Dr. Misty Navarro discusses how the SVMH Emergency Department is a safe place to come if you're having a medical emergency during the COVID-19 Pandemic.
Learn more about SVMHS Podcast - Ask The Experts
Selected Podcast
SVMH Emergency Department Care During COVID-19 Pandemic
Featuring:
Learn more about Misty Navarro, MD
Misty Navarro, MD
Misty Navarro, MD is an ER Physician at Salinas Valley Memorial Hospital.Learn more about Misty Navarro, MD
Transcription:
Scott Webb: Despite COVID-19 concerns and confusion. The emergency room is still the safest place to be if you are a critically ill or injured. Joining me today to help emphasize this point is dr. Misty Navarro, an Emergency Department Physician at Salinas Valley Memorial Hospital. This is Ask the Experts. A podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Dr. Navarro, thanks so much for joining me today. During this COVID-19 pandemic, hospitals are seeing a drop in ER visits and people are putting off getting critical treatment. Is this happening at Salinas Valley Memorial Hospital? And if so, why do you believe it's happening?
Dr. Navarro: It's not only happening at Salinas Valley Memorial Hospital, it's actually happening at multiple emergency departments across the country and even just in our surrounding area. Our volume has been off by somewhere between a third to almost half of what we would normally see this time of year. And you know, we've looked at the surrounding hospitals, their volumes are equally off, and so it's not like our patients are seeking care elsewhere. They're just not seeking care. And our belief is that the reason this is happening is because people are just afraid to come to the emergency department. They're worried that they're going to get Coronavirus or they worry that perhaps we're overwhelmed, which at this point we're not. It's concerning because strokes and heart attacks, diabetes complications, infections, they're still happening. People still need care, but they're just delaying seeking that treatment and when they're coming in they're much sicker. You know, I've had patients coming in short of breath for a week that are in respiratory failure or infections that maybe started off minor that progressed rapidly. You know, patients who have been writing out their heart attacks at home and coming in and heart failure. So it's concerning as an emergency physician when I feel like people are afraid to seek care and by the time they're coming in they're just much sicker.
Host: Yeah, that is concerning. I know the emergency department is open and safe. Can you talk about the safety precautions in place and how everyone is wearing proper PPE?
Dr. Navarro: So when you come to the emergency department as a patient, you're initially greeted by what's called a quick look nurse outside the emergency department, that nurses in full PPE and we'll screen you for what symptoms that you've come to the emergency department for. If you're minimally symptomatic and you're presenting for testing because you're concerned that you've been either been exposed to someone with Coronavirus or traveled to a high risk area. Those patients we're trying to actually keep in their car, and test and screen them from there. If they have symptoms but they're stable, they're relatively young, they look well, those patients are being directed to our alternative care site for treatment. And inside this alternative care site, the nurses and the providers, the doctors, the physicians assistants, are all in personal protective equipment. Now if you're presenting to the emergency department and you have a non respiratory complaint like abdominal pain or chest pain or you know, cellulitis leg infection of some sort, those patients are being directed to what we call our clean side of the emergency department, which are non respiratory complaints.
And if you are an elderly patient with multiple medical conditions and you are having, you know, respiratory symptoms, something that might be concerning for coronavirus, those patients are being massed and then taken into a room where they can be isolated on our respiratory side. So we are taking precautions to try to segregate out patients. We're, you know, fully cleaning many, many, many times per day the emergency department, all of our staff are, you know, in PPE for every patient interaction. You know, the level of PPE varies. You know, if you're collecting a swab to test for Coronavirus, you might be in a more enhanced PPE than say if you're just examining a patient that was coming in with abdominal pain. But we did Institute a universal masking policy at our hospital, so everyone can feel safe and protected, patients and staff.
Host: Yeah, there's no doubt it's about protecting the patients and the hospital staff. I know you guys have multiple testing sites including drive up testing. Let's break that down for people.
