COVID PATIENTS HEADED TO ESCONDIDO HOSPITAL
Transfers will help ease pressure on other facilities in Southern California
“Now we have the ability to make what is, essentially, a regional COVID surge hospital right here inside the medical center.”
With hospitals throughout Southern California increasingly overwhelmed by COVID-19 patients, and another surge linked to holiday activity expected to arrive this month, plans to help take the pressure off have continued to evolve at Palomar Medical Center Escondido.
About 20 COVID-19 patients, possibly from as far away as San Bernardino and Imperial counties, were expected to start arriving Tuesday, occupying beds that recently replaced cots on the facility’s 10th f loor. Though there are now 100 beds available, staffing limitations are expected to keep them from filling immediately though 35 to 40 should hold patients with stable forms of the disease by the weekend.
While bare concrete f loors and exposed overhead utilities make it clear that this remains an unfinished space, it is one that has recently come alive as the state and Palomar Health put the finishing touches on upgrades that, taken together, are expected to allow the facility to serve as a kind of pressure-relief valve for hospitals throughout Southern California.
“Now we have the ability to make what is, essentially, a regional COVID surge hospital right here inside the medical center,” said Diane Hansen, Palomar’s chief executive officer. “It has just been an incredible collaboration.”
Initially filled with row after row of narrow cots, the setup has recently undergone a transformation as discussions with the state Office of Emergency Services evolved in late December.
There has been a concerted effort not just to add beds and increase privacy by separating them with fabric dividers on metal frames but also to make it possible to serve mid-severity COVID-19 cases by expanding key infrastructure into a f loor that has remained “shelled space” since Palomar opened in 2012.
Physical plant workers labored through the holidays, Hansen said, to extend Palomar’s existing built-in medical
Diane Hansen
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Palomar’s chief executive officer
oxygen system to the 10th f loor, running copper pipes up walls, across exposed ceiling girders, then down temporary columns, terminating in ports capable of serving the same kinds of gear used in the rest of the hospital. Information technology workers also doubled down, extending records systems to the space that are necessary to keep track of care that often requires tracking the use of multiple medications and therapies across 12-hour rotating shifts.
“The initial estimate was 30 days just to get IT capabilities here and they were able to do it in three days,” Hansen said.
Now, 44 of the 100 beds have a house oxygen port available, and plans call for additional upgrades as the number of patients increases.
The severe lung inf lammation and damage that is a signature feature of COVID-19 has created a massive demand for supplemental oxygen throughout the state.
Paul Sas, Palomar’s chief administrative officer, said that recent tests showed that there is enough available in Palomar’s oxygen system to keep the pressure up for many more patients in need of supplemental oxygen, even with the hospital already serving about 140 COVID-19 patients Tuesday, a number that is nearly four times higher than the last peak seen in July.
“It’s the same delivery system, the same type of pressure, that you have in the rest of the hospital,” Sas said.
The first 10 or so patients to spend the night in the unit started arriving on New Year’s Eve.
Stacy Lower was allocated a bed on Friday after arriving with gall bladder problems that turned into pancreatitis.
Traveling up the elevator to the 10th, she said, she expected to see a standard hospital hallway, and was momentarily taken aback by the
industrial feel of the space. Settling in, though, she said that the care has been up to snuff.
“It’s not what anybody would expect, but the nurses have been amazing even though they’re getting used to it as well,” Lower said, reclining in her bed Tuesday afternoon after walking several circuits with her IV pole in tow.
But Tuesday was the last day for patients like Lower who do not have COVID-19 diagnoses. Starting that
afternoon, Palomar expected to start receiving only COVID-19 patients, generally cases deemed stable enough to not require electronic monitoring and able to walk on their own.
Mel Russell, Palomar’s chief nursing officer, said that the idea is to remove patients with less-demanding needs from overburdened hospitals throughout Southern California, freeing up space for those facilities to further expand their already-overburdened intensive care units.
The key, Russell said, is to bring in those patients who are not likely to end up needing ICU-level care. Doing so would just end up f looding Palomar’s already overfull intensive care unit though Hansen added that discussions are already underway about adding ICU capacity within the federal medical station.
“We’re in constant communication and collaboration with the transfer center to identify patients that will be the best fit,” Russell said.
Hansen was careful to note that none of what has grown at Palomar would have happened without state and federal funding and the cooperation of Dr. Dave Duncan, director of the California Emergency Medical Services Authority. Locally, she added, Dr. Nick Yphantides, the county’s chief medical officer, and Dr.
Kristi Koenig, the county’s medical director of emergency services, were linchpins in bringing the facility to Palomar and in helping its operating plan evolve as the reality on the ground has changed.
“They had the foresight to bring in the asset and have it ready, even though it sat empty for many, many months,” Hansen said.
Meeting the current and future COVID-19 demand is not just about having enough beds.
Staffing is often the limiting factor that decides just how many patients can be served simultaneously. Hansen said the state has allocated 47 staff for the unit, including nurses, respiratory therapists and even environmental services workers. Palomar also has contracts in place, she added, for an additional 50 nurses who started arriving for duty on Monday.
Staffing the unit, though, is not like f lipping a switch. After workers arrive, they must be introduced to the facility and oriented to how Palomar’s systems work before they can begin filling shifts. For this reason, the unit’s treatment capacity will not start at 100 but will gradually grow as additional staff are brought on board and oriented.
For now, the original cots installed by the state in April continue to occupy Palomar’s 11th floor. At the moment, Hansen said, it is not clear exactly what will happen up there.
“At this point, we’re focusing on spinning up the 100 beds on the 10th,” Hansen said. “Depending upon where the numbers go by mid-January, then we may activate that 11th f loor.”