December 4 Employee Huddle

December 4, 2020

Please Note: When time does not allow us to answer every submitted question, we answer questions at the next week KD Huddle. Submit a question now for next week by e-mailing dvolosin@kaweahhealth.org.

Questions and Answers from the December 4 Kaweah Health Employee Huddle

KD made the decision not to match the 401K for 2020/2021. Do you know if that will be the same in 2021/2022?

The 401k plan is a calendar year plan and based on the financial projections, we don’t believe that Kaweah Health will be able to make the match for calendar year 2020. This match would be made by October 2021. The option to make the match (or a portion of it) is open if the financials improve. We will have to wait and see how we’re doing as an organization in the Spring; ultimately the Board will make the final decision.

When is KD receiving the vaccine and what is the plan to administer it?
1. How and when can departments and employees find out when it’s their turn? Who is involved in making these decisions?

The State has developed criteria for who should receive the vaccine first and health care workers are at the top of the list. There is a KD multidisciplinary team (nursing, pharmacy, employee health, HR, medical staff, infection prevention, etc.) that has taken all KD employees and developed a priority list based on risk of COVID and on work area so that internally we could further prioritize who will be offered the vaccine first based on the amount of vaccine we receive. This list is being finalized and going through final review by leadership and medical staff this week. For example, the ED has employees that are at higher risk of exposure to COVID and those staff and ancillary staff in that area would be considered in the first tier along with other areas that have higher risk. We are planning to potentially provide the vaccine starting December 14^th out of the Acequia Wing lobby. This is dependent on FDA approval of an EUA for the Pfizer product and if the County receives product as expected.

Can you speak to the All Facilities Letter that Kaweah Health just received?

This All Facilities Letter just came out and does require us to submit a plan by December 7^th. At this point the California Department of Public Health is recommending testing health care workers on a weekly basis who directly care for or support the care of covid+ patients; and possibly all health care workers. A committee began work on this plan immediately, and it is possible that we will begin testing employees in the next couple of weeks in compliance with the recommendation. This is a large undertaking and we’ll communicate as soon as we have more details.

I see the number of COVID patients we currently have, but I have no point of reference. Is that a lot of patients? How many patients can KD handle? What is considered maximum capacity? What is the feeling among doctors and nurses as to how busy the hospital is?

It is difficult to say a specific number that KD could handle or is considered maximum capacity. It all depends on staffing, bed availability, the acuity of the patients, and the number of med/surgical patients, etc. There is a multitude of factors that are considered when evaluating capacity related issues on a daily basis.

Is it true that if you die in a car accident, but test positive for COVID it is counted as a COVID death?

No, this would not count as a COVID death. We code the chart based on what brought you in to the hospital as the primary diagnosis, and then comorbidities are listed based on what else the doctor is treating you for. So if you come in due to a car accident and die, the cause of death is listed as the multi-system trauma due to the car accident. COVID would NOT be listed as cause of death.

With the increased employee positivity numbers is Kaweah Health concerned about staffing?

In the month of November, we saw a substantial increase in the number of COVID positive employees We are now at 125 out on leave and others are on quarantine due to living in the home of a positive individual. This, along with flu and general illness, is impact our staffing at a time when our community is requesting a very large increase in testing and more patients are hospitalized. A number of initiatives are being discussed to assist with staffing. The Executive Team is aware and engaged to do everything we can to address staffing as this surge develops.

With the COVID cases increasing in Tulare County will the hospital decide to shut down or start “Stay at home” orders for some of the out-lying offices that are not “Essential”, such as the Sleep Lab??

In March and April we had to make very difficult decisions to close some services and/or lessen the volumes we could handle. We are evaluating this again.

It is unclear what current screening standards to use when patients come to outpatient PT / OT services. Just temperature checks? What screening questions are required or recommended for follow up sessions? What is the consistent policy we should be following?

Therapy outpatients are screened for COVID symptoms and for exposure to anyone who has tested positive. The screening questions are to be presented at every appointment, as the patient’s symptoms or exposures may have changed.

