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Community Hospitals and Wellness Centers (CHWC) is a small healthcare system in northwestern Ohio, very close to both the Indiana and Michigan state lines. We consist of a community hospital, a critical access hospital, an outpatient center, and a radiation oncology center. With large healthcare systems an hour to our west, an hour to our east, and just over an hour to our north, we serve the needs of a large, rural community.

Week 1

News of Covid-19 was widespread..

That week and was covered by all of the media outlets, but was still very foreign to most of us in the US healthcare systems. That week, calls had started to come in from media and community members to all the local health agencies. They were curious, scared, and wanted answers. It was evident by CHWC Administration and the local Health Department that we needed to be aligned in our responses and actions, and we were sitting in our first (of many) meetings to ensure that occurred. No one had any idea, on that day, during that particular meeting, the mountains that would need to be moved in the coming weeks. Weekly, and sometimes more frequent, conference calls have continued with the local Department of Health and other health agencies to this day..

Weeks 2-7

“Incident Command Center”

Until now, “Incident Command Center” and “Incident Commander” were terms that were heard during annual healthcare drills at the regional levels and occasionally may pop up in some action movies. They weren’t commonly used phrases in day-to-day hospital operations…until week two. Since then, our Incident Command meetings became as regular and commonplace as getting caffeine in the morning. Daily Incident Command meetings, a dedicated team of Incident Command Officers, and an ongoing and quickly-changing list of tasks took over the daily routine at all of our facilities. It was now official, Covid-19 efforts consumed all of our working hours by about week three. In looking at our healthcare peers around the nation and globe, it was evident that we weren’t alone in this respect. The following actions that would take place over the coming days and weeks both locally and on a world-wide scale were unprecedented and would likely have been scoffed at by healthcare administrators weeks prior:

Visitor Limitations…
& sending some workers home

For everyone’s protection, CHWC would start by limiting the number of visitors in the hospital at first, and ultimately moved to a “no visitation” policy with very few exceptions. Non-clinical departments would evaluate who might be able to work from home, and CHWC would end up starting a never-before-considered work-from-home program that will likely become a standard operating procedure for many employees moving forward.

Scanning at entrances

Like most other facilities, CHWC began scanning employees and patients for Covid-19 symptoms at every entrance. Where possible, employees who worked in departments that saw decreased volumes due to Covid were repurposed to staff these scanning stations and potentially other needs throughout the facility.

Personal Protective Equipment

Like others, CHWC quickly realized that there would not be enough PPE to handle projected patient volumes, and would need to invent procedures and policies that keep patients and employees as safe as possible with the limited resources available. The task became even more insurmountable as the onion layers were peeled back. N95 masks, of all various sizes and models, would become one of the most sought supplies and the most difficult to replenish. Gowns, face shields, and foot coverings would follow. Companies (local and statewide) would feverishly work with the FDA to receive approvals for their sterilization tools that would allow N95 masks and other supplies to be cleaned and reused. Cloth masks and face shields would become a requirement to enter the building, both to protect one’s self and others around them. Later, these same cloth masks would be an expectation both in the community and in local businesses.

Tests and test supplies

In the beginning, “Unavailable” would be the descriptive word. Then came “Sparse, ” “long turnaround time,” and “only test the most symptomatic.” Providers and community members were frustrated by the lack of available testing for everyone. Turnaround times ultimately improved from 1-2 weeks, to less than a week, then later to 24-36 hours, and then finally an in-house test available in 45 minutes. Testing continues to be limited to this day.

Shutting things down

For a community hospital that thrives on providing elective services to both serve the community’s needs and to pay the bills, the Covid pandemic, in boxing terms, had us both literally and figuratively “on the ropes.” Elective surgeries, canceled. Physician clinics, while they remained open, had very little volume. Elective imaging and lab services, canceled. Therapies, unless post-surgical or crucial to the patient’s future health, canceled. If the healthcare needs weren’t coming through the Emergency Department or the OB Department, they probably weren’t getting done. For the community, this meant that healthcare visits and procedures were being postponed or canceled altogether. For CHWC, it basically meant that we were paying the bills out of our savings.

The “shutting down” also applied to non-essential businesses within the community and also to travelers as stay-at-home orders were given by the state government. The economic impact and isolation that the hospitals had been experiencing were now a factor everywhere, to community members and businesses alike.

“Kiddy City” – A daycare out of nowhere

Non-essential businesses were being shut down around the state and nation, which included daycare facilities. For hospital “essential” workers, that meant their kids now had nowhere to go while mom or dad went to work. For hospitals, that meant a staff shortage unless we could get creative. Even before the state of Ohio began a temporary approval process for daycare facilities, CHWC was working on innovative ways to create our own solution. “Kiddy City” would emerge from an empty building on our hospital parking lot, mainly due to the energy and vision of a few dedicated employees. The hospital would have been far more challenged from a staffing perspective were it not for this home-grown solution. Kiddy City also allowed for employees who worked in departments with decreased patient volumes to be repurposed to help out at the daycare center.