Dr. Navarro: Like I said, if you are coming for screening to be tested and we still aren't able to test a hundred percent of the people that are coming, but if you are a high risk worker, you know farm worker, fire, police, working in a grocery store where you're interacting with the public, and you've been exposed or you have some mild symptoms and are concerned that you have Coronavirus, those patients are being moved sort of to the top of the line for testing. But if they're not having a lot of symptoms, those patients are being screened and if they need to be tested, they're staying in their cars. If they are having some mild symptoms, maybe they need a little bit of treatment, but they're relatively stable as we would say. Then those are going to our alternative care site, which is the tents that we have set up outside of the emergency department. So we're testing there, we're testing in the cars, but we're actually also testing patients in the emergency department. We do have a limited number of a rapid test for Coronavirus, but those are usually for admitted patients. So we can try to figure out how to cohort them in the hospital. So there we're keeping all of the patients that are either positive for Coronavirus or concern for Coronavirus on together in a cohort. And this helps, you know, the staff know if the patient has the Coronavirus and also just to protect our workers and the patients.
Host: Absolutely. You guys are really on your game between the drive up and screening and alternative sites and even testing inside, you know, the emergency department. That's really amazing. You know, Dr. Navarro, I read your Facebook post encouraging people to seek care if they need it. Can you tell us about the critically ill patients that you're treating and why it's so important for you that they get this message, that the safest place to be if you're critically ill is the hospital, right?
Dr. Navarro: Yes. Like I was saying, I noticed that although our volumes have been off, that what we call our, the acuity or how sick someone is went up dramatically. You know, I'm putting in more central lines and more breathing tubes in patients and putting them on ventilators then I would on a normal shift and, it's because patients are waiting longer to come in. That difficulty breathing that they would have called an ambulance for and come into the emergency department. Now they're writing that out for a couple of days at home or the chest pain in a patient who's had a heart attack before or maybe has diabetes or high blood pressure or other risk factors. They're just kind of riding that out at home. So because they're afraid to come in because they don't want to get Coronavirus, their likelihood of dying from their underlying illness, their infection, their stroke, their heart attack is far higher than their risk of dying of Coronavirus. And so I was trying to send a message out to my community and I luckily have a lot of friends across the country and across the world that were able to share this post because they're seeing the same thing all across the United States. And probably in other countries as well, where patients are delaying care and coming in sicker almost to the point where it's a lot harder for us to treat them because the disease has progressed beyond what we would normally see presenting to an emergency department. You know, and my concern has always been, you know, for my patients. I love what I do and I want to take care of people and get them healthy and save lives. I mean, that's why I signed up to go into this. So it was really just a plea to kind of share that information out there with the general public.
Host: Well, I read it and I thought it was really effective and I know that many others were moved by it as well. And I just love your perspective on all of this. And I think I know the answer to some of these questions, but, right. We still want people to call 911 right? We don't want people driving themselves to the ER, do we?
Dr. Navarro: No. And you know, the EMS is also protecting themselves. So when you call 911 the dispatcher is screening for respiratory symptoms so that EMS can be protected. They're cleaning their rigs, you know, between patients and decontaminating everything they're wearing personal protective equipment so that they don't expose, you know, patients if they've got, you know, little cough or sniffle and maybe they have some mild symptoms. You know, they're monitoring their temperatures, you know, before they go on shift. Everybody's doing what they can to protect patients from getting this but also protecting themselves, you know. And so yes, it's still safe to call 911. And you know, if a patient is having concerning symptoms and they just don't know whether or not they should go to the emergency department, primary care providers are still available, you know, our healthcare system has moved to a lot of televisits or video conferencing, or even just a phone call where you know, your primary care physician, if you're on the fence can help you decide where you should best seek care.
Host: Yeah, it does seem that the whole country, the whole medical system had to pivot really quickly that telemedicine, telehealth, you know, has been kind of inching along for awhile, you know, but now it's become almost mandatory, especially with, you know, primary doctors and you're so right. Whether it's FaceTime or Zoom or an old fashioned phone call, a lot can and should be done, you know, electronically now. Right?
