Heeding the call

Southside hospitals face COVID-19 head on
By Jon Shoulders  //  photography submitted by Johnson Memorial Health

As health care facilities nationwide deal with the novel coronavirus that has spread worldwide, leaders from southside hospitals say their teams have adjusted, accommodated, altered and adapted in several ways to take care of affected southsiders.

“It’s a stressful time for those involved in the care of patients, especially since there’s such an important issue of keeping those caring for patients healthy themselves: preventing exposure to the virus and taking it home to their families,” says Dr. David Dunkle, chief executive officer for Johnson Memorial Health.
Dunkle says early social distancing measures throughout the county and state have paid off in keeping emergency room and intensive care unit populations at manageable levels.

“Early on, some of the predictive models looked dire for Indiana because it was based on past reported data on bed availability and ICU bed availability especially,” Dunkle says. “But what a lot of organizations have done around here is increase the capacity for ICU beds. With a lot of the larger hospitals — especially with surgery centers and that kind of thing, with elective surgeries being canceled — a lot of the ventilators used in those surgery centers were redirected to the main hospitals to potentially ventilate COVID-19 patients requiring aid in breathing.”

Christopher Doehring, vice president of medical affairs for Franciscan Health, says leaders at his hospital began taking appropriate measures and planning against potential supply shortages back in early March, when suspected COVID-19 cases first appeared in Indiana.

“We started refreshing everyone on the use of appropriate protection right away and updating fit testing for our respirator masks,” he says.
Anita Capps, hospital administrator and chief nurse executive for Community Hospital South, says one of the staff’s biggest challenges in the early stages of preparation for a patient surge was determining appropriate placement of non-COVID patients.

“On the front end of this, we had quite a few patients come in that were what we call rule-out patients, that we tested and had to wait for results on,” she says, adding that Community Hospital South, like most other hospitals across the state and country, canceled elective surgeries and procedures early on to free up as many hospitals beds and as much equipment as possible.

“From a nursing perspective, we began looking at where to place patients so that we are cohorting appropriately and managing resources around our personal protective equipment — goggles, face masks, gowns and so forth,” Capps adds. “We started looking from a clinical perspective at how we isolate patient populations to keep the other patients safe.”

Doehring says personal protective equipment shortages, including N95 respirators and surgical masks, have not been an issue thus far at Franciscan, and hospital leaders have implemented several initiatives to extend supply availability.

“Some of us who have friends and colleagues in areas that were hit very early told us to conserve supplies,” he says. “At Franciscan our supply chain folks did have some significant stockpiles in advance, so we’ve not had any critical shortages of the primary components of PPE. We do have day-to-day challenges around things like hand sanitizer, cleansing wipes, lab test kits and some medications. We’re adapting every day.”

A new wing at JMH was slated for an official April opening this year prior to the pandemic, and when the first COVID-19 cases reached Indiana, JMH leaders decided to fast-track the opening of a new emergency department, essentially providing the hospital with an isolation wing, on a separate air-flow system, capable of accommodating up to 28 positive COVID patients.

“The emergency department was actually slated to be the last part of the expansion that was completed, but as we started hearing about COVID cases in Indiana and around the country, we decided that we had the ability to pivot on our plan and put all our efforts into finishing the space that was meant to be an emergency department,” Dunkle says. “It allowed us to protect staff and other hospitalized patients in our main hospital building.”

Later this year Dunkle and his fellow JMH leaders will reassess an official opening date for the remainder of the JMH expansion, which will include an outpatient center with state-of-the-art lab and radiology services.

Dunkle says that while JMH has not experienced PPE shortages, the hospital has suffered from a dearth of certain drugs used to keep patients on ventilators, specifically propofol and fentanyl.

“The thing that has kept me up at night is not masks and gowns, it’s drugs and people,” he says. “Some of it gets into where hospitals need government help. During the opioid crisis, a lot of the manufacturers were given annual allotments of how much they could produce. Hospitals are trying to get their hands on as many of these drugs as they can, and there just isn’t much out there circulating.”

Dunkle says the most helpful measures the public can take to aid hospitals in the coronavirus fight is to rigorously follow the guidelines set forth by the Centers for Disease Control and Prevention.

“We have to continue to take social distancing seriously, wash our hands regularly and not touch our faces,” Dunkle says. “We’re seeing that these things work. Also, we could not be more grateful for the support the community has shown to the staff of Johnson Memorial. We’ve received countless donations of supplies and food for frontline workers. It’s been amazing to see such outstanding support.”

During the month of March, several local volunteers began sewing and donating cloth masks for southside hospitals, including Community South, which Capps says has helped both her staff and patients.

“There are groups of people in the hospital who don’t actually need the N95 masks, and it’s wonderful because our patients can wear these cloth masks when appropriate, and I wear one as an administrator walking the hallways,” Capps says. “The outpouring of the community with donating masks for us has been really wonderful and overwhelming. Residents out in the community should put masks on if they need to go out for necessity runs to a pharmacy or grocery. This will help us minimize the spread of this virus and get back to the normal life that we’re missing.”

Doehring sees a silver lining to the coronavirus situation, in that hospitals across the nation will likely be better prepared in the future for similar situations.

“I have no doubt that many hospital systems across the country will change and adapt after this is over, to be ready,” Doehring says. “The same goes for local, state and federal governments. We’ve been through dry runs with this kind of thing over the last 10 or 15 years with Ebola and H1N1, but a lot of places I think let their preparations fall by the wayside a little bit. The upside now is that I think most areas will be much more prepared in the future.”

Photo: Johnson Memorial Health nurse Laura Stafford wears a powered air purifying respirator.