Like many organizations, hospitals regularly create detailed contingency plans for various crisis scenarios—and then hope they never have to use them. If a crisis does occur, however, such plans enable decision-makers to meet challenges more effectively, rather than inventing responses “on the fly.”
Sentara RMH Medical Center has multiple emergency plans in place to help staff respond to a variety of crisis situations, including mass-casualty events, severe weather, information systems downtime and other disruptive events. In addition, hospital physicians, nurses and other clinicians are well trained in how to handle infectious and dangerous pathogens.
So in many respects, Sentara RMH wasn’t caught off guard by the onset of the novel coronavirus. The challenge presented by COVID-19 instead primarily was due to the fact that there were so many unknowns about the virus as it first struck.
Working with the Sentara system’s crisis-management team, Sentara RMH began putting processes and infrastructure in place to address the pandemic, even as the public began hearing initial media reports about the coronavirus. One of the first things administrators did was assemble an incident-command team to guide the hospital’s response, in accordance with guidelines established by the Centers for Disease Control and Prevention (CDC) and the Virginia Department of Health (VDH).
Before the first COVID patients presented to the hospital, an early priority for planners was to set up logistics to handle COVID-positive and COVID-suspected patients, in order to keep them separated from non-COVID patients. With this goal in mind, the Sentara RMH Facilities Management team set up two tents outside the Emergency Department (ED) to serve as screening sites for all ambulatory patients coming to the ED.
“This allowed us to triage patients safely at the start of their emergency visit,” says Donna Hahn, DNP, RN, NEA-BC, vice president of acute care services and chief nurse executive for Sentara RMH. “Patients would be greeted outside the ED entrance by a team member who would ask them a series of screening questions about symptoms, travel history and other COVID-related details.”
If the patient’s answers were consistent with potential coronavirus infection, they were directed to the tents, where a second team member in full personal protective equipment (PPE) would ask more detailed questions to determine if the patient should be tested for COVID-19.
Inside the hospital, several nursing units were converted into units capable of safely caring for COVID-positive and COVID-suspected patients. Sentara RMH also began preparing for a predicted surge in COVID patients, which, thankfully, has not materialized as of this writing.
All Sentara hospitals, including Sentara RMH, quickly established dedicated respiratory units for inpatients who tested “presumptive positive” for COVID-19, and for those awaiting test results. High-risk or confirmed COVID-19 patients whose symptoms required hospitalization were cared for in individual patient rooms within these dedicated respiratory units.
The Sentara RMH nursing team began planning immediately to cross-train and credential nurses to work in COVID units, or to work in other units where they were not normally assigned. Jill Delawder, DNP, RN, APRN, ACCNS-AG, CCRN-CSC, manager of patient care services, nursing education and staff development, led the staff development education team to provide the training.
“We redeployed staff from the procedural areas—where patient volumes had decreased due to canceled elective surgeries and other procedures—and cross-trained them to work in the inpatient units in preparation for a surge of COVID-19 patients,” says Delawder. “We assessed their current skills and competency levels and then held skills classes to provide the additional training and hands-on experience they needed.”
Redeployed nurses also spent time on the units with a preceptor to gain additional skills and competence, notes Delawder.
Other Notable Changes
The limited availability of COVID-19 testing has been a concern for caregivers and others from the beginning of the pandemic. To help address this issue, Sentara Norfolk General began conducting in-house testing in its labs early on. Not long after, Sentara RMH also began providing some limited in-house COVID-19 testing.
Personal protective equipment (PPE) and other supplies have been managed carefully during the COVID-19 crisis. Although there was a nationwide shortage of PPE, especially in the first weeks of the pandemic, Sentara hospitals were able to meet staff needs through conservation, sanitization and reuse programs, as well as thanks to the many generous donations from providers and others in the community.
After the U.S. Surgeon General recommended postponement of all elective surgeries and other procedures—to protect patients and staff, and to help preserve precious PPE—Sentara RMH quickly complied.
Following directives of the CDC, the VDH, Sentara Healthcare and Virginia Governor Ralph Northam, Sentara RMH also began restricting visitation in the hospital, with only a few exceptions.
In addition, many Sentara RMH office staff team members began working from home, and nearly all meetings since have taken place by conference or video calls.
Keeping Spirits Up
Open and frequent communication has been a key factor in the hospital’s successful response to COVID-19. For the first two months, Chief Nurse Executive Donna Hahn and Vice President of Medical Affairs Anthony Bruno, MD, sent daily emails to all staff to provide the latest information about a multitude of topics—including facts about the virus and how to treat patients; tips on how to protect the public, patients and staff from getting COVID; and updated policies and procedures. Similar communications also came several times a week from the Sentara corporate incident-command team in Hampton Roads.
Many of these messages contained words of encouragement and pointers on how to cope with the stress of the pandemic. Hospital chaplains have put their expertise to work as well, stepping up to address the emotional and spiritual needs of both staff and patients. A great sense of urgency—and the recognition that “we are all in this together, and together we will get through it”— have helped Sentara RMH staff members handle the immense anxieties of their work.
As Hahn, Dr. Bruno and others have reminded staff on multiple occasions: “We are in a marathon, not a sprint.”
Even as the urgency that accompanied the early weeks of the pandemic has lessened and society reopens incrementally, the Sentara RMH team remains vigilant, continuing to hone plans for handling any future spikes in numbers of COVID patients, and providing compassionate and effective care to patients and their families.