Dr. Navarro: I actually think that this is great and this is, I think this is probably one of the good things that's going to come out of this Coronavirus pandemic is that there's been, you know, an inching towards telemedicine in the past. But you're right, we've absolutely pivoted on this and to good results. By being able to get a provider in front of a patient quicker, you know, you decrease the burden to the patient, you decrease the burden to the system, to the insurance companies, to the hospitals. I mean it's a win, win, win for everyone. I recently had a follow-up visit, you know, for my ankle and I had surgery back in November and my doctor is up in San Francisco and I, you know, saved myself a two hour drive each way for a 15 minute visit by doing it over telehealth. So I really feel like there's a big role for telehealth in the future of medicine and we will see things change drastically once the dust settles.
Host: I think you're right. If there is some good that can come out of this, it's that, you know, just limiting this to healthcare. But when you look at education as well, you know, being prepared, accepting, being creative about how we can do things. Just because we've always done them a certain way doesn't mean that there isn't a better, more efficient way to do that. And I think right now, doctor, the biggest thing is getting people to maintain, you know, their mental and their physical health. What recommendations do you have for that? Just even you personally, you know, you have to go to work every day. You're on the front lines every day. How are you doing it and how do you recommend the rest of us sort of stay mentally and physically connected and, well?
Dr. Navarro: I will tell you my recipe. So I'm not only an emergency physician, I'm also a mother and a wife. I have two boys, nine and 11, who I'm homeschooling with some assistance from their teachers, but still the print of it is falling on myself and my husband, you know, so we make sure that we have at least 30 minutes of time outside getting fresh air, whether it's in the backyard, taking a walk, going for a bike ride. We also make sure that we have another 30 minutes that we have social time. So, you know, a video call with friends or family. You know, my children have a daily Zoom set up with their buddies to play video games or chess or online UNO, you know, there are still ways to connect socially to make sure that you're still staying connected. I actually probably talk and see my friends that live around the country more now than I did before, which is great. It's a wonderful thing to come out of it.
Exercise, make sure that I get exercise every day. I'm very fortunate that I have a Peloton at home that I ride almost every day. And then, you know, maintaining a good diet. I know it's hard when that constant snacking urge when you're at home, but you know, making sure that you have good food in your house, it's an opportunity to learn something new, whether it's going on YouTube and figuring out how to cook something or craft something or fix something. You know, I unfortunately am not one of those people that has lots of downtime, but you know, I've been encouraging my friends, Hey, this is maybe a time to learn something new. At the end of the day, you just have to remember to breathe. It's going to end at some point. You know, we don't know when and that's what makes it so scary and so difficult, but it's going to end and we will come out of this stronger on the other side. I'm very confident of that.
Host: Yeah, definitely. And you're so right. Like I've been doing things that I never would've done before. My daughter taught me how to make cake pops because Starbucks is only open a limited amount of time and we don't want to leave the house. So what do we do? We made cake pops and they were amazing. No offense to Starbucks but they were so good. And you know, I posted on Facebook, I'm like, you know, dad and daughter cake pop makers, you know, it's, it's really there has been some good that's come out of this for sure. You know, before we close here today, Doctor, I want you to just, you know, kind of put a period at the end of the sentence. Tell everybody once again why it's so important. If they think they have COVID-19 come and get screened, get tested and whether they have COVID-19 or not, if they are critically ill, if they're suffering, if the best place for them to be is the emergency room, the emergency department, please come right. Let me hear it in your words.
Dr. Navarro: Yes. So I just want to assure everyone that if you have an emergency, you should come to the emergency department. We are there, we are ready to take care of you. We are prepared. We have been preparing for this our whole careers. And if you know, if you're unsure, call your doctor. They're there for you too. We are all across medicine there for our patients. We want to promote health, you know, mental health. Whatever you need, there is a provider that you can get in contact with. And if you have an emergency, come to the emergency department. Please let us take care of you.
