WOW! What a difference to all of healthcare in the past 60 days. In my last Ask Bruce article dated, February 2020, I addressed all the services provided at Newberry Hospital and introduced our new Marketing Campaign Theme “All Roads Lead to Newberry County Memorial Hospital.”
Just a couple weeks later, we find ourselves in a pandemic crisis that most of us have never seen before and pray we never see again.
In my 44 years in healthcare, I have always had regulations and agencies that established guidelines that hospitals must function under to continue to keep their licenses. These guidelines, although sometimes very stringent or tedious to comply with, have always been in place to assure quality care, safety, low (no) infection rates, treatment for patients in the correct setting based on meeting criteria medically, and assuring all patients are evaluated regardless of ability to pay. The Joint Commission, Occupational Safety and Health Administration (OSHA), The South Carolina Department of Health and Environmental Control (DHEC), Centers for Disease (CDC), Medicare/Medicaid (CMS), South Carolina Hospital Association (SCHA) and many others have always proposed regulations and recommendations on how hospitals operate.
In the five years I have been CEO at Newberry Hospital, I am proud to say we have always followed regulations and recommendations from all these agencies. I am also proud to say we have received many awards from these organizations.
The first two weeks of March, NCMH was very busy and functioning under these regulations. Then comes COVID-19! Our world, as did your worlds, changed dramatically. We were watching the media regarding COVID-19 in Washington State, New York City, and a few other areas.
The CDC, SCHA, OSHA, the Governor, and many others went to work immediately in South Carolina. Every day there were telephone conference calls, emails, the Governor and DHEC video meetings, and ongoing internal meetings at NCMH.
I am so proud of the team of “Heroes” at Newberry County Memorial Hospital. Even under the very toughest of times, my employees, the medical staff, and our Governing Board’s first and most important goal was to protect our patients, employees, our community and our medical staff.
From the very beginning, on a daily basis, the CDC, the Governor and DHEC instructed each hospital on mandatory regulations, recommendations, statistics on testing, and statistics on positive cases by county and zip code. Many shortfalls in Personal Protective Equipment (PPE), staffing issues, delays in test results, “who gets tested and by whom,” and many daily questions.
Below is a list of some of the changes that were directed or recommended by the Governor and the CDC:
1. March 23 – The Governor asked hospitals to suspend elective surgeries and elective procedures to reduce occupied beds, staff needs and PPE needs.
2. The Governor requested hospitals develop a plan to maximize available hospital beds in the case of COVID-19 surge.
3. Mandatory Daily Hospital Reporting, including number of ICU beds, number of ventilators available, number of patients occupying a bed, and number of patients who have tested positive or possible positive.
4. CDC issued recommendations and best practices related to handling employees or medical staff that were exposed to a positive or possible positive COVID-19 patient.
5. Visitation and entry into NCMH. Unfortunately, we had to eliminate visitation for patients on our patient units. We also had to eliminate any family or friend from accompanying patients having surgery or any x-ray or lab work.
6. We locked down the hospital front door and all patients must enter through the Emergency Department.
7. Before entering the hospital, all patients are screened outside the ED doors for temperature and any health concerns or known exposures.
8. The dining room closed to the outside and employees must eat at their desks or break rooms.
9. All volunteers and students from surrounding schools and colleges were restricted from NCMH until further notice.
10. All clinical employees trained and provided appropriate PPE. All staff must wear a mask and practice social distancing.
During this period, NCMH has followed these directives and recommendations. During this period, volumes have decreased approximately 45 percent. We have continued to treat ED patients, inpatients and necessary surgeries, x-rays, and lab tests.
Even before the COVID-19 crisis, the hospital has always adhered to regulations from CDC, Joint Commission, OSHA, DHEC and CMS. This crisis has caused these agencies to change some rules, but many rules have been in place long before this crisis.
An example of this is:
1. For a long time, a patient must meet certain clinical criteria to be admitted to the hospital. When a patient presents to the Emergency Department, the ED physician will access the patients clinical condition and should the ED physician feel the patient might need to be admitted, the on-call inpatient primary care physician is consulted and that physician determines if the patient is admitted or sent home.
Ten or twenty years ago, the criteria for admission was much different than today. These guidelines have been established by CMS (Medicare and Medicaid), as well as some of the other insurers, such as Blue Cross or United Healthcare. Today, many more patients are treated on an outpatient basis based on these criteria.
In Mid-March, the COVID-19 pandemic added additional directions and regulations. CMS, Blue Cross, United Healthcare continue to demand the patient meet clinical criteria to be admitted. Like with any other diagnosis, COVID-19 has different clinical presentations; however, just the positive test does not qualify the patient to be admitted. If a patient has tested positive for COVID-19, but does not have the symptoms of an advanced stage that will require invasive treatment, the patient is best quarantined at home and told if they get worse to please return to the hospital ED.
What complicates this example further is that the Governor, DHEC and SCHA requested hospitals attempt to keep the volumes in their inpatient beds low — if there is the surge anticipated with COVID-19 patients needing hospital, ICU or ventilator support. With daily reporting S.C. hospitals are currently running approximately 60 percent occupied. Hospitals, including NCMH, followed this directive and eliminated surgeries and tests that could have increased the volumes in inpatient beds.
Unfortunately, like with any crisis, the unknown causes great concerns. Hospitals have been working on “worst case scenarios” along with SCHA and the National Guard to establish potential off-sight areas should NCMH be “slammed” with COVID-19 patients needing inpatient care or ventilator care. To date, we have not had to implement worst-case plans.
Just like hospitals, all other healthcare providers have been receiving direction, recommendations, and support from the Governor, DHEC, and CDC. Surgery centers, nursing homes, rehab centers, and other entities continue to have many of the same challenges as NCMH. All of us want what is best for the patients, the medical staff and the community. Unfortunately, we each have guidelines and regulations that may put the hospital and one of these other healthcare providers at an adversarial position.
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