April 25, 2020 — On Thursday, Ore. Gov. Kate Brown released a roadmap for lifting restrictions on the state’s hospitals, including the resumption of elective procedures.
“You have to have an adequate supply of PPE (personal protective equipment), you have to have in-patient capacity and you have to have testing and testing results in a reasonable period of time,” explained PeaceHealth Peace Harbor Chief Administrative Officer Jason Hawkins. “If you have most of those things in place, and a few other things, you can start to do elective procedures, effective May 1, up to 50 percent of what you were doing pre-coronavirus.”
Hawkins stated that with the preparations the medical center has made during the initial stages of the novel coronavirus COVID-19 pandemic, Peace Harbor is “well positioned” to meet the criteria before the May 1 deadline. The preparations include the hospital’s recent introduction of rapid COVID-19 testing, a meticulous plan to ensure patient safety within the confines of the hospital, and an early push to store PPE.
“Our goal is for this to be the safest part of Florence,” Hawkins said. “People should feel comfortable coming here. I think we’re accomplishing that with our protocols that we put in place.”
This is not to say that the hospital is expecting to turn to full capacity any time soon, as the hospital still must be prepared for a possible surge in COVID-19 cases.
“We want to be thoughtful on any elective procedures we do, that maybe would use a significant amount of resources, like transfusions and such. We need to be thoughtful about it being medically necessary,” he said.
But still, Peace Harbor is encouraging people to keep in contact with their providers for care.
“If you need to be here, whether it’s an emergency — whatever that is — it’s a safe place to come,” said William Foster, medical director of the emergency department. “Providers will be reaching out to them to reschedule things they had in the past, eventually to get that back on track. But patients can always call up the provider and say, ‘Hey, can we move forward?’ If people had been scheduled, eventually they should be contacted in the next couple of weeks, whether it be a routine mammogram that needed to be put on hold, or other procedures.”
When the state first locked down, all “elective procedures” were barred by the governor’s order.
“We took that very literally,” Foster said. “The only procedures that we’ve been doing are truly emergency procedures. Partly, that was wanting to conserve PPE while not knowing how big the surge was going to be.”
But only focusing on emergency procedures caused a dip in patients, not just those who wanted elective surgery, but for emergencies as well.
“We have seen our emergency department volume go down during this quarantine period,” said Robin Allen, director of clinical services. “We’ve seen incidents where patients have not come in when they should have. They waited until later, and then had more serious issues. I think people have been told to stay home, so things they may have come in for before, they’re holding back on and not coming in until the symptoms are so bad that it becomes a big issue.”
Ignoring symptoms can cause issues, including having patients being admitted to the hospital when they normally didn’t need to be.
“We want them to come in if they normally would have come in,” Allen said. “We don’t want them staying at home thinking, ‘Oh, I can wait this out.’ If someone has something serious going on, whether it be chest pain or symptoms of a stroke, we don’t want them waiting at home to see it resolve. They need to get in here.”
Another example of an issue would be someone who needs a hip replacement.
“If you have severe pain, and you’re taking a bunch of opiates to get by, this is not like, ‘Oh, I just want to get my hip done,’” Foster said. “There’s actual pain involved.”
Testing was also put on hold.
“Not COVID testing, but like routine mammograms. Bone density stuff, a lot of that was put on hold because we didn’t want people to come to the hospital not knowing if there was going to be a big surge,” Foster said.
In the past week, the hospital is beginning to see more patients come in for a variety of issues.
“It’s still below normal levels, but I think people are maybe understanding that COVID is out there and it’s real, but they don’t have to hide under their bed. I think that’s why people are starting to come back,” Foster said. “They’re starting to realize that the chance of catching COVID in the hospital is no greater than at the grocery store. Probably even less so.”
Foster pointed to the hospital’s commitment to regularly checking employees for fevers, requiring the wearing of masks, and testing of patients for COVID-19.
Regarding testing capacity, Peace Harbor has begun gradually expanding what is available.
“I would say on the slower side than the faster side, but it is expanding gradually,” Foster said.
Currently, Peace Harbor is offering two tests: a rapid test which can give results back in an hour or less, and a second test that is sent out to the state lab, which takes one-to-two days for results. People who are suspected of having the virus are administered the more accurate state test, while rapid testing is saved for people who are not suspected.
As for who qualifies, all patients admitted to the hospital will receive a test, while in the past week testing in the walk-in clinic has expanded, which has also allowed the hospital to expand who they are giving the tests to.
“Initially when testing first began, the only way in Oregon to get a test was to be sick enough to be admitted to the hospital with suspected COVID symptoms,” Foster explained.
While there are still restrictions on who can get tested, they are nowhere near as stringent.
“If you have some symptoms — a cough, shortness of breath, fever, those kind of things — you can get a test as long as you’re in a high-risk category,” Foster said.
That includes people over the age of 65 and those with preexisting conditions, such as diabetes, hypertension, cancer and COPD (chronic obstructive pulmonary disease).
“There’s a pretty long list that would qualify you to not get the rapid test, because those are somewhat limited, but the tests that have a couple day turnaround,” Foster said. “You would just call up your provider, and sometimes they could arrange this to be done where you drive in and get tested.”
Ultimately, the lack of patients has hurt the financial stability of hospitals across the country and particularly in rural areas.
“Absolutely there was concern about healthcare across the country, even more pronounced in rural healthcare,” Hawkins said.
However, Peace Harbor was able to avoid many of the financial traps because it was part of the PeaceHealth system.
“I can comfortably say that PeaceHealth really stepped out there and applied for the funding that was available for healthcare organizations to bridge us through this period of time,” Hawkins said. “They’ve stabilized the cash flow for all the hospitals, including the rural hospitals. The knowledge they brought to how to apply for all the different sources of funds that were available. They really stepped up there and did a great job stabilizing the financial situation.”
Financial help was also provided by members of the community through programs like the PeaceHealth Peace harbor Medical Center Foundation, www.peacehealth.org/foundation/peace-harbor/donate-now, which allows individuals to make donations directly to the hospital.
“Now, with bringing elective procedures back, we have certain things in place that will allow ourselves to be available to the community and help us with our cash flow streams,” Hawkins said.
Editor’s Note: In the next edition of the Siuslaw News, Hawkins talks about the procedures PeaceHealth is undertaking to remain prepared for the pandemic, as well as new technologies introduced, such as telehealth services.