April 29, 2020 — “Telehealth isn’t necessarily new, but this is new to us,” said PeaceHealth Peace Harbor Nurse Practitioner Heather Posegate. “The virus kind of jumpstarted us into this technological age and will help us in many different ways.”
As the Siuslaw region began preparing for the first wave of COVID-19 infections earlier this year, PeaceHealth Peace Harbor looked at technologies and practices that would help prepare for any possible spikes in infections. Telehealth, which will allow patients to get a variety of medical advice from their home computers, is just one of a multitude of preventive measures put in place to ensure the hospital is protected in any potential surge in COVID-19.
As the state begins the process of reopening, along with allowing the hospital the ability to begin non-emergency procedures, Peace Harbor representatives spoke on the different aspects of their response, from creating complex patient flows to minimize infection, mapping out specific action plans for possible hotspots in the city, and introducing technology like telehealth. In the process, the medical center’s staff believe they made improvements that will create a better experience for patients beyond the concerns of COVID-19.
“The one thing we want to get out is that the hospital is the safe place to come,” said William Foster, medical director of the emergency department. “We’re screening people, we’re masking people. We’re still limiting visitors to a large extent, but that’s probably going to relax some. But if you need to be here, whether it’s an emergency or whatever, it’s a safe place to come.”
A Peace Harbor staff member welcomes patients to the hospital with a temperature check.
While telehealth has been used at Peace Harbor for a while, particularly in the field of mental health, this is the first time the hospital has seen a wide adoption of telehealth. Primary care has been working with it for two weeks, while specialty care is rolling out this week.
The process of setting up a telehealth appointment is relatively simple. Once a patient has contacted their provider and set up a time, patients will need to sign up online. For the next couple of months, PeaceHealth is providing free guidance on how to sign up for the service.
“If you’re not tech savvy, like me perhaps, and need a little help, we have people that will walk you through,” said Heather MacArthur.
Once online, patients will be asked a series of pre-screening questions, just as they would do through a regular office visit.
“And once they’re ready, they get a notice about 30 minutes before the appointment,” MacArthur said.
Before the provider meets with the patient, they pull up all relevant health information, from medical charts to scans. They then start the session, taking special care in how they present themselves to patients.
“We make sure we’re looking at the patients directly, bringing the charts close to the camera,” said Posegate, who has been utilizing the service for the two weeks. “I try to be intentional. I always say, ‘Let me look something up,’ if I’m looking away from the camera. That’s so they know I’m not surfing the web. We have video-side manner now.”
The sessions can be used for a whole host of visits, including follow up exams and checkups.
“They can check their blood pressure at home for me, or rashes even,” Posegate said. “You have that visual component, so you can see a lot. You can see if someone is having a hard time breathing. You can look down their throat. You can be a little flexible.”
To help prevent the spread of COVID-19, telehealth helps by allowing patients to stay at home while still being able to get needed medical help. In the long term, the technology has the opportunity to fix long standing issues with the isolated Siuslaw region.
“It’s going to be huge, being able to interface with specialists in Eugene,” Posegate said. “That could really help people who are driving to Eugene or have transportation issues.”
Whether or not Peace Harbor will see a widespread adoption of the technology is still left to be seen.
“I think we have an older population that likes being in our office,” Posegate said. “They’re hard of hearing, or sometimes it’s difficult to use a video.”
And telehealth would not replace hospital visits entirely, with patients still needing to come in for blood work and yearly physicals.
“But I think once people start doing it, they’ll get comfortable,” Posegate said. “They can be in their pajamas and talking about their lab. It will probably change the way we do healthcare, and I think really, for that benefit, I think it’s a good thing.”
Telehealth was only one part of the hospital’s response to a possible outbreak of COVID-19 in the region.
Because of Peace Harbor Medical Center’s association with the PeaceHealth network in Alaska, Washington and Oregon, the western Lane County hospital was able to get an inside view of the novel coronavirus COVID-19 early on in the pandemic.
Peace Harbor CAO Jason Hawkins, in the hospital’s command center, shows off a zoning map of the Siuslaw region where COVID hotspots could occur.
PeaceHealth Peace Harbor Chief Administrative Officer Jason Hawkins said, “We were able to see things in Washington at other PeaceHealth facilities a month or so in advance. It really afforded us the opportunity to get out ahead. We were learning a lot from those facilities.”
Such insight included how shortages of supplies in Washington were affecting hospitals and what was needed to properly quarantine COVID-19 patients along with general patients.
“And if we needed a protocol with all the data requirements that were happening, being part of that network allowed those things to be done by the system for us,” Hawkins said.
PeaceHealth set up an incident command structure that is still being used today.
“I think another big advantage of being a system is, we had a system-wide incident command, and then each network had an incident command,” Hawkins said. “And each hospital within the network had an incident command.”
Peace Harbor’s command center is set up in a conference room next to the cafeteria. The walls are filled with charts and maps, planning out a possible rise in COVID-19 cases.
PeaceHealth Peace Harbor staff prepare for the day in the COVID-19 resource war-room.
“Every day, we’re meeting here and working five, six hours a day, working on different projects, different meetings. We had a correspondence board, we have situational stats that we’re working through,” Hawkins said.
