a hospital while learning how to handle a pandemic.
Q: Well I suspect being so new to the role will enable you to provide insight that will be helpful for organizations bringing in new people during this outbreak. So let's dive right in. As Ochsner Health began to hear about the COVID-19 outbreaks in Wuhan, China, and then in Washington, at what point did the system initiate their disaster plan? How has the response evolved since then?
Grimes: In some ways, planning for the COVID outbreak happened long before anyone was aware of this disease. Our experience preparing for weather-related natural disasters has led to the development of a comprehensive Disaster Management team. Having those resources in place prior to this outbreak has been a tremendous asset for the organization. Once COVID-19 became known, Ochsner employees began receiving updates from a COVID-19 response team on how the health system was preparing for the outbreak. Our Infectious Disease clinicians and other administrative leaders in the organization led this response team. Our Supply Chain team immediately began their preparations to ensure we had sufficient supplies through this outbreak and have been working around the clock ever since. It’s been a system-wide effort with too many departments to name.
Personally, the first thing I did locally was establish a patient and visitor restriction policy. We closed most of our hospital entrances, except for one, and screened people as they came in. If a patient or visitor had a known travel history or any of the main symptoms, they were immediately masked and sent to a screening site outside the ED. Depending on their symptoms and temperatures, we sent them to our triage site inside. We also began taking temperatures for all patients and visitors and kept visitors with a fever out of the building.
We initially set out to mask all employees, but that policy—as well as others—has evolved over time. Because of the PPE supply concerns, we're now just masking potential cases and employees that attend to them. We've recently barred any visitors, with exceptions for end-of-life patients, labor and delivery patients, and mentally disabled patients with compromised decision-making abilities who are allowed one visitor.
We also require all employees to get temperature checks at the front door, and we have an internal system in place for leaders to report which employees might be sick. We have had some health care workers exposed to some initial cases that we learned were positive after the fact. So those people had to be sent home for isolation, including phlebotomists and radiology technicians.
Q: Hospitals are now directed to consider cancelling all elective surgeries and certain outpatient procedures that they can to free up staff and increase capacity for COVID-19 patients. How has Ochsner approached that issue?
Grimes: On the hospital side, we've cancelled almost all elective procedures and endoscopies, except those procedures that surgeons have deemed necessary for the patient's well-being. We’re still doing some cath lab and interventional radiology cases, but not as many. This allowed our certified registered nurse anesthetists (CRNAs) to help with critical care nursing which has been a tremendous help to our already-stretched-thin nursing staff. In the outpatient space we cancelled all annual wellness check-ups for the time being at West Bank. Where appropriate we're also pushing patients to use telemedicine, which Ochsner has been investing in for about five years now.
We've redeployed staff from certain areas that aren't doing as many procedures right now to new roles to support the influx of COVID-19 patients. They have been really valuable in these new roles, which include running specimens, delivering supplies, doing temperature checks, delivering meals, and some patient transport. A lot of our employees have had job responsibilities altered over the past few weeks, and it’s been really encouraging to see everyone come together to care for patients.
Q: What other ways is your hospital looking at the potential for capacity issues if the virus continues to spread in the United States like we've seen in Italy and other countries? How is your hospital shoring up capacity?
Grimes: Looking at capacity, we have 180 beds on this campus. So far, we have converted the same-day pre-operation area to an ICU space and moved true non-COVID-19 hospital patients there to free up ICU beds. This freed up 15 beds right away.
For additional capacity, we also designated our endoscopy space, and one wing on both the medical-surgery and telemetry floors into spaces for COVID-19 patients. Those areas are ideal for COVID-19 patients because we're able to seal off those wings and convert them to negative pressure rooms. If cases continue to spike, we'll take another wing from medical-surgery and telemetry and continue to expand. However as our beds fill up, we'll likely direct ICU overflow out of this facility to the main campus before we convert more of our facility.
Q: Now let's switch tracks a bit to communication, which has been a big challenge for a lot of hospitals and health systems. What mechanisms have you put in place to communicate with your staff, and emergency management teams?
Grimes: I'm glad you brought this up. At the system-level, we receive daily email updates from our COVID-19 response team. Our system leadership does twice-weekly webcasts for everyone. At West Bank, leadership starts the day with a huddle and ends with a huddle. We also have a daily communication huddle for providers to keep them up to speed. At these huddles we're looking at everything from best practices to how quickly things are changing. Our policies right now are all subject to change multiple times per day, and if people missed the emails, they might have missed something important. So we employed a lean-trained black belt to manage our communications between leaders and employees. The black belt sends a single email out at the end of the day, so we can send one message and not inundate people. We think it is working well.
Q: Are there other challenges you're facing that we haven’t discussed?
Grimes: One thing I'm concerned about is how we're going to manage wellness and burnout among staff. We're stretched so thin at this point. We're working to schedule days off for our team members, but with our resources as strained as they are, my concern is that we’re not giving our frontline staff enough time away from work. So working through that has been challenging. We've pushed out a lot of health and wellness resources, and have really encouraged our staff to utilize them. It’s not going to be sustainable if we can’t find ways to increase staff resiliency.
Your top resources for COVID-19 readiness
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