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May 15 Employee Huddle

May 15, 2020

Please Note: Time did not allow us to answer every submitted question, so we will get to unanswered questions at next week's KD Huddle. Submit a question now for next week by e-mailing dvolosin@kdhcd.org.

Frequently Asked Questions from May 15 Employee Huddle

  1. Our elective surgeries and some outpatient services have been shut down for several weeks. You both were chosen to lead the demobilization. What was the very first thing you did to start the planning process of reopening these areas?
  • Is my passport up-to-date and what’s the price for tickets to Mexico?!
  • No, seriously, the first order of business was to recognize the great work that was already well underway by service line directors, managers and staff and their respective VPs. These teams have been constantly refining their plans for demobilization based on daily changes in guidance and the evolving situation.
  • Knowing we needed to prioritize our focus, we worked with Malinda Tupper and the Finance team to develop a very high-level report that allowed us to quickly identify, based on pre/post COVID volumes and revenue, which service lines we needed to focus our efforts on. Our assumption was quickly confirmed that elective surgeries and procedures needed to be our initial focus.
  1. Who were the key players that had to be brought to the table?
  • From a practical level, the first thing Jag and I did was engage Suzy Plummer and JC Palermo. The Internal Consulting team is amazing and we knew we’d need help on project planning and organization
  • Once we knew elective surgeries and procedures would be our initial focus the key stakeholders became clear:
    • Dan Allain, Brian Piearcy, Kari Knudsen, and all the supporting departments leadership, i.e. Lab, EVS, Pharmacy, etc.
  1. What has been the most challenging part of reopening?
  • Reaching consensus on the multiple critical decisions that had to be made. There are huge variations in other institutions in terms of bringing elective surgery back online, testing vs screening, and assessing whether we have enough supplies to even support the ideas that were being discussed.
  1. Do we have enough PPE to cover the additional supply that will be needed by our surgical team?
  • Yes, we have four months’ worth of surgical masks on hand and we are starting to get shipments twice per week.
  1. With the limited amount of isolation gowns available, why not consider using sterile or non-sterile disposable surgical gowns or the disposable white “lab/cover coats” used in surgery in lieu of (or in addition to) isolation gowns?
  • We have 450 extra gowns in stock currently which equates to over 200 surgical cases. In addition, we have over 1,100 surgical packs which all contain two gowns each, so in combined inventory, we have over 2,500 gowns.
  1. What extra steps have been taken to assure our community that our surgical rooms are sterile and safe and that our hospital is a safe place?
  • First of all, surgery department cleaning and sterility protocols are already very stringent without even considering COVID, but we do take extra precautions for COVID positive patients and treat those without a negative test as if they were. We are also working with the Marketing team to develop communication tools.
  • If a COVID patient is negative, we will use the normal surgical cleaning and turn-over. (everything wiped down, mopped, etc. (20 min))
  • In the event we have an emergent surgical case of a COVID positive patient they go to a dedicated COVID OR.
    • After the positive COVID patient’s surgery is complete, the room will sit for one hour to get the maximum number of air exchanges in that room. Operating rooms have 13-20 air exchanges per hour.
    • After the one hour of sitting, the room is terminally cleaned by operating room Surgical Team assistants. (Ceilings, walls, high touch surface areas, lights, equipment, anesthesia machine, beds, and floors).
  • PPE for COVID positive surgical patients:
    • The surgical tech, RNFA and surgeon are in a surgical gown, shoe covers, disposable bouffant, eye goggles, face shield, and N95 mask.
    • The RN and anesthesiologist are in a white bunny suit, shoe covers, disposable bouffant, eye goggles, face shield, and N95 mask.
    • Every anesthesia machines airway circuit has a filter on the machine.
    • Before intubation occurs, a Plexiglass intubation box is positioned over the patients head. The anesthesiologist is able to put their arms through the glass and visualize the patients airway. Plexiglass is removed after intubation.
    • RNFA, Surgical Tech, and Surgeon (if they are present), leave the room during intubation and estuation.
  1. After surgery, what are the next services that will reopen?