Host: Well, Dr. Navarro, I really appreciate your time today. Thank you so much for being on. I don't use this word often, but I've been using it a lot during this time that you know you heroes on the front line. We needed all of you to be safe, to be protected. We need to know that if we go to Salinas Valley Memorial Hospital that things are safe and everybody's well and protected and that there's a process in place for all of this. And every time I talk to one of the doctors there including you today, I always feel a little bit better because I'm like, you know what? They're really on their game. They've got this worked out, they're open, they're safe. If I need to go, I can go, and I should and it's awesome. Thank you so much, Dr. Navarro. To get regular updates and information about COVID-19 visit SVMH.com/Coronavirus. And we hope you found this podcast to be helpful and informative. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb: Despite COVID-19 concerns and confusion. The emergency room is still the safest place to be if you are a critically ill or injured. Joining me today to help emphasize this point is dr. Misty Navarro, an Emergency Department Physician at Salinas Valley Memorial Hospital. This is Ask the Experts. A podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Dr. Navarro, thanks so much for joining me today. During this COVID-19 pandemic, hospitals are seeing a drop in ER visits and people are putting off getting critical treatment. Is this happening at Salinas Valley Memorial Hospital? And if so, why do you believe it's happening?
Dr. Navarro: It's not only happening at Salinas Valley Memorial Hospital, it's actually happening at multiple emergency departments across the country and even just in our surrounding area. Our volume has been off by somewhere between a third to almost half of what we would normally see this time of year. And you know, we've looked at the surrounding hospitals, their volumes are equally off, and so it's not like our patients are seeking care elsewhere. They're just not seeking care. And our belief is that the reason this is happening is because people are just afraid to come to the emergency department. They're worried that they're going to get Coronavirus or they worry that perhaps we're overwhelmed, which at this point we're not. It's concerning because strokes and heart attacks, diabetes complications, infections, they're still happening. People still need care, but they're just delaying seeking that treatment and when they're coming in they're much sicker. You know, I've had patients coming in short of breath for a week that are in respiratory failure or infections that maybe started off minor that progressed rapidly. You know, patients who have been writing out their heart attacks at home and coming in and heart failure. So it's concerning as an emergency physician when I feel like people are afraid to seek care and by the time they're coming in they're just much sicker.
Host: Yeah, that is concerning. I know the emergency department is open and safe. Can you talk about the safety precautions in place and how everyone is wearing proper PPE?
Dr. Navarro: So when you come to the emergency department as a patient, you're initially greeted by what's called a quick look nurse outside the emergency department, that nurses in full PPE and we'll screen you for what symptoms that you've come to the emergency department for. If you're minimally symptomatic and you're presenting for testing because you're concerned that you've been either been exposed to someone with Coronavirus or traveled to a high risk area. Those patients we're trying to actually keep in their car, and test and screen them from there. If they have symptoms but they're stable, they're relatively young, they look well, those patients are being directed to our alternative care site for treatment. And inside this alternative care site, the nurses and the providers, the doctors, the physicians assistants, are all in personal protective equipment. Now if you're presenting to the emergency department and you have a non respiratory complaint like abdominal pain or chest pain or you know, cellulitis leg infection of some sort, those patients are being directed to what we call our clean side of the emergency department, which are non respiratory complaints.
And if you are an elderly patient with multiple medical conditions and you are having, you know, respiratory symptoms, something that might be concerning for coronavirus, those patients are being massed and then taken into a room where they can be isolated on our respiratory side. So we are taking precautions to try to segregate out patients. We're, you know, fully cleaning many, many, many times per day the emergency department, all of our staff are, you know, in PPE for every patient interaction. You know, the level of PPE varies. You know, if you're collecting a swab to test for Coronavirus, you might be in a more enhanced PPE than say if you're just examining a patient that was coming in with abdominal pain. But we did Institute a universal masking policy at our hospital, so everyone can feel safe and protected, patients and staff.
Host: Yeah, there's no doubt it's about protecting the patients and the hospital staff. I know you guys have multiple testing sites including drive up testing. Let's break that down for people.
