On May 6, Augusta Health initiated a carefully thought-out plan to resume its elective outpatient services such as diagnostic imaging, diagnostic cardiology procedures, elective outpatient procedures and non-emergency surgeries in three phases.
Reopening of these services and moving from one phase to the next is dependent on several factors: The prevalence of COVID-19 in the community and the hospital, the stock of PPE and other medical supplies, the availability of COVID-19 tests, and physicians and staff. A dashboard of statistics tracking testing, patient volume, PPE volume, number of positive cases and other markers was created to monitor all the indicators easily and consistently.
Using the dashboard tool, Augusta Health staff can determine if the phased re-opening can continue and progress, or detect a developing surge of COVID-19 cases that would indicate the number and types of procedures should be scaled back
Keeping Patients Safe
"We've been very diligent and deliberate about developing a plan that will work to keep our patients and staff safe and healthy while providing the services that many people in our community need," says Shawn Craddock, DNP, RN, CNOR, NE-BC, Administrative Director of Surgical Services who is leading the team working on re-opening and resumption of services. "In addition to monitoring our dashboard, we are compliant with all social distancing guidelines for waiting rooms and masking of patients and staff. We are also maintaining visitor policy restrictions and the separate, negative pressure Respiratory Care Unit to care for COVID positive and pending patients apart from the general patient population."
What has happened during Phase I?
"Phase I, which began May 6, included procedures that do not require sedation or intubation of the patient, additional PPE, or COVID-19 testing of the patient prior to the procedure," explains Craddock. "So the first outpatient procedures resumed were Imaging studies and exams such as LDCT lung cancer screenings, mammograms, x-rays, CTs, MRIs, ultrasounds and nuclear medicine; as well as cardiology services such as echocardiograms, vascular ultrasounds, stress tests, our Cardiac/Pulmonary Rehab program and the Device Clinic."
Also in Phase I, the Center for Cancer and Blood Disorders resumed routine follow-up visits, the volume of patients being seen by Augusta Medical Group providers increased, the Pain Clinic resumed its procedures and the Skilled Nursing Floor and Inpatient Rehab Floor re-opened.
So far, the dashboard has stayed on "green" and the departments involved in Phase I are encouraged by the safe resumption of services.
Diagnostic Imaging now schedules more than 200 imaging exams each day, more than doubling the number of exams since May 6.
"We've worked with the HICS (Hospital Incident Command Structure) team and our Patient Access department to spread our exam schedule out a bit so we can practice social distancing and keep our patients safe," says William Rader Dod, Director of Radiology. "We are limiting the number of patients in our registration area to practice social distancing, and limiting the physical time patients are inside the department. In addition to cleaning between patients, both patients and employees are masked."
Dod adds that the Imaging schedule was operating at 50% capacity, but is now moving to 75-85% of capacity as indicated by the dashboard.
Cardiology has also implemented the hospital-wide policies for masking of patients and employees, coordinating scheduling and registration of patients to limit time in the hospital, practicing social distancing and robust cleaning of patient areas.
"We are scheduling at about 80% capacity for echocardiograms, vascular ultrasounds, Cath Lab, EP (Electrophysiology) Lab, Device Clinic and Cardiac/Pulmonary Rehab," reports Daniel Grantham (RT)(R)(MR), MBA, Director of Cardiovascular Services. "We are ready to go to 100% now, and look forward to welcoming back all our patients soon."
In the Center for Cancer and Blood Disorders, radiation and chemotherapy treatments for active cancer patients never stopped. Routine follow-up visits for patients past treatment have resumed now. This is an additional 25 to 30 patients per day, bringing the Center back to its pre-pandemic patient services and volumes.
"We are still working diligently to keep our patients and staff safe, as we have during the entire pandemic response," says John Girard, Administrative Director of the Center. "Maintaining social distancing and masking standards is very, very important for us because our patients' safety is critical. We've continued the limitation on visitors and family members coming to appointments. We don't like to say 'no', and hope everyone can understand this is important to keeping everyone safe."
Patients are still checked-in curbside outside and personally escorted to their appointments, eliminating the waiting room for the Center for Cancer and Blood Disorders. "We've also added an additional screening question," says Mary-Kate DePriest, MSN, RN, OCN. "Because testing is more prevalent now, we ask if the patient has ever been tested for COVID-19."
Throughout the pandemic response, Augusta Medical Group medical practices continued to provide both acute and follow-up patient visits. The implementation of telehealth technology allowed an innovative option to help physicians meet the needs of patients who required immediate attention safely, through remote visits, without compromising their care.
"Telehealth visits will continue as an option when appropriate," says John Mack, PA, Chief Operating Officer of Augusta Medical Group. "However, we recognize that to ensure the health and wellness of our patients and community, in-person visits are also essential. In compliance with state and local restrictions, Augusta Medical Group is prepared to welcome patients, where appropriate, back to our practice locations. The Centralized Scheduling Center (833-AHC-HLTH) is once again available to assist patients' with all your scheduling needs."
"We've developed a playbook to help guide our offices with policies and practices for social distancing and infection control to ensure the safety of our patients," adds Mack. "A key policy for ensuring the safety of all is that anyone who presents with respiratory symptoms, or makes an appointment for respiratory symptoms, will continue to be referred to the Respiratory Assessment Center in Waynesboro."
With all options—both old and new—now available to patients, the Augusta Medical Group physician offices continue to see a steady increase in patient visits.
Ready for Phase II?
The week of May 25, with dashboard indicators favorable, Augusta Health enters Phase II, which includes procedures that require pre-procedure testing of the patient for COVID-19. The pre-procedure COVID-19 testing began the week of May 18 at the Waynesboro Assessment Center Drive-Thru.
The Phase II procedures include Outpatient Surgery, Endoscopy, Cath Lab, Sleep Lab, and Inpatient and Outpatient Invasive Radiology Procedures.
"Social distancing in both Augusta Health and the community are keys to keeping the indicators strong and continuing to meet the criteria for advancing the phases," says Craddock. "It's important for everyone to help keep those who have been waiting for healthcare avoid exposure to COVID-19 and cause further delays. Keep patients—and each other—safe and healthy!"