The command structure has finance and administration chiefs looking at the variety of forms that needed to be filled out for FEMA funding. They broke the hospital into different sections, creating surge plans for the emergency department, walk-in clinic, primary care and palliative care.
Hawkins also pointed to a large picture of the city, which has different areas sectioned off.
“If we had a community surge, they are going to have providers in the city of Florence and serve the community in certain hotspots,” he explained.
There are constant discussions on PPE (personal protective equipment), testing swabs, putting together confirmed COVID-19 units, along with the suspected COVID-19 unit.
“And then we would look out how we would operationalize them, in terms of staffing, position, supplies, PPE, pharmaceuticals. Just go down through the whole list,” Hawkins said.
Hawkins and the Peace Harbor staff frequently visit with local governmental agencies, as well as create partnerships with various other agencies to bring in volunteers and needed supplies.
In addition, the hospital’s conference room has been turned into a sewing unit so workers could make masks, while PeaceHealth created its own interconnected network to keep supplies going.
A Peace Harbor conference room is used for sewing PPE.
“If we were short on a particular item, maybe certain size gowns or masks, maybe RiverBend had an excess they could allocate to us,” Hawkins said, referencing PeaceHealth Sacred Heart Medical Center at RiverBend, located in Springfield. “There were things we shared with them. It was really good to be part of a network that could share PPE when we had pinch points.”
A triage center has been placed outdoors, allowing for suspected COVID-19 patients to safely check in without infecting other patients.
Indoors, the hospital has a closed-off section of rooms specifically for suspected COVID patients. As of right now, there are only two rooms, “but they could move this wall out and have it be four rooms down here,” Foster said.
Ventilators were increased from four to nine, and “we even kicked up our food inventory, if by chance food inventories became a problem,” Hawkins said.
Patient flow is strictly regulated.
Robin Allen, director of clinical services, said, “If they had respiratory symptoms, they wouldn’t be crossing paths with patients that were coming in that were not respiratory patients. We made sure that we had a plan to make sure that those patients weren’t crossing paths.”
Hawkins points to chart showing how different staff would be used in the advent of an outbreak.
Strict policies are in place for healthcare workers, with daily temperature checks and requirements to wear masks. Anyone walking into the facility is also subject to a temperature check.
Plus, if PeaceHealth hospitals in Eugene were to overflow, Peace Harbor created plans to take on more patients.
“If RiverBend was unable to take anymore, we had a plan that would turn our (post-anesthesia care unit) into a nine bed COVID unit,” Allen said.
Peace Harbor also created a labor resource war room to ensure the labor pool was utilized.
“When areas got slower, instead of asking people to go home, we saw there was other work that needed to be done,” Hawkins said. “So caregivers and managers said, ‘Hey, we’ve got some extra help, what do you need?’”
In the last month, lists of available employees, from caregivers to physicians, were posted on the walls of the war room, allowing certain sections of the hospital to match people to needed areas. Physical therapists were now taking temperatures at the front door. Caregivers were serving food in the cafeteria.
PeaceHealth also created extra sick time for employees, 80 hours if they were to fall ill to COVID. Pay is protected through April, and partnerships with organizations like the Siuslaw School District allowed employees to have childcare, further maintaining the workforce.
“Nobody was furloughed, nobody was laid off,” Allen said. “They might have not been busy with their normal job, but they were doing other things. PeaceHealth has made sure that we have not lost any income due to the COVID crisis.”
While the hospital meticulously planned for a surge of COVID-19 patients in the initial phase of the pandemic, the Siuslaw region, and Oregon as a whole, has largely been spared at this point.
“I don’t think we saw a huge rush of people with COVID symptoms,” Foster said. “We saw people with shortness of breath, cough and fever. Before, we would have thought it was pneumonia or the flu. Now we just added COVID onto that list. But it wasn’t a huge number more that came in, at least to the emergency department and the clinics. I think Florence has been relatively spared, as has Lane County and Oregon.”
Does this mean that Oregonians essentially avoided COVID-19?
“We’re not sure,” Hawkins said. “We need to watch and learn as we wade back into this. The first step is how do we take care of more of our patients, how do we start to live in a new normal. I think we’ll learn from each step. We learn, we pause, and then we take the next step.”
Instead of preparing for a surge, the hospital is now preparing to mitigate flare ups that could occur. As to if/when those flare ups will occur, and how severe they could be, it’s anybody’s guess. The only certainty is that COVID-19 will be with the world for some time to come.
“How do we live amongst the virus without a vaccine?” Hawkins asked. “What’s the impact going to be in the way we’re living our life? I think those are things we’re all going to have to measure and understand. I think we all need to realize that our actions can affect other people.”
The one thing that Hawkins is sure of is that the staff of Peace Harbor is prepared.
“We’ve done a lot of hard work here,” he said. “The staff, they know it’s a calling. They’re very resilient.”
In the next edition of the Siuslaw News, Foster and Hawkins will discuss the overall science of COVID-19, what is known, what isn’t known, and the controversies and questions surrounding opening up society in the age of a pandemic.