Dr. Navarro: Like I said, if you are coming for screening to be tested and we still aren't able to test a hundred percent of the people that are coming, but if you are a high risk worker, you know farm worker, fire, police, working in a grocery store where you're interacting with the public, and you've been exposed or you have some mild symptoms and are concerned that you have Coronavirus, those patients are being moved sort of to the top of the line for testing. But if they're not having a lot of symptoms, those patients are being screened and if they need to be tested, they're staying in their cars. If they are having some mild symptoms, maybe they need a little bit of treatment, but they're relatively stable as we would say. Then those are going to our alternative care site, which is the tents that we have set up outside of the emergency department. So we're testing there, we're testing in the cars, but we're actually also testing patients in the emergency department. We do have a limited number of a rapid test for Coronavirus, but those are usually for admitted patients. So we can try to figure out how to cohort them in the hospital. So there we're keeping all of the patients that are either positive for Coronavirus or concern for Coronavirus on together in a cohort. And this helps, you know, the staff know if the patient has the Coronavirus and also just to protect our workers and the patients.
Host: Absolutely. You guys are really on your game between the drive up and screening and alternative sites and even testing inside, you know, the emergency department. That's really amazing. You know, Dr. Navarro, I read your Facebook post encouraging people to seek care if they need it. Can you tell us about the critically ill patients that you're treating and why it's so important for you that they get this message, that the safest place to be if you're critically ill is the hospital, right?
Dr. Navarro: Yes. Like I was saying, I noticed that although our volumes have been off, that what we call our, the acuity or how sick someone is went up dramatically. You know, I'm putting in more central lines and more breathing tubes in patients and putting them on ventilators then I would on a normal shift and, it's because patients are waiting longer to come in. That difficulty breathing that they would have called an ambulance for and come into the emergency department. Now they're writing that out for a couple of days at home or the chest pain in a patient who's had a heart attack before or maybe has diabetes or high blood pressure or other risk factors. They're just kind of riding that out at home. So because they're afraid to come in because they don't want to get Coronavirus, their likelihood of dying from their underlying illness, their infection, their stroke, their heart attack is far higher than their risk of dying of Coronavirus. And so I was trying to send a message out to my community and I luckily have a lot of friends across the country and across the world that were able to share this post because they're seeing the same thing all across the United States. And probably in other countries as well, where patients are delaying care and coming in sicker almost to the point where it's a lot harder for us to treat them because the disease has progressed beyond what we would normally see presenting to an emergency department. You know, and my concern has always been, you know, for my patients. I love what I do and I want to take care of people and get them healthy and save lives. I mean, that's why I signed up to go into this. So it was really just a plea to kind of share that information out there with the general public.
Host: Well, I read it and I thought it was really effective and I know that many others were moved by it as well. And I just love your perspective on all of this. And I think I know the answer to some of these questions, but, right. We still want people to call 911 right? We don't want people driving themselves to the ER, do we?
Dr. Navarro: No. And you know, the EMS is also protecting themselves. So when you call 911 the dispatcher is screening for respiratory symptoms so that EMS can be protected. They're cleaning their rigs, you know, between patients and decontaminating everything they're wearing personal protective equipment so that they don't expose, you know, patients if they've got, you know, little cough or sniffle and maybe they have some mild symptoms. You know, they're monitoring their temperatures, you know, before they go on shift. Everybody's doing what they can to protect patients from getting this but also protecting themselves, you know. And so yes, it's still safe to call 911. And you know, if a patient is having concerning symptoms and they just don't know whether or not they should go to the emergency department, primary care providers are still available, you know, our healthcare system has moved to a lot of televisits or video conferencing, or even just a phone call where you know, your primary care physician, if you're on the fence can help you decide where you should best seek care.
Host: Yeah, it does seem that the whole country, the whole medical system had to pivot really quickly that telemedicine, telehealth, you know, has been kind of inching along for awhile, you know, but now it's become almost mandatory, especially with, you know, primary doctors and you're so right. Whether it's FaceTime or Zoom or an old fashioned phone call, a lot can and should be done, you know, electronically now. Right?
Dr. Navarro: I actually think that this is great and this is, I think this is probably one of the good things that's going to come out of this Coronavirus pandemic is that there's been, you know, an inching towards telemedicine in the past. But you're right, we've absolutely pivoted on this and to good results. By being able to get a provider in front of a patient quicker, you know, you decrease the burden to the patient, you decrease the burden to the system, to the insurance companies, to the hospitals. I mean it's a win, win, win for everyone. I recently had a follow-up visit, you know, for my ankle and I had surgery back in November and my doctor is up in San Francisco and I, you know, saved myself a two hour drive each way for a 15 minute visit by doing it over telehealth. So I really feel like there's a big role for telehealth in the future of medicine and we will see things change drastically once the dust settles.
