The phone rang in countless homes with a message from an old friend just checking in. It was Lane Regional Medical Center calling to remind area residents that despite the ongoing uncertainty of a global pandemic, babies were still being born, broken bones were still being set, and the follow-up appointments to manage chronic conditions were available.
The coronavirus is still in pandemic proportions, but hospitals like Lane are past the height of inpatient surges and have put protocols in place to both remain on the front lines against the virus and offer it regular services, said Julie McLin, Lane Regional marketing director.
McLin assembled members of the Lane team to explain what proactive measures were in place before the first cases in the area, how the hospital altered operations during the height of inpatient surges, and why it’s important patients return for care and plan for yearly vaccinations.
Lane’s COVID-19 response plan started long before most Louisianans had the virus on their radars. Dana Bellefontaine, Lane’s infection preventionist, calls herself a “behind the scenes gal,” but that’s also where the early signs of the coming crisis resided. She noticed documents and recommendation on the virus spread. “At that step, we reached out to start doing training of our employees,” she said. “Proper PPE (personal protective equipment) that they need to be wearing when confronted with possible COVID, or what we call the ‘person under investigation.’ ”
Bellefontaine said the protocols started in the Emergency Department. Anyone who came in with respiratory symptoms was flagged and signs were placed in the department asking if patients had traveled to China and that was later expanded to U.S. hot spots like Seattle and New York City.
“And then we added more questions as it began to expand and we would get more information from CDC,” she said. “I was getting with Materials Management and making sure that we were going to have the supplies that we needed for our personnel to be protected, and for setting up negative pressure rooms in conjunction with our plan operations.”
A negative pressure room is a space with air pressure that allows outside air into the room that has been filtered. By contrast, a positive pressure room maintains a higher pressure inside the treated area than that outside it. Clean filtered air is pumped in; if there’s a leak, the air is forced out of the room. Positive pressure rooms are usually used for patients with compromised immune systems; negative pressure rooms are common in infection control, to ensure infectious germs don’t spread via the heating, ventilation, and air conditioning system.
The hospital added more negative pressure rooms and created a surge plan that created a unit that was just COVID patients. The plan also split the ICU into COVID intensive care and non-COVID intensive care. Steps were taken to address possible shortages of masks and other protection gear that include a sterilization machine that could be used if gear needed to be reused.
Bellefontaine said the hospital was proactive with the spreading virus. “I think the first patient was a week behind the first Baton Rouge patient so like at March 17, or something like that, they had their first positive and on March 23 we had our first positive, but during this whole entire time, we are planning daily,” she said. “When we got our first positive, we sent out reassurances to our staff, ‘OK, you know, we, we've got this, this is here, and this is what we're going to do.' ”
Team huddles were called daily and afterward guidance and updates were sent to the staff. “Through all of this everyone was very fluid and being able to change and we kept sending out that information to our employees just to subside their fears,” Bellefontaine said.
The hospital has 850 employees and 13 of them have tested positive during the pandemic, Bellefontaine said. “We never have a staff person that ended up in ICU.”
Staci Sullivan, Lane’s chief nursing officer, said the infectious disease director understated her role in pandemic response. “Dana's been extremely modest about her behind the scenes role in things, “Sullivan said. “She was right up front and making key decisions.”
Sullivan said she and Bellefontaine had the unpleasant task of asking a family camped out in the ICU waiting room to leave when the decision was made to shut down visitation. “We tried to manage that situation as compassionately as possible and gave them some time and they worked with us on and it turned out to be a really positive outcome for the whole family,” she said.
Sullivan manages a nursing staff of about 350. That’s nearly half of the 850 Lane employees. She said nurses are a part of the command center huddle. “Daily, we were having new decisions come out about how we do things,” she said. “Initially, we started utilizing the isolation rooms that we have in the hospital and quickly we realized that we were going to run out of rooms for COVID positive patients.”
The hospital’s plant operations staff and their director quickly got on ways to convert rooms. The decision was made to take the One South back hallway and convert the whole thing and flood the hallway into negative pressure so that once a person entered the two doors leading to the hallway, every room was a negative pressure environment. “This meant the nursing staff didn’t have to don PPE before they went into necessarily every room,” Sullivan said. “We did have to do some on-the-spot re-education about what it meant to use PPE appropriately in this situation so that you didn't end up self-contaminating yourself.”