Dept name

Director

Current Status

Re-Open Date

EEG

Wendy Jones

Closed

May 5th

HBO

Lisa Harrold

Closed

May 6th

Sleep Lab

Wendy Jones

Closed

May 11th

Pulm Function

Wendy Jones

Closed

May 11th

Surgery - Inpt

Brian Piearcy

Limited

May 18th

Surgery - Outpt

Brian Piearcy

Closed

May 18th

KATS

Brian Piearcy

Limited

May 18th

Mammography

Renee Lauck

Closed

May 18th

Endoscopy

Brian Piearcy

Closed

May 18th

Cardiac Rehab

Lisa Harrold

Closed

June 1st

Pulm Rehab

Lisa Harrold

Closed

TBD

TLC

Patrick Tazio

Closed

TBD

ECHO

Barry Royce

Limited

  1. Will there be any changes made to the way outpatient clinics and therapy clinics have operated going forward once census starts to increase again and everything starts opening up? For example, before COVID-19, clinics often operated at full capacity with limited to no space in the waiting rooms and therapy clinic spaces.
  • Will we have to maintain social distancing in the clinics going forward and if so, how will Kaweah be addressing this in these areas?
    • Again, this is a very fluid situation and we will be following closely CDC guidelines and the directives from the state and county health departments. With the advent of telehealth visits now being allowed in the clinics, this has and will continue to help decrease the need for patients to physically come to the clinic to receive care. We will continue to be intentional with our mix of patient scheduling of face-to-face vs telehealth visits to maximize our ability to maintain social distancing in our waiting rooms and outpatient service areas. In general, we will maintain social distancing standards where possible and utilize PPE and standards of care as appropriate
  • Will they decrease the number of staff treating at those sites, decrease the number of patients each person is treating during the same hour, etc?
    • In terms of the clinics, with telehealth, we do not expect to decrease the number of patients we treat during the same hour. In fact, the number of visits in two of our rural health clinics in the last couple weeks exceeded pre-COVID volumes. We’re very excited about what the future of health care looks like with the integration of telehealth.
  1. How long will the ED tents stay up?
  • The tents will stay up for the foreseeable future. It takes a lot of time and effort to set up those tents and establish the workflows, etc. With the community beginning to open back up, we want to maintain the great infrastructure we’ve put into place.
  1. How long will we continue to test on Floral Street?
  • We will continue to test at Floral Street for the next several weeks. John Leal, Mary Laufer, Deiter Reichmann and their teams continue to map out long term solutions.
  1. Are we going to bring clinical staff back in waves or all at once?
  • The leadership of each service line and department will be making the determinations in terms of their staffing needs and working with HR in bringing folks back.
  1. When do you anticipate bringing non-clinical staff back?
  • Again, leadership of each service line will make these determinations.
  1. How will we stay within the Governor’s orders if our staff are not
    sitting 6 feet apart?
  • We will take every measure possible to maintain 6-foot spacing for staff, patients and visitors. As with patient care, when we cannot maintain 6-foot spacing we need to be intentional to ensure we are maintaining safety standards, hand hygiene and wearing our masks, etc.
  1. Are we anticipating another surge?
  • As society begins to open up, we do expect to have in increase in the number of positive cases. Whether this turns into a surge in terms of ED visits and hospital admissions is yet to be seen.
  1. If we have another surge, will we shut everything down again?
  • We’ve learned a lot as an organization, and as a nation, in general during this pandemic. Going forward we need to employ more intention and precision in terms of our decisions on how to respond to potential surges. Access to health care is essential for our society and we cannot continue to turn services on and off like a light switch. We will be monitoring inpatient staffed bed and ventilator capacity on a daily basis and will be making very intentional and careful decisions about individual service lines. We have created, and will continue to refine, protocols and workflows in place to keep patients and employees safe moving forward.
  1. Have our baselines changed as far as what we are stocking for PPE?
  • The manufacturing world has pivoted during this pandemic to make more supplies available, so we are hopeful we won’t run into the shortages we have had in the past. We will set par levels for our supplies and do our best to maintain them.
  1. What will opening up KATS mean for the Skilled Nursing Facility portion of West Campus?
  • It is important to remember we did not close KATS, only limited their services. We will work with the leadership at the facility to determine what precautions need to be taken in order to insure the safety of our patients and employees.
  1. How do we communicate to the community that it is safe to come to the hospital, but they also need to remain vigilant with their precautions.
  • The Tulare-Kings COVID-19 Coalition has a PIO group that works on the messaging sent out to the community. This group includes Dru Quesnoy, Laura Florez-McCusker, and public information officers from different hospitals. Their goal is to share consistent and clear messaging with the community about all things COVID. We don’t want the community to let their guard down once we start opening up businesses and services, so they are working on messaging that reiterates the precautions we need to take, while navigating through this new normal.
  1. Watching the news, we see a lot of graphs that show the trending line. I think that information is helpful in understanding the current impact of the virus on our community. TCHHS has not really showed a graph showing the trend. In particular, the trend of hospitalizations. I think this information would be the most helpful to show the trend in our community. I know that a lot of new cases are from SNF's and those numbers wouldn't necessarily show up in hospitalizations but knowing what the trend on hospitalizations would show how the community in general is faring.