Play Podcast Download Podcast

Transcription:

Scott Webb: This podcast was recorded on December 14th, 2020. Although the region has been hit hard by the coronavirus, news of vaccines arriving and the resilient spirit of healthcare workers and residents, are providing some light at the end of the tunnel. And joining me today to discuss the vaccines and what we've learned about the virus so far, are Salinas Valley Memorial Healthcare System President and CEO, Pete Delgado, and Carla Spencer, she's the director of Emergency Services and Associate Chief Nursing officer at SVMH.

This is Ask the Experts, a podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. And Pete and Carla, so great to be back on with you. Just wish we weren't talking about COVID-19 again, but we're also talking about shipments of the coronavirus vaccine arriving in California, which is exciting. And plans are currently underway for the vaccination of healthcare workers and the most vulnerable in the community. So, Pete, what do we want the community to know about the vaccines and what do we need to keep doing in order to eradicate COVID-19.

Pete Delgado: Because of technology advances, we've got a vaccine that's about 90 to 95% effective. I mean, that is huge. The regular flu is about 60% effective. And so that's a huge advancement and a very high effectiveness was gives us the confidence that we've got the right vaccine. And what we want everyone to do, is keep doing what they're doing, washing their hands frequently, wearing a mask when out in public, social distancing, and not gathering with people outside of their own home.

Scott Webb: So, Pete, what have we learned as a healthcare system about the Coronavirus in the last 10 months? We've learned a lot. There's still a lot we don't know, but what have we learned so far?

Pete Delgado: This virus is sneaky, nasty, and sometimes deadly, but it can be outsmarted. It is unpredictable. And then Carla can respond to the clinical implications.

Carla Spencer: Like Pete said, it is a very sneaky virus. If I think back and I know Scott, we had early on when COVID-19 started, I think one of the first podcasts we did, was you and I, and thinking back to that time, and now we've learned so, so much. However, we've also learned that, it is not as straightforward as we thought it would be at the beginning. And where we were looking at just a few signs and symptoms for COVID, that really, morphed to something much larger. At this point, what we know is anybody that comes in the door could have it. So, we've changed a lot of our practice, with our staff, just to make sure that we are practicing the utmost safety for our staff, for our patients. And so we've just learned a lot over the last 10 months, regarding the virus alone and have tailored our practice to what we know.

Pete Delgado: The organization as a whole, I think we've learned a lot that remote work does work for some departments and not so much for others. As we tried to test out different modes of getting the work done. For one thing, we learned that management needs to have boots on the ground, to properly manage, mentor, direct and inspire the frontline folks that really need the attention.

Scott Webb: Definitely. And I was just thinking back Carla, to that first one that we did and how much we thought we knew and then came to realize, we didn't know. Pete, in these last 10 months, what are some of the changes the hospital has had to make to better support staff and community?

Pete Delgado: Looking at the work that needs to get done, a number of the departments are working remotely in it, and we're finding that we're getting the work done. The business office, the accountants, and a lot of the nonclinical functions can be done remotely. And then we've introduced new types of activity to help reduce stress. We've introduced tranquility rooms available to all the staff, just to give them some time for quiet time and a break from work. Psychologists are now proactively rounding on the nursing units to talk to staff, to help them through some of their challenges on the unit and at home. You got spiritual providers and having a proactively rounding on the nursing unit, staff and physicians, both have access to counseling services because it is a very taxing and very intense services. And, after nine or 10 months, so, without any end in sight, it is exhausting, but fortunately

Scott Webb: Yeah, it is good to see that light off in the distance there at the end of the tunnel, the vaccine. Everybody's excited about that. Carla what have been some of the changes in the processes in the Emergency Department that you've had to make, whether it's medical procedures, visitor restrictions, just the patient experience?