Other COVID evolutions included limiting the number of caregivers that enter the room. “The nurse then became the phlebotomist, the environmental services person for the room, the nurse for the room, as well as many times becoming, the chief social support for that patient and the family, on the other hand, because they needed to be responsible for contacting that family and giving updates,” Sullivan said. “So, the work itself was hard and hot.
“It was challenging a lot of times just because they weren't carrying with them everything that those patients were experiencing and everything that the family members were experiencing,” Sullivan added.
Nurses helped convert ICU. On a normal day, Lane has an eight-bed intensive care unit and six beds of intermediate care. During the height of the pandemic surge, that whole area became a COVID ICU. Non-COVID ICU patients were cared for in the heart catheterization lab.
Lane adapted some suggestions to have nurses take care of multiple patients and reduce contamination risks. “You may have read some articles that talked about how they added extension tubing to IV pumps and then put the pumps on the outside of the ICU door,” Sullivan said. “That way during the frequent changes they didn't have to go in and out and break the airflow and all they could do almost everything outside of the door with the IV pump and then just go in when they needed to directly assess the patient.”
While the world still grapples with the pandemic, Lane's initial surge is over. The week of July 6, the hospital only had a few COVID-19 positive patients. “On the report today, we have three positives,” Sullivan said. “We have gotten down to zero for a couple weeks at a time and there are ups and downs.
Sullivan attributes improved testing with the decline in hospitalizations. “One of the things that I actually started thinking about a lot over this past weekend was what makes it different now, and it's the turnaround of the tests,” she said. “At the height of it, we would have to wait sometimes up to five days to get a test result back. You had people that you suspected were COVID positive and you also had tests that were confirmed. So, you had full units everywhere. Well, now we can get a test back in 45 minutes if we need to. Now, it's truly the real positive patients that are in hospital.”
The hospital is still isolating COVID-19 patients and that has turned into separate emergency room areas, ICU units, operating rooms, and the clinics and practices that are also a part of the Lane Medical Center.
Abby Landreneau, director of Lane Physician Practice, is proud of the pandemic response but also carries the message that non-COVID patients must not neglect their health.
The clinics include Lane Family Practice, Fastlane urgent care clinic, Lane GI, Lane Surgery Group, Lane OB-GYN Group, Lane Pediatric Group, and an audiology clinic. “So we have a lot of moving pieces in place because you people don't stop having babies,” Landreneau said.
The Lane clinics were also proactive in developing strategies as the first cases were confirmed in Seattle. As the virus spread through the state, the clinics were temporarily closed. “During that time in the clinics, we became unable to see patients in the clinic at all,” Landreneau said. “So, what I was tasked with doing was implementing telehealth. Before COVID, we actually did not offer telehealth for the Lane Physician Group. So that's something we went ahead and brought up.”
Landreneau said her physicians and staff were versatile and quick. When they had to stop seeing patients in person, they transitioned to a telehealth platform. “That was very challenging, but we did we figured it all out, put it all into place and really just shifted gears and with the telehealth route,” she said. “We decided that we were going to have our nursing staff and a chronic care manager proactively reaching out to patients just to check in on them because we knew patients were staying away, and we didn't want patients to be home and be unmanaged and not have what they need.”
As the staff began to reach out to patients, some insurance companies contacted the offices and with lists of high-risk patients. “So, with those patients as our highest priority, we did reach out to them,” Landreneau said. “We gave them access to community resources, made sure that they knew which pharmacies were delivering medications for the elderly, and tried to make sure they had access to grocery stores that would deliver groceries and those types of resources.”
When the offices reopened, Bellefontaine helped the clinics implemented infection control procedures. “We modified the environments of all the waiting rooms that included just turning chairs away from each other in the waiting room,” Landreneau said. “We created an ER follow up program for patients that come into the emergency room who aren’t sick enough to be admitted, but they may struggle at home.”
The outpatient clinic will follow up with that patient to make sure they're doing OK 48 to 72 hours after they're discharged from the emergency room. Similar services are available for patients discharged from inpatient floors to ensure smooth transitions to home, home health or therapy services.
Landreneau said the clinics are raising awareness of the seasonal flu season and explaining why patients need to factor the pandemic in their thinking. “I think that you need to be your healthiest in order to be able to battle the flu and fight off a potential COVID infection,” she said. “Putting your health care off puts you at a higher a higher mortality risk; so, you know, if your diabetes, high blood pressure, or a heart condition, and you do happen to contract the COVID virus, your chances for a poor outcome is higher, versus if you do let your physician continue to manage you well.”