Host: I think you're right. If there is some good that can come out of this, it's that, you know, just limiting this to healthcare. But when you look at education as well, you know, being prepared, accepting, being creative about how we can do things. Just because we've always done them a certain way doesn't mean that there isn't a better, more efficient way to do that. And I think right now, doctor, the biggest thing is getting people to maintain, you know, their mental and their physical health. What recommendations do you have for that? Just even you personally, you know, you have to go to work every day. You're on the front lines every day. How are you doing it and how do you recommend the rest of us sort of stay mentally and physically connected and, well?
Dr. Navarro: I will tell you my recipe. So I'm not only an emergency physician, I'm also a mother and a wife. I have two boys, nine and 11, who I'm homeschooling with some assistance from their teachers, but still the print of it is falling on myself and my husband, you know, so we make sure that we have at least 30 minutes of time outside getting fresh air, whether it's in the backyard, taking a walk, going for a bike ride. We also make sure that we have another 30 minutes that we have social time. So, you know, a video call with friends or family. You know, my children have a daily Zoom set up with their buddies to play video games or chess or online UNO, you know, there are still ways to connect socially to make sure that you're still staying connected. I actually probably talk and see my friends that live around the country more now than I did before, which is great. It's a wonderful thing to come out of it.
Exercise, make sure that I get exercise every day. I'm very fortunate that I have a Peloton at home that I ride almost every day. And then, you know, maintaining a good diet. I know it's hard when that constant snacking urge when you're at home, but you know, making sure that you have good food in your house, it's an opportunity to learn something new, whether it's going on YouTube and figuring out how to cook something or craft something or fix something. You know, I unfortunately am not one of those people that has lots of downtime, but you know, I've been encouraging my friends, Hey, this is maybe a time to learn something new. At the end of the day, you just have to remember to breathe. It's going to end at some point. You know, we don't know when and that's what makes it so scary and so difficult, but it's going to end and we will come out of this stronger on the other side. I'm very confident of that.
Host: Yeah, definitely. And you're so right. Like I've been doing things that I never would've done before. My daughter taught me how to make cake pops because Starbucks is only open a limited amount of time and we don't want to leave the house. So what do we do? We made cake pops and they were amazing. No offense to Starbucks but they were so good. And you know, I posted on Facebook, I'm like, you know, dad and daughter cake pop makers, you know, it's, it's really there has been some good that's come out of this for sure. You know, before we close here today, Doctor, I want you to just, you know, kind of put a period at the end of the sentence. Tell everybody once again why it's so important. If they think they have COVID-19 come and get screened, get tested and whether they have COVID-19 or not, if they are critically ill, if they're suffering, if the best place for them to be is the emergency room, the emergency department, please come right. Let me hear it in your words.
Dr. Navarro: Yes. So I just want to assure everyone that if you have an emergency, you should come to the emergency department. We are there, we are ready to take care of you. We are prepared. We have been preparing for this our whole careers. And if you know, if you're unsure, call your doctor. They're there for you too. We are all across medicine there for our patients. We want to promote health, you know, mental health. Whatever you need, there is a provider that you can get in contact with. And if you have an emergency, come to the emergency department. Please let us take care of you.
Host: Well, Dr. Navarro, I really appreciate your time today. Thank you so much for being on. I don't use this word often, but I've been using it a lot during this time that you know you heroes on the front line. We needed all of you to be safe, to be protected. We need to know that if we go to Salinas Valley Memorial Hospital that things are safe and everybody's well and protected and that there's a process in place for all of this. And every time I talk to one of the doctors there including you today, I always feel a little bit better because I'm like, you know what? They're really on their game. They've got this worked out, they're open, they're safe. If I need to go, I can go, and I should and it's awesome. Thank you so much, Dr. Navarro. To get regular updates and information about COVID-19 visit SVMH.com/Coronavirus. And we hope you found this podcast to be helpful and informative. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well, and we'll talk again next time.