Over the past several weeks, the Emergency Department – and much of the CHA Everett hospital – has seemed like a facility devoted entirely to the incredibly stressing task of treating COVID-19 patients, but over the last two weeks the hospital has slowly transformed in many ways back to its pre-virus flows.
For Dr. Melisa Lai-Becker, chief of the Emergency Department at CHA Everett, and her staff in the ER, that has been measured in the number of conference calls per day focused on finding space and beds for those who are sick. At the height, that was a conference call that happened three times a day as the health system tried to find places to take care of the surging patient loads.
On Monday, that transitioned to a once-a-day call – which Lai-Becker said was a big example of how things are moving towards pre-COVID
“For these last two and a half months, we have been talking two times a day and sometimes three times a day the director level staff…in order to figure out how to get patients where they should be for care and transfers. As of Monday, we decided we can now take our foot off the gas pedal and not meet two time a day. Now we’ll meet one time a day and see that that goes. It’s big for us and a turning point in terms of how we’ve now configured our work flows.”
The story of CHA Everett looking back is one of getting ready for the pandemic – wondering if it would be as bad as expected, treating what was a horrendous surge of sick people who struggled to get better or died, a flattening of the curve of sickness, and now a return to some normal patterns while also still treating COVID-19 patients.
“Everything put into place in March and early April, it is nice to see as all the big changes operationally have made a difference because we can let the system handle the flow, especially since having a lull now the volumes are climbing back up quite nicely, but with a medium level of mix,” she said. Now it seems like it’s a more even mixture of patients.”
One clear example of that was a patient who came in last weekend with pneumonia – a nearly 100 percent sign of COVID-19 over the past two months. Lai-Becker said they did all the testing and were perplexed as to why there was no COVID showing up. After some further testing, they realized it was just standard pneumonia and not related to COVID.
“We were like, ‘Wow, it’s just regular pneumonia,’” she said. “So welcome back to just plain old community-acquired pneumonia.”
The hospital has closed down some of the specialty spaces created on the fly for COVID-19 over the past several weeks, and they are looking at returning to elective, but necessary, surgeries. They are also bringing back routine tests like colonoscopies.
“The hospital operations are slowly re-opening,” she said. “As of Monday, they were looking at bringing back certain elective scheduled procedures. We want to keep up with the elective surgeries – maybe they can be done later, but need to be done. It’s also colonoscopies and mammography. These are important and it’s been three months without doing them now. These are having a very slow start-up.”
Likewise, the respiratory clinic has been full-speed for so long now, but they are beginning to add outpatient hours.
At the same time, they are planning on how to return some of the clinical departments. That comes with a lot of planning, she said, about how to handle such visits with providers and how to handle the waiting rooms.
“It’s now a slow unwinding of these processes to see if any outpatient sites can re-open and how does it change the setup,” she said. “It’s similar to what dental offices in the Commonwealth are facing. Everyone wants to eliminate the waiting rooms. That’s going to take careful planning.”
One thing that they are also seeing as they re-open so many things are the new innovations done on the fly for COVID-19 that they hope to keep as part of traditional medical treatments.
Tele-medicine visits have become the norm, and there are a lot of patients that Lai-Becker said will likely continue with those appointments on a screen – particularly as many in the older adult population in large part has become adept at using Zoom and other face-to-face platforms online.
Many chronically ill patients have found the visits to be better for them, as it can be strenuous to get a ride to the hospital for an appointment that can be done over a screen.
Likewise, CHA Everett has rolled out over the last week a new program called MobileHome in association with Cataldo Ambulance. That is a program they have dreamed of and worked on for a long time, she said. With the pandemic, they were able to roll it out fast. That program allows EMTs at Cataldo to do more advanced visits while in connection online with a physician. They can do more than a visiting nurse and can gauge whether a patient needs to be brought into the hospital or not. Using tele-medicine check-ups, and then MobileHome, many unnecessary trips to the hospital can be avoided to make patients more comfortable and medical delivery more efficient. The crux has always been about who was going to pay for it and how would they pay for it, Lai Becker said.
That year’s-long battle was resolved in a matter of weeks.
“I think people will recognize a lot of operational challenges in having these programs with tele-health and para-medicine…were hampered by who was going to pay for it,” she said. “Remarkably, the tele-health visits can be paid. Apparently it is possible to have them both paid for now. That is the opportunity of this crisis. I think they are an enormous positive and they will stay even after…we see so many other things settle out. They are positive changes.”
• Tylenol Antidote Now Goes to Trial
One of the innovations at CHA Everett during the COVID-19 crisis was using the antidote for Tylenol poisoning to treat patients with several sickness related to COVID-19. It particularly helped the immune response in the lungs, and now CHA Everett is going to be moving that treatment to a clinical trial to see if it is an effective treatment for the virus.
They will be going to trial with Clintrials.gov.
“We’re happy that CHA-wide our respiratory clinic is starting to prescribe it in the same manner as the Emergency Department has,” she said. “We will embark on the randomized trial of patients and then share the results. It seem to help…It would be great because it is off-patent, doesn’t cost much and has been around more than 50 years…It’s not very sexy for that reason, but if it works, great.”
She said they would need three months at a minimum, but likely six months to get enough treatment information. Already, they have some information in using the treatment over the last two months, but need more solid study.”
• Large Gatherings a Concern
As the weather lightens up and gatherings seem to increase – in addition to the large-scale protests that have happened in Boston – Dr. Lai-Becker said those in the hospital have had a concern.
That also goes for the gradual re-opening of businesses and services.
“It is a concern and it’s something in the hospital we’ve been paying attention to over the last week,” she said.
She said they will watch over the next two or three weeks to see if new cases arise, and if they can be traced to large gatherings like the protests. She said being that they were outside, there could be some saving grace in that.