For Methodist COVID-19-WING workers, everything has changed
For Methodist COVID-19-WING workers, everything has changed during pandemic
On a Friday afternoon, registered nurse Alan Strickland, one of the head nurses on Methodist University Hospital's COVID-19 floor, moved around his unit, checking on patients and consulting other nurses, some of the same things he might have done in the Medical Intensive Care Unit he previously worked in.
But on the COVID-19 floor, everything is different, not the least of which is how sick the patients are and how quickly patients' conditions can change.
“COVID patients do not have a lot of reserves,” Strickland said. “They are fighting, and when they crash, they crash quickly.”
The pandemic has presented unique challenges and prompted changes across the entire Methodist Le Bonheur Healthcare System. Every patient and worker who comes into the hospital is screened and has their temperature taken. Patients are not allowed visitors. Masks have to be worn at all times, and social distancing is enforced as much as possible in common areas and the emergency department.
Whole wings of Methodist University have been set aside for COVID-19 patients — the highest number of concurrent virus patients the hospital has had is 60 — and High-efficiency Particulate Air filters have been installed in the rooms in those areas.
Treatments used on patients change frequently as more research is done and as medical professionals treat more patients, become more familiar with the virus, see in practice what works and what doesn't. Some commonplace ac
tions, like rotating a patient, have to be done manually rather than with a specialized bed that can do it automatically.
On top of all that, the virus itself is unpredictable, Strickland said. He's seen patients with comorbidities come in as acute patients and recover well, and he's seen young healthy people in critical condition.
For people who have COVID-19 and get sick enough to be in ICU, “we don't really have anybody on low settings anymore. It's all very high acuity,” said registered nurse Hunter Delk, who, with Strickland, helps coordinate the nursing staff in the 48-bed universal COVID-19 unit, which houses acute, ICU and ICU stepdown patients.
A whole new floor
Six months ago, the sixth floor was another hospital floor, barely distinguishable from those above or below it. In the spring, when Methodist first started to receive a trickle of COVID-19 patients, it started to group them together on the floor. As the virus spread through the community, sickening more people and leading to more hospitalizations, two walls were built, sealing off the ever-growing COVID-19 unit from the elevators that led to the rest of the hospital.
On the elevator side — the cold zone — wire racks holding rows of paper bags filled with military-grade N-95 respirators line the hallway leading from the elevator bay to the first wall. The hospital hasn't faced personal protective equipment shortages since the beginning of the pandemic, said Jennifer Nitschmann, chief nursing officer at the hospital. But the hospital does try to reuse things when it's safe to do so, so the respirators are put in the paper bags to hang up and dry out until their owners return for their next shift.
A greeter sits at a desk in the cold zone, noting everyone who comes in and out of the unit and handing out the PPE necessary to proceed — a gown, an N-95 and a surgical mask to go over it, as well as gloves and a face shield for those interacting with patients.
The warm zone, a sort of COVIDWING purgatory that connects the hot zone behind the second wall with the world outside, prevents air from flowing out of the patient area into the hallway beyond. And once they're in the hot zone, the 15 to 20 nurses working with the COVID-19 patients at Methodist University stay there, in their PPE, for the next 12 hours.
“Coming into the COVID unit, you're gowning up, you're masking up, you're gloving up and this is for the entire shift,” said COVID-19 wing director Gladys Harris. “It makes it a lot more challenging just to deliver your everyday patient care.”
Personal, professional adaptations
Harris said almost everything has had to be rethought on her wing. The personal protective equipment required to keep medical workers safe is uncomfortable and hot, so she had to figure out how to keep nurses hydrated during their shifts. They can't leave the wing during their shift, so a cold zone break room was created at the northeast corner of the wing — with its own warm zone in between — for nurses to be able to eat.
Gatorade is brought up for them and lunch is sometimes brought in for them, either ordered by the hospital or donated by local restaurants that want to show their appreciation. A second break room, which is still a hot zone where workers cannot doff any of their PPE, sits at the northwest corner of the wing, in what used to be a family waiting room. The corners were chosen as break rooms for their wall-to-wall windows since the COVID-19-WING workers can't go outside during their shifts, Nitschmann said.
Working on the COVID-19 floor also takes a mental toll on the personnel who staff it, some of whom have volunteered to work all their shifts there since the hospital received its first virus patients, Harris said. And the mix of care levels in the unit — acute, ICU and stepdown patients — makes caretaking complex.
Dr. Andrew Pierce, one of the physicians who sees COVID-19 patients at Methodist University, said as the pandemic has continued, it was still unclear how effective some of the treatments used at the beginning of the pandemic are, but that as they treat more patients, they've become more assertive with some of the treatments they've seen success with.
“We're more aggressive with some of the things we were more tentative with at first. Specifically steroid therapy, antiviral therapy,” he said.
Starting treatment early, and getting a better understanding right away of the status of the patients as soon as they're admitted, has been essential, he said.
“These patients go down hard and go down fast. If you let them slip through the first 24 hours and you don't realize just how sick they are when they walk through the door, then you really get behind,” Pierce said.
He also spends more time with COVID-19 patients than he would with others. As a doctor, he said his normal routine would be to check on patients in the morning, consult with the nurses and then he might not see that patient again until the next day.
“But you've got to see these patients a couple times a day, I think, in order to catch when they're going up and going down,” Pierce said. “The nurses are awesome but there are only so many of them and they've got however many more patients to take care of so these patients, they need an extra eye looking at them a couple times a day.”
‘There’s a long way to go’
COVID-19 has impacted the hospital even outside of the dedicated treatment areas. Dr. Kelinda Ramsay, a physician at Methodist-north Hospital, said many people were putting off routine healthcare or not presenting in the emergency department out of fear of the virus.
For many of these patients, their conditions steadily worsen, and they end up needing more intensive care, leading to longer, more complicated hospitalizations and a higher risk of a poor outcome, Ramsay said.
“While the COVID cases are down, our ICU bed availability is smaller,” she said. “Those are not COVID patients that are sitting in those beds. Those are our chronic medical patients that are so exacerbated that they are requiring an intensive care unit.”
As of Sept. 1, there were 84 COVID-19 patients hospitalized across the Methodist Le Bonheur Healthcare system, 41 of whom were in the ICU, down from 101 total patients and 50 in the ICU a week before. However, there were 15 ICU beds available system-wide that day, down from 24 the week before, Ramsay said, adding the number of available beds constantly fluctuates based on multiple factors.
Each day at 5 p.m., leaders from all the system's hospitals talk about everything from those patient numbers to supply chains and look at COVID-19 data from the community as a whole, said Roland Cruickshank, president of Methodist University Hospital.
He said hospital staff has learned and adapted over the past six months and as a collective, from medical workers to the custodial staff to food services, they have supported one another and done what needed to be done to keep the hospital functioning each day.
They watched what happened closely in New York City and learned from that. They monitored Centers for Disease Control and Prevention guidance closely and learned from that.
But everyone remains concerned about what the future holds, Cruickshank said, concerned about what could happen after Labor Day weekend, during football season and as the school year continues on.
“People can fall into a false sense of security. There's a long way to go,” he said. “But we have learned. I'm optimistic.”