Carla Spencer: It's been challenging. I can speak for both the Emergency Department and the inpatient areas. It's so difficult when we have people in the hospital and their family members can't be with them. And this has been so hard on the staff as well, because we know as caregivers that your family is half of your support while you're there. And so, we've had to overcome challenges with that. We've put into place iPads so that family members can talk to their loved ones on the iPads and, just doing Facetime, utilizing WebEx. We've done all kinds of different things to keep that communication with our patients and their family members. It's definitely been difficult. Naturally even in certain circumstances, we do let family members in just depending on what's happening. But overall that's been a hard thing, I think for healthcare in general, because most hospitals had to limit visiting for obvious reasons.

And we worked through that. And, the last, probably I'd say three, four months has all been focused on the staff resilience, like Pete said, and he spoke very well about what we have been doing, but the staff have seen good. And they have seen bad. And, unfortunately once patients are hospitalized and on ventilators, the mortality rate is very high, which means that we do oftentimes see people die and it wears on staff because we have these patients in house for many weeks and the staff get attached and it's a very difficult thing. So, we've been focused on resilience with our staff and also doing event based, debriefs if a patient passes. So, doing things like that.

The other thing we've been focused on not only in the Emergency Department, but in the inpatient side, which is really, coming to light now it's surge planning. We had a surge back in July and then it went down, but we didn't even know what was ahead of us until it was here. And so we are, in a significant surge right now. Pretty much happened right after Halloween and we expected to see this. I think people, they want to be with their family and they want to be with their friends. And we've done so much media outreach to get out there and say, please don't do that because it's oftentimes parents and grandparents and people with medical problems that then wind up getting the virus and then wind up having to be admitted. We saw it after Halloween. We definitely saw it after Thanksgiving.

And so, we have a pretty full house. So we're having twice daily meetings with the other hospitals in the County working very close with the Monterey County Health Department, because we are neck deep in the surge right now. And so, that's probably one of the biggest priorities is thinking outside the box. We're going to open a fourth unit, thinking outside the box on how we could staff, where we put different types of patients. So it's just been very busy.

Scott Webb: Yeah, it has. And I know there's been a lot of highs and lows. There's been celebrations when coronavirus patients have gone home and a lot of lows and it's difficult to be resilient. It's difficult to stay focused and stay positive. Cause as you say, patients are there, people get to know them, get to love them. And when you lose patients, it's very difficult, right?

Carla Spencer: Right. And now that we're in this surge is, the staff they've been working so hard for 10 months and people, I think we're all getting tired. Right? And so it's just really keeping our team, taking care of each other, keeping each other safe. These are our big goals right now is keeping each other safe and giving that feedback, resilience and really trying to do everything we can as an organization to keep our staff resilient. That's a big focus of ours right now.

Scott Webb: It really is so true that you and everybody else on the front lines, healthcare heroes. So Carla, during the last 10 months, who's been the most impacted by the coronavirus in terms of age and race in the community. And why is that?

Carla Spencer: We've had patients in their thirties that are on ventilators and patients in their eighties that are on ventilators. It's very difficult to pinpoint one specific group and that's when Pete talks about that the virus is very sneaky. It is very sneaky. And I get asked this question all the time because of what I d o, family members and friends, and they say, well, who's going to wind up in the hospital?

And that's really hard to say, because like I said, we have had patients that have medical problems and are in their seventies and eighties, and that come in and then they're the ones that tend to do bad, but then we've also had people in their thirties that maybe have high blood pressure that have also done very bad. So, it's very difficult to say and pinpoint exactly what it is. I would say, if we had to say our largest subset, I would say is definitely elderly, more elderly people with lots of different medical problems. But you just don't know, unfortunately, who's going to come in the door and who's going to do worse than someone else. So, it’s, it's difficult to tell.

Scott Webb: Yeah. And I think that's why we've all been so eager despite doing all the right things. It's really sneaky. It's like something out of a movie. It's like it's actively been fighting against healthcare workers and scientists and learning along the way. I don't want to be too dramatic, but that's how it

Carla Spencer: feels.