Creating a “Covid Unit,” & Overflow Units

For CHWC’s county, initial models showed a potential surge of over 100 Covid+ patients. For the CHWC facility that was an unfathomable number, especially with the current facility setup. Countless hours and sleepless nights led to the creation of a Covid Unit within the hospital. A formerly-closed patient unit was reopened. Adjustments were made to make the unit negative pressure. Surgery anesthesia machines were relocated. Vents, supplies, and air tanks were found and bought. Donning and doffing spaces were created. An elevator was isolated and designated as “dirty” for Covid patient and staff transport. Tele-health equipment was purchased and installed to help minimize risk, computer systems were modified, the staff was trained, and the list goes on. We were learning and planning “on the fly,” and the only available teachers were those facilities that were ahead of us in terms of caring for the Covid+ patients.

But the Covid unit alone wouldn’t be enough. For the surge models predicted, CHWC would also end up converting the Ambulatory Care Unit to accommodate Covid+ patients, and even preparing the PACU unit for additional patient overflow. Patient bays were converted to handle two patients instead of one, which included modifying the oxygen, monitors, other equipment, and adding a second patient cart. The unit was modified to make it negative pressure, and changes in the computer system needed to be made to account for the additional patient beds. Pharmacy medication carts were also identified and altered to serve the new patient area. Space was tight, but it was the only way to accommodate the number of patients predicted to hit the facility.

Weeks 8-9

Another Covid Unit

The initial modeling numbers had recently changed. Drastically. This meant that CHWC needed to shift our design not only to treat any Covid+ patients that were sure to arrive but also to prepare to open back services that had been closed and get back to some semblance of “normalcy” for overall patient care. Ramping “up” for the expected surge, that luckily hadn’t occurred at this point, involved a lot of adrenaline and quick actions based on limited knowledge of the disease. The more we learned, the more we had to course-correct and change what had been built. Now, we needed to decide how to ramp “down” a bit and figure out how to open up our services while still dealing with the Covid disease that we knew wouldn’t be going away anytime soon. We hoped to do it with less adrenaline and more knowledge and planning based on what we had learned during the initial phases. Some major changes needed to occur, including the moving of the primary Covid unit to another floor, which would create many questions as to how/why/when/etc. We had to remind staff (and ourselves) to be patient and forgiving. It was frustrating to build something only to tear it down and build something else, but it was what made the most long-term sense, especially since the surge modeling numbers radically changed. We ended up splitting our existing Telemetry unit into a negative-pressure Covid unit on one side, and regular Telemetry on the other. The units previously created weren’t wasted time or effort however, and could be put back into operation quickly if needed.

Opening Things Back Up

After almost two months of only providing services that were absolutely necessary, the thought of opening back up elective surgeries and outpatient procedures was a breath of fresh air for everyone – community and hospital employees alike. Doing so would mean a “wading into the water” approach rather than a cannonball, since the patient backlog would need to be triaged and scheduled by the providers and the various departments. However slow it was, it was a change in the right direction of getting back to providing the care that everyone needed. And, in light of the time and energy that Covid had consumed over the past two months, anything close to “normal” was like seeing the sun for the first time after a week of storms.

Week 10

Here we are today, May 15th..

Here we are today, May 15th. Basically the end of the tenth week for us since the wheels really started turning in March. Quarantines and isolations have been in effect for almost two months; schools moved to online classes, graduations have been canceled, restaurants, bars, theaters, and many businesses have been closed seemingly forever. We’ve witnessed both hopeful and tearful accounts of what this foul, real, virus can do to people both in our county and in the surrounding areas. We’ve also witnessed what our magnificent CHWC family can accomplish together, along with the strong and generous support of our community. These are things that we’ll never forget and are hopefully lessons that will stand the test of time.

The last ten weeks have been filled with unprecedented frustrations and challenges to the healthcare industry and surrounding communities. Tears, anger, despair, and countless other emotions have been evident. But, so have some very positive emotions and interactions. As I write this, community businesses have partnered to provide lunch for the entire hospital staff today. This is one of many times where this has occurred over the past weeks. Yesterday, there was a flyover to honor healthcare workers everywhere. Community members, businesses, and even vendor partners have reached out wanting to know how they can help, whether it be by making a donation, making cloth masks or simply putting a sign in their yard about supporting healthcare workers. For as ugly as this virus can be, it’s comforting to know that it has also brought out a very attractive, supportive side of our staff, community members, and stakeholders…