Hospitals, including DCH Health System locally, have worked since spring to meet the continuous challenges of caring for patients infected with Covid-19 and respond to a tremendous public health crisis.
Hospitals have established testing sites and are treating countless patients. They have purchased additional personal protective equipment, ventilators and therapeutic medications. They have added intensive care unit bed capacity and have developed Covid-19 units to isolate and treat patients with the virus while safeguarding the health of other patients and hospital staff.
Paul Betz, DCH Health System’s chief operating officer, sat down last week with Dr. Richard Friend, dean of The University of Alabama College of Community Health Sciences, to talk about the impact Covid-19 has had on DCH.
Friend: How many hospitals does DCH Health System have?
Betz: We have three hospitals. We have the regional medical center here in Tuscaloosa, a 583-bed regional referral center that cares for about 350,000 people in the West Alabama region. It has a certain array of services spanning open heart surgery, a Level 2 trauma center, a Level 3 neo-natal intensive care unit and a battery of radiation and medical oncology services. We also have Northport Medical Center four miles to the north (of DCH Regional Medical Center in Tuscaloosa), a 204-bed facility that has a couple of unique services – an inpatient rehabilitative unit and North Harbor Pavilion, where we have in-patient behavioral health services. Our third campus is located in Fayette, Alabama. We manage that 61-bed facility, and it is one of the two top hospitals of that size in the state. Associated with it is a 122-bed nursing home facility, along with other services – home medical equipment and home health services.
Friend: How have you adapted since Covid-19?
Betz: My role on a day-to-day basis is to make sure we’re working proactively and re-actively to meet any challenge that may present itself to the operations of our organization. In some ways, the pandemic has not really changed my role, although it has become quite intense at times.
Friend: I know there is a lot of anxiety and fear in communities about going to hospitals now, during Covid-19. Can you describe what safety protocols are in place at DCH Health System?
Betz: When this pandemic started to affect our community and our hospital, we were quick to put into place some different things. One was a limited visitation policy, and that remains in effect today. We put in a universal masking policy so that everyone who comes into the hospital – employees and those visitors who come to see other patients – must wear a mask. We take temperatures at all the doors (of the hospital). But probably the most important thing we’ve done is work to protect our staff, not only to protect their health but also to protect the (potential) spread (of the virus) between individual patients. So, we have protocols in place that provide them with the proper equipment and supplies they need to protect themselves and their patients.
Friend: What are some of the challenges DCH Health System has faced with Covid-19, and how have you overcome them?
Betz: One of the things that we’ve worked hard to do throughout this whole event is to try and be as open as possible with the community and the public. We’ve worked very hard to talk about the daily impact on our (hospital) bed capacity by publishing the numbers that we have, and other information that may be affecting our operations. That has created some challenges at times because we’ve had to explain the complexity of hospital operations to a lot of different people. But I think it’s been well accepted, and I have heard good reviews and feedback.
Friend: I’ve worked at all three campuses (of DCH Health System) and I’ve always been impressed with the patient care and the commitment of the staff and administration to make sure that resources and beds were available and that the staff was well trained and protected. Other than the obvious Covid-19 pandemic, why are (patient) volumes high at DCH?
Betz: Being a regional referral center, there are hospitals throughout West Alabama that don’t have the services we provide. So, there’s always been a fair amount of pressure on the beds and the needs for our services and specialists that we have within our organization. Even before Covid-19, we had certain pressures on our beds for ICU (intensive care unit) needs that continue during the pandemic.
Friend: When we dial up the news every night, we see the decline in ICU beds in certain hotspots, currently Texas and Florida. And you and I know, being involved in hospital care for so long, that it’s not uncommon for (ICU beds) to be full. What kinds of things has DCH Health System done to assure that there’s going to ICU beds and ventilators available when people need them?
Betz: Back before the onset of the pandemic, we actually were in the process of buying more ventilators. Luckily, we had 22 arrive in March, new ventilators with new, sophisticated technology. What that allowed us to do was keep the ventilators we already had and add to our capacity. So, we’ve got 80 ventilators in-house right now, and we have not needed nearly as many as we have. So, that’s a good thing. The other thing that we’ve done, up until this point and we continue to work on this, is where we can place patients in the hospital. We have identified different units, and expanded ICU beds, by adding negative pressure technology to various rooms around the hospital so that we can care for these types of patients in those rooms. That has been very beneficial, and we use those (rooms) on a regular basis and we’ll continue to use more. The challenge that we really have is around staffing. We have to continuously work to recruit staff to come in and to be able to provide the care for these (Covid-19) patients.
Friend: Testing is another issue, and DCH really took the lead with testing in the community. What’s going on with testing at DCH? Who are you testing and how many are you doing a day?