It does. It does. And we know that, there's a certain degree and I think this is what's really difficult for the general population to understand is that there's a certain subset of patients that have very mild symptoms to no symptoms. And then what happens is that they might go to dinner with their parents, or they might go to dinner with a sister who, is, has a lot of health problems and then they pass the virus along and then it's them, their family members who are the ones that get worse. Right? And so it's like a vicious cycle because, and that's why when we talk about and talk with the media and really urge people not to have family gatherings, even if you're gathering with your sister in our family. Right? Which you would think, well, that's immediate family.

I'm thinking, for Thanksgiving it was my husband, my two boys and me, that's it. Right? And we didn't let my mom, my mother-in-law come over, my father-in-law and that's immediate family, but you just gotta be so careful because you don't know if you're one of those asymptomatic carriers and now you've infected somebody who is not going to have the outcome you're going to have. Right? And that's the dangerous part about it.

Scott Webb: And Pete, what has the healthcare system done to reach out to the most vulnerable in the community? That's kind of what we're talking about here is we know that there's a vulnerable population out there. So, what has the whole healthcare system done to reach out to them?

Pete Delgado: Early on when we canceled surgeries, elective surgeries and the clinics were, were not getting the throughput that we were used to, we found ourselves, our volume went down. We found ourselves with about 200 employees, maybe a little bit more that we didn't have enough work for. And we could have done like any other organization that has implemented for a low or whatever, but I know they would not find a job back in April, May and June. And so what we did is we moved them to a call center, just to keep track of those FTEs. And we asked the community, the non-profits if they needed any help, and sure enough, the demand was greater than supply in this case. The Salvation Army, the Senior Citizens, we did some outgoing calls to make sure they were getting their medication. They had a support and the food bank. The AG industry. In this part of the country, there's about 75,000 to a hundred thousand, harvesters come in from all over the world and they live in conditions similar to Manhattan on top of each other and buses that would bus them in and buses busing them out.

It was a prime, a breeding ground for the virus. And so they needed help. And so we deployed nurses and clinicians out to these non-profits and out in the field, they were, there were, our nurses were there at 5:30, 6:30 in the morning, educating the workers before they go in and out in the field, how to keep safe at work and at home. And so obviously in the community, we got good feedback from the community. And of course our employees were very grateful that we were able to keep them on, and providing this service to the community.

We've done that and we done patient testimonial videos to showcase all the good work that we've done, the patient testimonial showcase that's where the rubber meets the road. This is where all the care gets done. And actually the patients are sharing their good stories. We've done social media outreaches in both languages. We've done a lot in the community, which we're very proud and I think it made a big difference in the community.

Scott Webb: And Carla, you mentioned the holidays and how there's been an uptick. And we know after every holiday, we've seen that, an uptake in infections and hospitalizations and with Christmas right around the corner, what are you doing to prepare for the possible explosion of sick people, hospitalizations in early 2021? And how are the clinics preparing?

Carla Spencer: Like I said, we've been really focused on surge planning, so, we are preparing to open our fourth COVID unit. We have three units that are virtually full right now with us also holding patients in the Emergency Department. So, we actually are just about done with everything that we need to do to open our fourth unit. So, we will do that. And the other thing that is probably the most challenging is having enough staff to staff these, to staff the different units, especially as you get more and more intensive care type patients. So, we're not alone. This has been the experience around the country with staffing, especially for ICU.

And what we're doing is taking a very proactive approach on our staffing model. We developed a staffing model that would utilize nurses from other departments that have ICU skills. For example, with us canceling surgeries and elective surgeries, we have nurses that have ICU skills that could potentially help the ICU nurses in the COVID unit. So, what we've spent the last, month or so working on is, what that surge plan is. And then having a plan that if we do get overloaded with patients, what our staffing model look like at different phases. So, we've done a lot of work with the leaders and the staff, done a lot of work around that, so that we're ready if it does continue to explode the way it is now.

