It seems almost hubristic to say it, but we’ve made some progress in the COVID-19 pandemic this year. Obviously we’re still dealing with infections and new variants; plenty of people still refuse the vaccine. And no doubt we’ll deal with the crisis fallout for years to come, including treating long-haulers and (ideally) rectifying the factors that placed certain groups at high risk.
But it can’t be denied that the pandemic inspired some much-needed innovation. In addition to the inspiring vaccine development programs, telemedicine adoption rose dramatically – and so did nursing school applications. The strong spotlight on healthcare disparities motivated some researchers to focus on social determinants of health, while many Americans started new nutrition and fitness regimes to address their chronic conditions.
Many hospital staff took the same approach, reinventing their capacity management workflows, staff training modules, and care delivery methods. That includes our teams, who launched innovative new programs designed to improve outcomes across entire communities. Here are just a few of the groundbreaking changes they made as part of COVID-19’s legacy.
A Second Emergency Department Limits Contagion
Like many facilities in Native American communities, one tribal Arizona hospital was hit hard with COVID-19 patients. Their emergency room was overcrowded, the providers working long hours. While other hospitals often deal with high demand by transferring patients to another facility, this reservation is the size of Connecticut. Transporting patients can take hours. Another factor are the crowded local residences. One household might have 14 members, which means diagnosing and controlling infection is critical.
The team came up with several solutions. One was converting a local community center into a ward for COVID-19 patients. Another ambitious endeavor was developing a second emergency department. Launching April 1, 2020, the new emergency department was designated the Red Unit for COVID-19 and other infectious patients. The new ER had 10 beds, a separate entrance, and a holding area for patients that only needed testing. The old unit was designated as the Blue Unit for non-infectious patients. Outside both units, a nurse triaged all patients, ensuring the patients were triaged into the appropriate location.
“Patients who need to get tested may not want to go into the COVID-19 unit – so they go into a designated room for swabbing and testing,” explained Brian Gallagher, Chief Clinical Officer. Another effective infection control: “They put up plexiglass so radiology techs can take x-rays through it without entering the infectious ward, which maximized infection control. We required all staff to comply with the infection control procedures. To date, we have had zero team members acquire COVID-19 from work. This is a momentous achievement.”
Exceeding the National Standard of Care and Beyond
The benefits were immediate. Providers weren’t traveling between wards, which kept both patients and providers safer. In fact, the concept was so successful that the hospital has designed a mobile ER unit for infectious patients. The trailer unit is equipped with two beds, telemetry, oxygen, computers, and other technology.
The result: despite the crush of COVID-19 patients, the facility managed to drive better efficiencies across the emergency department. In addition to increasing the acuity of the patients being treated, some metric improvements included:
- Discharge time improved to 100 minutes (National standard of care:120 minutes)
- Door to Triage Time has been 4 minutes or less (National standard of care: 10 minutes)
- Door to Provider Time has been shorter than 10 minutes over the last year (National standard of care: 30 minutes)
- Left Without Being Seen Time is 0.5% or less since April of 2020 (National standard of care is under 2%)
A New ER and Stroke Program
Up in the Great Plains, our team at another tribal facility faced a similar influx of COVID-19 patients. Unfortunately, they were forced to treat this rising wave of patients within the limits of a 7-bed emergency department.
“Before COVID, we’d see 70-120 patients a day,” said Jamie Keppel, RN Supervisor. “We quickly outgrew the seven-bed ER as our COVID-19 numbers kept increasing.”
Their solution: building a new, modern emergency department – one with two trauma rooms and new monitors, otoscopes, and other equipment. “Now we have a 14-bed ER with 4 fast-track rooms,” Jamie said. “Patients are surprised – they comment on how beautiful it is. We’ve invited tribal members in to see it too.”
The team also helped reopen the hospital’s ICU, allowing them to serve more high acuity care patients, and launched a mobile unit to provide vaccines to elderly patients. They also created a new stroke treatment program.
The clinicians designed the program after noticing a need to better communicate and accelerate treatment. “Time is of the essence with stroke,” Jamie said. “So, we’ve put new protocols and new policies in place. We clearly document the levels of care needed, which sharpens diagnosis and triaging, we track reviews and time blood cultures carefully. And we collaborate with radiology, EMS, and other teams to make sure patients get the best care.”
Today the stroke program aligns with American Heart Association, Joint Commission, and Centers for Medicare and Medicaid Services (CMS) standards.
The COVID-19 Legacy of Healthier Tomorrows
We’re proud of our teams’ courage, commitment, and innovation in the face of a horrendous pandemic. These clinicians provided patients with compassionate and expert care – but they also brought big-picture ingenuity to solving healthcare barriers in tribal communities. Even after the pandemic ends, their COVID-19 legacy will live on.
