Preparing for the peak

Brookings Health System photo: Quality Director Sandra Ruesch poses as a patient while Radiology Technologist Tori Arzdorf demonstrates how to take an X-ray of a COVID-19 patient through glass, a technique being taught to care givers at Brookings Health System. Brookings Health is educating team members in preparation for the COVID-19 peak, estimated to happen in June according to the South Dakota Department of Health.

Brookings Health readies for the COVID-19 worst-case scenario

BROOKINGS – For health care providers across the country, COVID-19 is an unexpected mountain thrust in their path, one that Alexa and Siri didn’t give any advance warning about in turn-by-turn directions. 

In South Dakota, the Department of Health’s models indicate the climb is just starting. 

The DOH currently predicts South Dakota will hit the peak number of COVID-19 cases sometime in May to mid-June. And while that peak is flatter thanks to measures taken by the community at large, it’s still a potential juggernaut for local health care teams. 

“We’ve been lucky,” Infection Preventionist Bunny Christie said. “Up to this point, our cases in Brookings County have been low and our community transmission is still in the mild to moderate category. The City of Brookings and Brookings County took prudent actions to restrict social gatherings and encourage social distancing. Not having school in session at both the K-12 and collegiate levels has also helped slow the spread.”

But Brookings Health System still isn’t leaving anything to chance. The team is preparing for battle, gearing up for the worst COVID-19 could throw the health system’s way. 

Learning and teaching

One of the big items Christie and others leading the COVID-19 charge at Brookings Health are doing: learning. 

Each day they sit in virtual classrooms, webinars hosted by the CDC, DOH and other subject matter expert organizations. They glean lessons learned from China, Italy, Seattle and New York, places that have already seen a COVID-19 surge. They gather new recommendations and best practices, see and hear new ways of providing care, and collect the why and scientific reasoning behind changes. 

With all that learning in hand, they take on the next hurdle: educating staff. 

“COVID-19 is an evolving situation which means information can change quickly,” Christie said. “We’re asking staff to adapt to the situation, sometimes asking them to change how they learned to give care, and trusting us we’re giving them the best information possible. It’s like we’re putting them in an ongoing continuing education class.”

To help prepare staff to care for an influx of positive COVID-19 patients, the health system has started running simulation drills. 

“We’ve set up a scenario where a sick patient enters our emergency room and then walk the team through what they should initially do as well as what care they should give when that person is admitted as an inpatient and their illness progresses,” said Quality Director Sandra Ruesch, RN. “By practicing these items, we want to make team members ready for the real-life situations.”

The COVID-19 action team also creates communication tools, such as recording simulation drills for replay, drawing out flowcharts for safe patient transport, and writing guidelines for proper and safe personal protective equipment (PPE) use and reuse.

“We’re trying to not put our team members in information overload,” Ruesch said. “During times like these, you can’t communicate too much. However, we’re also a small action team and really rely on our employees to pay attention and learn the communication we send out.”

Personal protective equipment, supplies

With the worldwide shortage of PPE, like respirators, masks and hand sanitizer, the health system has been mining supply chains as well as taking methods to preserve PPE. 

“All of the home sewn masks the community has been making, we’re putting them to good use,” Christie said. “To help protect our clinical workers and patients from unintentional COVID-19 exposure, we’ve started universal masking at both the hospital and The Neighborhoods at Brookview nursing home. What this means is our team members who have face-to-face contact with patients or residents are wearing a standard surgical mask in conjunction with a cloth mask.”

Each shift, staff don a clean cloth mask to wear over and preserve their medical grade mask. At the end of the shift, the cloth masks are put in a hamper for laundry personnel to clean for resuse. Staff carefully remove their medical grade masks and store them in a paper bag for resuse on their next shift. 

“The paper bag allows the mask to ‘breathe.’ Air exchanges of our medical grade HVAC system filter 99.9% of microbial particulate,” Christie said. “We’re asking staff to reuse those masks until they are visibly soiled or the material integrity degrades and no longer properly fits.”

In addition to PPE conservation, the health system is also tapping into unique supply chain resources. 

“We’re buying hand sanitizer in bulk from local distilleries,” said Supply Chain Director Jennifer Chandler, RN. “Larson Manufacturing is helping us by making intubation boxes. We’ve had over 5,000 masks donated by local businesses and SDSU. We’re getting isolation gowns from a manufacturer in Sioux Falls. We’re finding creative ways to get supplies.” 

Those supplies also include additional ventilators.

“We keep in contact with the Department of Health regarding our supplies and our needs,” Chandler said. “We have ventilators on-hand in our facility, but if we see a surge of patients and need more, we have the availability to request those through the Department of Health.”

Surge planning

No one knows for certain what the COVID-19 peak in South Dakota – or Brookings County – will look like. However, Brookings Health has been working on surge plans, details of what to do and where to relocate patients if certain numbers are reached.

“If the Sioux Falls hospitals and field hospitals are as busy as the Department of Health is predicting, we won’t be able to transport patients there,” Christie said. “We’re preparing to care for patients here at home.”

“We’re fortunate we still have extra space from our recent hospital expansion and renovation project,” Chief Nursing Officer (CNO) Tammy Hillestad, RN, adds. “If we need to, we’ve already figured out how we can safely house up to 63 COVID-19 patients. We have rooms available and operational in our old OB unit. We also have room in our outreach clinic and cardiopulmonary rehab area that we can convert and use as needed. We keep thinking about additional ways we can expand our capacity.”

As CNO, Hillestad leads the C19 Response Team, a collaborative effort between Brookings Health’s hospitalists and physicians from Avera Medical Group Brookings. Together the group of doctors has been working on possible treatment regiments for future patients. The physicians, too, have been educating themselves, gathering lessons learned from experiences in other places already impacted by COVID-19. 

“We’re developing protocols to provide patients maximum respiratory in hopes of avoiding intubation. While mechanical ventilation on a breathing machine is sometimes unavoidable, we will do everything we can not to get to that point,” said Hospitalist Dr. Catherine Leadabrand, MD.

The C19 Response Team’s care plans also include ethical guidance and considerations for the emotional toll on care providers.

“If we are placed in a situation where difficult decisions need to be made, we are fortunate to have access to an already well-established ethics committee to guide us in those decisions,” said Primary Care Physician Dr. Rachel Sunne, MD. 

Healthcare personnel will be key to delivering the C19 Response Team’s care plans. Local physicians have agreed to help hospitalists at Brookings Hospital. In addition, the team is collecting experience from clinic nurses, seeing where they may be able to help in the hospital during an all-hands-on-deck situation. 

“We’re preparing for the worst,” Christie said, “and also praying for the best.”

More information about Brookings Health System’s local efforts to fight COVID-19 can be found at brookingshealth.org/COVID.

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