And we're just trying to get staff from other areas. We've had nurses that have come out of retirement that used to work in the organization that have since come back, to help us. We've also reached out to some of the area outpatient clinics, surgery centers that have nurses that are ICU trained. So again, just taking a very proactive approach to foresee that we are going to get more patients definitely, and be ready as best we can,

Scott Webb: You know, that the surge is coming right, Pete. And, uh, how are you feeling about everything that your team is doing and preparing for that surge?

Pete Delgado: Our goal of course is to keep our staff and our patients safe. And the more patients with COVID that comes in within the four walls of this hospital, it makes it even more challenging. We are actively looking at some of the floors that can be converted into a COVID unit. You can't just move COVID patients into a med surg unit, because it doesn't have built in negative airflows. Most of them have positive airflows. So, you have to adjust. You've got to put in portable equipment and turn that basic med surg acute care bed into a potentially an ICU bed. And so, there's a lot of infrastructure changes that we've got to initiate and make it safe for the staffing. Carla and the nurse directors have their hands full converting from a staffing ratio that we've been used to for many years into something much more aggressive to handle the patient load.

We've got to be ready to expand because all signs are pointing that we've got to do that. We're communicating, I mean, communication is like number one for all of our employees. If you're not filling in that information that our frontline folks need, they will fill it up with you. And it's usually a lot worse. And so, we gotta be able to convey a well thought through implementation plan, that's safe for them and safe for our patients.

Scott Webb: This is a little bit of a loaded question and we've covered some of this, but I want to give you each a chance to tell us again, what have we learned, during this pandemic? What have we learned about ourselves, our system, the community? I'll have you go first, Carla.

Carla Spencer: I've been a nurse almost 25 years, and I've never been more proud to be a nurse and more proud to work with the team that I work with. You know, the frontline staff and the leaders of this hospital. When we started with COVID, we didn't really know, and we didn't know at all what was ahead of us. And I think that, looking back to where we started and where we are now, it is a very proud moment. And you talked about it, healthcare heroes, and I don't think it's ever been more true than today. And what I would say is that I'm proud to work for this organization. I'm proud to be a registered nurse and I'm confident that we will get through it.

I do see a little, a light at the end of the tunnel and I think it's important for the public and our county and all the surrounding areas to know that our hearts and our passion is here and we will continue to build the infrastructure we need to take great care of our patients and our staff.

And, we'll all get through it. We've said it from the beginning, we'll all get through it and hopefully be able to go back to some normal life and get all our kids back to school. And I think that would be great.

Scott Webb: So, Pete, what have you learned and what's your biggest takeaways from the pandemic?

Pete Delgado: Well, I keep telling our staff that we've got this. This is a challenge professionally, but we've all trained for this. That's why we became a professional nurse, a medical doctor, a lab technician, a lab scientist, we've - we know what we need to do. We just need to make sure that everyone is supporting each other and working as a team. And we're creating a safe environment of which they feel comfortable and working and doing what they know best.

Scott Webb: And Carla, as we get close to wrapping up here, I want to give you a last chance here. Anything else we want the community to know about COVID-19, about the vaccine, about staying resilient? Last word here.

Carla Spencer: We've all gone through a lot and it's been very challenging. It's very difficult to not see your family. And I think just stay the course. I would say, again, we're seeing the light at the end of the tunnel and it's just, it's very important that we all do our part and stay vigilant and we will get through this.

Scott Webb: Yeah, I think you're so right. We will get through this. We will get through this together. And Pete, you, as the CEO, you get the last word. What would you like people to know where you're at, where the system is at? How optimistic they should be about the vaccine? Last word to you, Pete.

Pete Delgado: This year has been tough. And next year, we'll start with lots of challenges, but things will get better. We will get through this by working together and supporting each other. Our healthcare workers need your help. I keep urging people to continue being smart and being safe. We should continue to do that.

Scott Webb: Yeah, here, here. I just want to thank you both for being on. Happy Holidays to both of you and please stay well.

Carla Spencer: Thank you, Scott. You too.

Happy Holidays to you. Thanks

Scott Webb: For up-to-date information on COVID-19, please 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.