Coordination, preparation and commitment is key to WTH Covid-19 plan
Benjamin Franklin once said, 'By failing to prepare you are preparing to fail,' and in the throes of the Covid-19 pandemic our nation is facing, those words ring very true. While West Tennessee is just starting to see the number of Covid-19 cases rise, West Tennessee Healthcare has a game plan in place and the prep work has been done to aid the area's largest healthcare provider in meeting the demands of this pandemic. Key to the plan is coordination, preparation and commitment.
While the world was just starting to hear of the Covid-19 virus early in 2020, West Tennessee Healthcare's emergency management team said that experiences from the past have had them prepping and planning for something like this for a long time. Drawing on lessons learned from 9/11, tornados and H1N1, as well as those learned from other areas, have helped formulate an ever evolving and fluid plan.
"We have been planning for a long time for really any disaster or pandemic that may come our way. While each situation and its associated challenges are unique, they help us for the next time." said Lyn Tisdale, Director of Respiratory Care for West Tennessee Healthcare. "We have stockpiled supplies and have identified where additional beds can be pulled from as well as additional staffing in the event they are needed."
Director of Emergency Management Services, Kevin Deaton, says training in the past and multiple annual drills have also gone a long way in helping with the system's emergency preparedness. "We have learned a lot, and communication is key," he said. "We have to change things on the fly as new guidelines and updates come out which can be on a daily, if not hourly basis. We then have to push that out to all the points in the system and community that need to have it."
Amy Garner, Vice President/Chief Compliance and Communication Officer for West Tennessee Healthcare says relationships forged in the past on the local, state and national level have really come into play. "Knowing who to call, who to vet information through has been so beneficial as we ramp up efforts to meet the demands placed on the system," she said. "All the players are at the table sharing information, ideas and best practices. It is really a 'we are all in this together mentality' across all lines."
Besides being the Executive Director of Emergency Services at West Tennessee Healthcare, James Fountain also serves as the Executive Director of the Watch Coalition for West Tennessee. Coalitions in Tennessee are aligned with the eight Emergency Medical Services (EMS) Regions. These coalitions work on planning, organizing, equipping, training, exercising and evaluation of healthcare system preparedness in their respective regions. Representatives from all healthcare related entities from assisted living facilities to hospitals to EMS and public health agencies meet monthly to discuss issues, plan, coordinate and prepare for issues such as this pandemic or natural disaster. The Watch Coalition serves 17 counites in West Tennessee.
"Being in emergency management gives you a worst-case scenario mindset that makes you always think what if. When this first emerged in China, discussions started. When the first case was reported outside of China, our radar kicked in. When it showed up in Washington state, we realized the impact it could have on the elderly," he said. "We started firming up our action plans because we knew it would make its way here."
The Watch coalition has played an integral part of WTH's plans. "Coalition members have been working at various stages for some time updating plans, resources and numbers. We are all working together because when disaster takes place, we are all stronger together," said Fountain. "Every day at 4pm, we hold a phone conference where we discuss everything from supply chain issues, resources to anything we need to send up to the state level. I also sit on the state advisory board and we have conference calls on Mondays and Fridays to discuss things we are experiencing in our hospitals so that we can work collectively to address issues across the state."
"Every disaster is a scalable event that requires that we plan at every level. Our plans have been adapted based on what we see happening in other places, but each area could be affected a little differently," said Tisdale. "Our initial response is isolation rooms. As the case load increases, we will cohort patients until the need arises to designate floors or areas in a patient tower. Ultimately, we could designate an affiliate hospital for these patients. Having multiple hospitals and affiliates in our system means we also have plans to support them as well as move critically ill patients as needed."
Communication is key says Garner, who has seen her role as Public Information Officer for the system take on an entirely new role with daily, if not hourly, demands. "We have daily huddles with all hospital and clinic administrators to report challenges, bed capacity, equipment needs as well as solutions and best practices," she said. "We are constantly in touch with other facilities and healthcare associations across the state and country sharing information."
"Tina Prescott, our Chief Operating Officer, runs daily conference calls with all administrators across the system in addition to other key personnel to maintain a system wide approach to things," said Fountain. "I hold a daily conference call with the Emergency Department personnel and chief of nursing in addition to after-hours calls as needed. It is imperative that we have a coordinated response so when we roll out information or a best practice at one place, it is done system wide. We are running 24/7 to stay in front of this and head things off as we can."
As larger areas in the nation are facing ventilator shortages due to the high volume of patients, the availability of those in West Tennessee is something Tisdale feels comfortable about. "Over there years we have allocated funds to purchase ventilators and maintain a stockpile of them. Other non-traditional ventilators have been ordered that we can use in the event they are needed," he said. "Over my career, at our highest point we had 38 ventilators running concurrently."
In addition to equipment needs, adequate manpower is also an important part of the WTH plan. "We have one director tasked with maintaining and scheduling a list of providers to work. It is volume driven and we have a plan for pulling staff in when needed," said Garner. "We have taken steps such as canceling non-essential surgeries to increase this pool of caregivers and providers."
"Protocols have been implemented for when a patient presents at a clinic or the emergency department. While we do not want someone to hesitate to seek medical attention, we are encouraging them to call ahead if they think they have the virus. If we suspect it could be a case, nursing staff meeting them outside and direct them to the appropriate entrance to be screened. We also screen visitors," said Fountain. "While it may be an inconvenience, it is prudent that this process takes place so that we protect patients and staff."
One of the hardest decisions that has had to be made in this process has been limiting visitors. "We realize that if you have a loved one in the hospital you want to be with them. There is a human and an emotional element," said Tisdale. "But it is what is best for the patient, the visitor and the general public. We want people to understand if they cannot be with their loved one, we are going to give them the best care."
Though the focus may seem to be on Covid-19, the reality is there are other patients that have to be cared for. "We still have the day to day illnesses, chest pains, traumas and such to take care of," said Deaton. "One decision we made early on was the route we would take once we had our first Covid-19 case. There is a flow chart we follow for every transport outlining communication with the ER, proper entrance to use, isolation rooms, etc. There are questions asked with every call we get so the process starts well before the ambulance arrives. We follow national standards for screening calls for potential patients who have symptoms so that we can alert medical staff to take proper precautions."
The level of anxiety in the community as a whole as well as the rapid spread of the virus throughout the nation are things that have surprised the team but what has not surprised them is that the greatest strength to fight this is people. "We have had things before, just nothing that has generated this much anxiety or concern," said Tisdale. "But what I am most proud of is our people, as that is who is going to fix this problem. The level of commitment and teamwork being displayed daily has been amazing."
"The response from the community has been overwhelming. People are coming to the hospital and writing messages on sidewalks or on signs for our healthcare workers. There is a gentleman who stands out at shift change to pray for our staff," said Garner. "Businesses are donating food and supplies. Churches are providing childcare. We are so thankful for all they are doing."
Despite the stress, Garner says morale is good. "We are staying in touch with those on the front lines, making sure they have what they need and that they are informed. Employees seem happy that we have taken that actions that we have. The hospital is not as chaotic and there is a sense of calm throughout the halls," she said. "The staff and leaders that are emerging throughout all this is what I am so proud of. We have some phenomenal young leaders stepping up to the task."
While the WTH team has huddled up to address the ever-changing horizon, what this pandemic has also brought to the forefront is a heightened sense of teamwork, both from other players in the healthcare arena as well as from staff members and the community. "One thing people need to realize is that while healthcare workers are on the front lines, the average citizen has just as much of an impact as they have," said Garner. "We have to rely on them to help stop the spread of this virus by following the protocols that have been implemented."