Are there a large number of asymptomatic people that test positive for COVID or do most positive cases exhibit symptoms?

We have no easy way to quantify which tests are for symptomatic vs. asymptomatic people. Anecdotally, however, we test a significant number of asymptomatic people for our pre-surgical testing and the positivity rate has been very low in this group.

Are co-workers notified if a team member tests positive for COVID? If no, why not? Shouldn’t we have a right to know we were possibly exposed and get tested if we choose?

An employer is obligated to report that an exposure might have occurred, but we are also held to protecting the privacy of an individual’s health status. An exposure is defined as being in the presence of an individual unmasked for 15 minutes or more and within 6 feet. Employees can always choose to get tested if they have a concern, but without exposure as defined, we don’t typically test through Employee Health.

How is it determined if someone out on quarantine because of exposure has to be tested or not?

We test through Employee Health today only if an employee has symptoms (as well as our Skilled Nursing employees as required by CDPH). If on quarantine because of living in the home of a COVID positive individual, we’ve not tested, but the employee is on quarantine for 14 days per the CDC. This week, that rule changed to 10 days. We may begin testing more employees regularly very soon.

If the spouse/parent/child/roommate an employee lives with is positive do they have to be tested before they can return even if they aren’t showing symptoms?

No, but it is important to continue to monitor for symptoms.

Will we be returning to a No Visitor Policy since our numbers are going up?

As the pandemic and our response evolves, we are going to do everything in our power to continue allowing our patients to have visitors. We know visitors are an important part of the healing process and we are going to work very hard to allow our patients to have a loved one by their side. That being said, it is necessary to modify our policy again to protect our team and patients. For the time being, we will continue allowing visitors but must reduce visiting hours and restrict alternates. Please note, the decisions made by the visitor policy team are highly discussed and evaluated with extreme thoughtfulness. We are doing our best to address a very difficult situation for our patients and team. The visitor policy change will likely go into effect on Tuesday, December 8. More information will be available soon.

We are continuing to have problems with the visitation policy at the rehab hospital. Apparently, family members are showing up and wanting to stay all day like they were at the main hospital, and becoming very upset when we have to turn them away. Because we are in conjunction with a Skilled Nursing Facility, the current state regulations only allow supervised visits for 30 min, 6 feet apart. Only two family members are allowed to be present, and no touching the patient. Because of room and staff availability, rehab/short stay currently has a limit of 4 patient visits/day, and none on the weekends. This means that during the patient's stay, they will only be able to have 1 or 2 visits totals, as visits needs to be rotated through all patients that would like one. The Social worker will reach out to the family to set them up.

Patients and their families are given written information about the visitation policy prior to admission by the nurse liaisons. Families may be understandably disappointed with these limitations, but this approach does significantly reduce the risks associated with visitation while allowing for in person contact. We can work to be compassionate while still communicating that the policy must be followed. Please seek assistance from management if needed.

It has come to my attention from various employees that potlucks and celebrations inside and outside of work continue to occur recently which is contributing to the spread. I am aware of employees carpooling and standing or sitting together without a mask on. What I have not seen is a strong message coming from administration cautioning employees from doing this on a weekly or daily basis. It seems employees are not held accountable for their risky actions and behavior. Will there be any temporary policies/rules implemented to ban gatherings with employees?

We’ve communicated regularly regarding the requirements to wear masks, physically distance and disinfect hands. Leaders have been instructed that pot lucks are not allowed. If an employee is aware of a breach of safe practice, they are encouraged to report that to a leader or they can report to HR or Infection Prevention.

Every year our patient volume increases during the months of January and February due to the influx of patients with the flu. In the past, this has created a strain on the inpatient and outpatient units without the added stress of COVID.
1. How can the hospital prepare for the upcoming months with both the Flu and COVID spikes (such as gaining additional medical equipment, computers, staff, PPE, patient care areas)?

