Pandemic Perspective: Be Prepared

As COVID-19 crept into the United States early this year, Washington state was the first to feel the true impact. In a recent webinar, Kim Petram, Director of Case Management at Valley Medical Center near Seattle, shared her perspective and first-hand experience of combating the virus and caring for her community.

Her largest takeaway? “Be prepared” and she offered tangible steps that she and her organization took to manage the outbreak from the beginning, including:

Targeted population analysis and action

Kim states: “by April, we knew that we had to support all of the community, not just our patients…” Moving quickly, Valley started working on building datasets to analyze where our hot spots were across our geographic catchment area; this analysis allowed them to start mapping and assessing total cases tested including positive cases.”

vmc analysis 2

“Data comes from a variety of sources including Valley’s data warehouse and Seattle King County Public Health sources. The light blue on this graphic reflects the totality of testing that was completed on this date.  We also started mapping where all of our shared living sites are which overlap the COVID status data…”

“We also started mapping using discrete data other elements including community members with English as a second language and demographic cohorting by zip code. vmc analysisSo, the example there is, marking circle 54, that has the black square around it, is demonstrating that zip code area. And then, we can break it down by gender, age, ethnicity, primary language, etcetera, helps us figure out how we were going to go out and support the community, and try and keep them as healthy and supported as possible without entering our system.”

Take care of your staff

According to Kim: COVID-19 “has had a significant impact on the community, and internally the no-visitor policy also impacted us greatly. Quite a bit of moral distress with our staff, managing very, very sick patients who could not have family with them even if they were dying. It changed the dynamic of how we were managing care.” The teams and staff at Valley Medical Center relied on one other for support throughout the initial outbreak and beyond. “We were working together with all King County hospitals to make sure no one entity was moving towards crisis standards of care. With most hospitals, while our census was dropping, our acuity was rising and the CCU census was often overwhelmed; we were continually trying to figure out ways to decompress,” said Kim. Working together as a community, and not in isolation was a key metric to the success of King County in keeping the overall surge managed.

Turn to your strategic partners

Kim outlined several key relationships that have supported her team throughout this time: her payer partners, her hospital association, and the collaborative care network created by the University of Washington.

According to Kim, payers have “really stepped up to the plate to assist with [discharge planning], between the CARES Act from the federal side to our own Washington State Initiatives. We have a very strong Washington State Hospital Association here. They took point on working with our Health Care Authority, which manages our Medicaid plans…” The “Washington State Hospital Association, was helping with very difficult-to-place patients, trying to knock down barriers of how we can move them out of our acute care system. Again, everyone was just continually looking at throughput, trying to keep that open, trying to keep [us] decompressed. And, to do that, we had to be moving patients continually through the system. In all, there was some great collaboration going on with the payers.”

Furthermore, the “University of Washington has designed a post-acute care network of, skilled nursing facilities, home health agencies, and home care agencies that meet certain standards to be considered in our network. Leaders within this PAC network were quickly mobilizing to start testing and surveillance work at these sites. … We also stood up a Valley [Medical Center] rapid response team made up of nurses and providers that were going into facilities to do testing and clinical support. Additionally, mobile test vans were being established. It became clear that it takes a village to manage this, no one entity can do this work in isolation. We also quickly aligned with other resources in the community, including Seattle King County Public Health, Washington State Department of Health, and our fire departments.

When crises strike, take stock of which organizations, individuals, and assets you can lean on to help learn and do.

For the future, it all comes back to preparation

Kim’s sentiment is echoed often: “Most hospitals across the country were not ready for what was coming… we’re [now] trying to prepare every which way we can…” When looking to the future, she recommends “managing the community, tracking the community for hot spots and outbreaks, treating residents that live in shared living environments that enter the ED system  as presumptive positive and doing the work necessary that will help keep all community members safe and well supported,