Betz: We have done 25,000 tests since (the pandemic) started. We’ve seen a conversion rate to positive (for Covid-19) of about 13% of those tests. We’re doing testing in a lot of different areas throughout the hospital, obvious ones like the Emergency Department and inpatient setting. We’ve brought different platforms online since we’ve started with varying capacity. The largest capacity platform we have right now is called Panther and it has the ability to run up to 3,000 tests per month. We’ve brought online some (rapid result) testing and that has given us the ability to have a quicker turnaround. We’re actually using that in our Emergency Department, and we’ve implemented that at our Fayette campus as well. One of the advantages of having that technology at that point of entry for our organization is that it allows the patients who are positive (for Covid-19) to be placed in the appropriate units inside the hospital the first time. We don’t have to move them around within the facility after we get test results back. So, the sooner we know the results about whether they’re positive or negative gives us the ability to manage them from the outset on a much more efficient basis.
Friend: Does every patient who comes into the Emergency Department get a Covid-19 test as a precaution? Or is it just those patients who are admitted to the hospital?
Betz: Just those who are symptomatic.
Friend: DCH has instituted universal masking, which seems to be working well for those organizations requiring and enforcing it. We are working hard to ensure the UA campus has universal masking. Are there any updates on masking protocols?
Betz: We have no plans to change that (masking policy). In fact, we think that is probably one of the most important aspects of safety that we’ve put into place to control or manage the spread of the virus amongst our staff. The majority of the cases that we see are coming from the community. That’s why we need to emphasize, and that’s why DCH supports, while understandably difficult, public policies that are being put in place to try and manage the spread of this virus in the community.
Friend: What about personal protective equipment? Costs have gone up and it’s hard to get certain items. What kind of experience is DCH having with this?
Betz: It’s changed over time. When (the pandemic) first started, we experienced a disintegration of the normal supply lines for our personal protective equipment. It got very concerning there for a while. Thank goodness the community rallied around the hospital and our organization by making masks, which we were very grateful for. Our staff was very grateful for them. That was an effective tool while we were rebuilding supply lines and getting in enough amounts of personal protective equipment for our staff and patients.
Friend: We know there have been a lot of positive (Covid-19) cases, and there’s some new therapeutics on the market – Remdesivir and Dexamethasone. What kind of access to you have to those medications?
Betz: I’ve been really proud of our medical staff. They have been able to research and keep up to date on the types of treatments and methods that are most effective for our patients and they have been able to implement them. They’ve used different plasma protocols and certainly have access to Remdesivir. All of that seems to be going well at this point.
Friend: And outcomes have been positive with those treatments?
Betz: From what I understand. We’ve actually discharged more than 600 patients that have been positive for Covid-19 inside our hospital since all this started. That’s a real positive.
Friend: Let’s talk a minute about flu season. What challenges do you see for the hospital with flu season and Covid-19 going on at the same time?
Betz: We anticipate that it will add extra strain, but I think the things that we are doing currently will help get us ready for that (flu season). We continue to recruit the staff that we need for all levels of care in the hospital. We continue to work on establishing beds, whether that’s medical surge or ICU beds, and new levels of care throughout the hospital. I think if we continue to do those things we will be as best positioned as possible for the challenges ahead.
Friend: UA students will be back in full swing August 19 when classes start. We are already seeing some of our residential students moving in on campus. From an epidemiological standpoint, many students won’t get sick. Many of them will be asymptomatic or not even know they have the virus. It’s really vulnerable folks who will need to be protected. What are your thoughts about students coming back? What kind of challenges do you think the student population will bring?
Betz: It is concerning. It is on our mind. I think the impact that our organization and our community is going to feel is going to be indirect. They (students) will be asymptomatic, although they will be carriers. The more that they can use masking, social distancing and washing their hands effectively will help protect those around them. It will help protect faculty and elders they may come in contact with out in the public, and it will help control and manage as best as possible the spread of the virus.
Friend: You have articulated very well from March on that DCH has adapted, adjusted and met the challenges from Covid-19. What do you see as challenges in the future for a virus with a time frame that’s really unknown?
Betz: We will continue to take a look for bed options within our hospitals. There’s a lot of square footage and a lot of places we can put patients in the hospital. Staffing is probably the bigger concern. We continue to work very hard and diligently on recruiting staff as quickly as possible to come in and take care of patients. We can take care of patients in a lot of different areas (in our hospitalist) as long as we have staff in place. I will also say that I have great confidence in our teams, our medical staff and our clinicians at the hospital that they will rise to the occasion with whatever challenge is presented. They have done so through their diligence and their willingness to help in any way they can. I have no doubt that we will meet whatever challenges we are faced with in the future.