We are tracking PPE on a daily basis and continuing to build inventory. Leadership is consistently evaluating patient care staffing and bed capacity needs/issues. The need for additional medical/computer equipment continues to be evaluated as well. At the Command Center/Section Chief meeting, all the above are discussed. We recently increased hours and the frequency at which we meet in order to spend additional time planning for the recent spike and winter months.

When we send an email to “suspect email” should we expect a response back letting us know if the email is safe to open? What is the correct procedure to do with the email after we notify suspect email?

Due to the increased VIGILANCE of everyone, we receive more suspicious emails than we can provide personal responses to. When forwarding a suspicious email to suspectemail@kaweahhealth.org, please indicate if you need a response and that will be helpful to those examining the email. Most do not need a response and just want to make us aware of the suspicious email. After forwarding the email, you may delete it, unless you need to keep it pending a reply from the cybersecurity team.

Are battery operated lights okay to use as part of holiday decorations?

We need to remember to be safe when decorating our departments. To ensure that Kaweah Health employees, patients, and visitors have a safe and enjoyable holiday season, please ensure the following regarding holiday decorations:
No Live Christmas Trees may be used in Kaweah Health facilities.
A non-lighted, artificial tree may be used within Kaweah Health facilities provided that it has been treated by a California State Fire Marshal rated flame resistant product. Proof of fire resistance must remain with the decorations or in the department.
Christmas lights and/or candles, of any variety or type, are prohibited in patient care areas. Battery operated lights/decorations are allowed in non-patient care areas, but MUST have the UL Listed or CSA Stamp of approval affixed to them.
The Flameless Candles will generally be allowed in ALL Patient Treatment areas with the exception of Electrically Sensitive Patient Areas, such as ICU, CVICU, CVOR, CVC, and specific areas of 3 West where patient monitoring is on-going. These items MUST have the UL Listed or CSA Stamp of approval affixed to them.
Decorations may only be used in Kaweah Health facilities provided they have been treated with a California State Fire Marshal rated flame resistant product or are fire retardant. Holiday decorations, including quilts, blankets and tapestries may never be placed in any Kaweah Health EXIT corridor. Proof of fire resistance must remain with the decorations or in the department.
Do not hang anything from the ceiling or the sprinkler heads.
Do not place decorations on any door.
Please use masking tape when necessary. Do not use scotch tape or thumb tacks on the walls.

Is there a way to notify staff when breakfast is not being served at the Siren Grill rather than finding out after you take the time to walk out there? Also a lot of times there is only one person taking orders, making food and drinks out there and the line gets really long and can take my whole lunch break just waiting to order and get my food. The gals there are doing a great job, but it needs to be staffed better during lunch and breakfast hours.

Thanks for that concern. I will forward it to Lawrence Headley, our Director for follow up. The Siren Grill has become more popular and is now open into the evening as well.

We know some symptoms of a common cold can overlap with COVID19 symptoms. If we know of a colleague that had only congestion, that followed the protocol by staying home and calling Employee Health, and was told they wouldn’t be tested due to lack of symptoms and to return to work when they feel able – can we assume the same is true for others if the only symptom one has is nasal congestion?

This is a tough one; we usually ask “is this different for you?” Especially one symptom that is mild and we normally wouldn’t even think about.So, it isn’t about one symptom or five symptoms, it is about what is ‘different’. Was there an exposure, how long was the exposure, was it an unprotected exposure, was it longer than 15 min?

Is the DOD going to come in and help us like they did in July?

We have not been contacted, but, we would certainly welcome them back.

Many of us are sending community members to the testing hotline. They are waiting on hold for several hours. What is being done to relieve this backlog of calls?

We want to be your health care provide and we took on the mass testing without realizing the volumes that we would be dealing with. Not only were we understaffed, but some of our staff contracted the virus further exasperating our challenges. A decision was made this week that beginning Monday we will no longer accept walk-ins. Patients will go to the KD website and schedule their COVID test. It will allow you to schedule 2 days in advance and let you see when the next appointment is available and will give you same day results. That will be a big change that will have significant improvement to testing throughput. I also would encourage people to go to the county website to view a listing of the numerous testing sites. The results are not same day, but they are getting better.