The health and safety of patients is at the heart of every healthcare facility’s safety plan, and the onset of COVID-19 only amplified the safety protocols that were already in place. However, the COVID pandemic has made it clear that it’s not only important to keep patients and staff safe but family members and loved ones as well. We spoke with two hospital systems — Presbyterian Healthcare Services in Albuquerque, New Mexico, and UPMC in Pittsburgh, Pennsylvania — to learn what they are doing to protect against the spread of COVID-19 in their facilities and the community as a whole.
Dr. Denise A. Gonzales, senior medical director and critical care pulmonologist at Presbyterian Healthcare Services, says screening patients, visitors, and staff at the first point of contact — before they enter the building — is crucial. This includes prescreening patients over the phone who are scheduled for non-emergent procedures.
“For patients who are coming in for a surgery or colonoscopy, for example, they get screened for COVID symptoms on the phone, their anesthesia preparation is done via phone,” she explains. “They're sent to get a COVID swab 72 hours prior to their procedure and then once confirmed negative, they come in and have their procedure.”
UPMC and Presbyterian Healthcare Services also screen all patients and employees on arrival.
“Patients, support persons, and non-UPMC providers and vendors are screened upon entry to our hospitals with the support of temperature measurement terminals and on-site screeners who ask questions about symptoms and potential exposure,” says Byron Wade, Vice President of UPMC Locum Clinicians. “All employees and employed providers are screened daily via electronic self-screening, which creates a tracking mechanism maximizing individual accountability and overall safety.”
Both UPMC and Presbyterian also require everyone who sets foot in their buildings to wear masks. Both provide patients and visitors with surgical masks to wear even if they have brought their own masks from home. “Everyone is screened at the entrances and they’re all required to wear a surgical mask, which we provide to them,” Dr. Gonzales says.
Universal masking isn’t a big thing to ask patients to do, according to Wade. “It's simple; we have found that masking and hand washing and sanitizing do a good job of making sure we have a healthy population to care for our patients,” Wade says. “We don't ask you to do anything we're not asking ourselves to do. We have also embraced COVID-level PPE in all of the high-risk areas.”
At Presbyterian, Dr. Gonzales says everybody must wear a surgical mask at all times, even if they’ve not tested positive for COVID. And she says that those staff members who are in the room for an aerosol-generating procedure are required to wear full PPE, including N95 masks and eye protection. “We also supply full enhanced airborne precaution PPE to all of our staff for every single patient, whether they’re COVID positive or negative,” she says.
Since patients coming in for aerosol-generating procedures are at higher risk for spreading the virus, Dr. Gonzales says these patients are required to take a COVID test 72 hours prior to their appointment. “Then when they’re confirmed negative, they can come in for their surgery or procedure.”
At the start of the pandemic, Wade says UPMC offered testing to every patient pre-procedure, but now they’ve adjusted their testing protocols. “We're using science-based decision making, we're keeping our own data and we're using that data in conjunction with CDC and Department of Health. Our data doesn’t indicate that pre-procedural testing is necessary for all of our patients, so we strategically offer it to those whose procedure or course of care would change if the result is positive, which is different than when we started preprocedural testing in May or April.”
Wade says they also take into consideration other factors before testing a patient, such as if they’ve been in a controlled environment in which they get regular testing. “A lot of times when they're coming from nursing homes, for example, they’re getting adequate testing on a regular interval. So if they're not coming in for a COVID-related issue and there's no need to suspect that it’s COVID, we're not employing this universal testing.”
Both Presbyterian and UPMC have stringent guidelines for isolating patients who are COVID-positive in order to keep those without the virus healthy. For certain procedures, Wade says his hospital performs them in negative-pressure rooms.
“When patients have pulmonary testing, for example, they’re expelling germs for 30 minutes,” he explains, “and specifically the germs that we’re concerned about for COVID-19. So we created these negative-pressure areas, which keep our staff and patients safe.”
At Presbyterian, Dr. Gonzales says they had already retrofitted rooms to care for patients with tuberculosis, and these proved to be ideal locations to treat their patients with coronavirus. “These rooms are appropriate for airborne precautions. They have negative airflow that exhausts to the outside world. Now we have many, many negative-airflow rooms.”
“And if it's not possible to have negative airflow and vent externally, then we've installed air scrubbers which have internal HEPA filtration with rapid room turn so that it decreases the viral load in those rooms,” she says. “So now for me as a pulmonologist taking care of TB patients, that's fantastic.”
Along with universal masking requirements, both UPMC and Presbyterian follow CDC guidelines for social distancing in their facilities, but they’ve also become stricter with their cleaning policies.
“We’ve ramped up our cleaning,” Wade says. “Our environmental services team is phenomenal. They are unsung heroes of healthcare every day. We've built in protocols and procedures for cleaning common areas. These are the things that we already did every night, but now we’ve put a greater focus on it. The staff are responsible for wiping down the armchairs on a regular basis, things like that.”
Wade says it’s important to remain hyper-vigilant to these issues and to keep their environment safe for their patients, loved ones, and staff. “We’re doing our best to keep our area clean and our environment safe. This is very important to us,” he says.
Presbyterian has also put a higher priority on cleaning and stresses the importance of social distancing at their facilities. “We conduct their visit and make everything as touch-free as possible,” Dr. Gonzales says. “We room patients directly rather than having them wait in areas with other people so that we can ensure that they're not coming into contact with a large number of people.”
Telehealth has played a large part in keeping patients, staff, and loved ones safe since the start of the pandemic. Both health systems plan to continue taking advantage of the benefits of telehealth moving forward, regardless of the status of the pandemic.
“We have a very robust telehealth platform we use,” Wade says. “We've been aggressive and a leader in telehealth, so we've leveraged that technology from day one to ensure we can care for patients appropriately — whether it's direct-to-consumer telehealth or tele-critical care. We did that during the onset of COVID in New York, and we continue to provide tele-critical care to some of our outside hospitals. We can now see those patients and do consults with their hospitalist or specialist there in-house.”
Dr. Gonzales says she’s thrilled that telehealth has revolutionized the way they practice medicine and provide support to their community, but admits payors made it difficult in the beginning. “The financial infrastructure and the billing codes needed to evolve. But because they did evolve, we've been able to deliver the type of telemedicine that we've wanted to do all along but just haven't been able to because it wasn't financed.”
Specialized care and tele-education
In response to the pandemic, the University of New Mexico School of Medicine created a program called Project ECHO COVID-19 Response, which uses telemedicine capabilities to help bring specialized care and education to smaller, rural hospitals and clinics. It is also a forum to educate the healthcare providers and the public as a whole about the COVID-19 pandemic.
“We use this to provide information to small hospitals across the state, just on what the state-of-the-art was at the time for COVID care, as well as to just help people have a forum where they could express where they were feeling tired or scared or apprehensive, or even their joy,” Dr. Gonzales says.
The value of being proactive
Both UPMC and Presbyterian have proactively implemented policies designed to curb the spread of COVID-19 in their patients, loved ones, and their staff. Their increased emphasis on masking, cleaning, social distancing, telehealth, patient segregation, and environmental changes has helped ensure their communities successfully weather the pandemic and stay as healthy as possible.
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