Baptist’s Response to COVID-19
James Borders, MD
Chief Medial Officer, Baptist Health Lexington
Baptist’s response to the pandemic was early, aggressive, and coordinated. Leadership meetings included quality personnel, personnel in infection control, nursing administration, and physicians in infectious disease and our hospitalist group along with administration. We took inventory of space, ICU resources, ventilator supply, and supplies of personal protective equipment (PPE). We designated hospital units where COVID-19 infected patients would be placed and developed protocols of patient screening to identify patients suspect for COVID-19. Nursing and allied medical personnel reviewed proper isolation techniques and use of PPE, aided by our nurse educators.
We added a walled off entrance area to our emergency department where patients entering would first be triaged into either a COVID-19 suspect area or into our general emergency room population. Our hospitalist group committed to implementing the screening protocols and to evaluate each patient that was admitted directly or accepted for admission in transfer. We enacted a policy stipulating that all patients admitted directly or accepted in transfers would go to a designated screening unit where a hospitalist familiar with the screening protocol and order sets would evaluate the patient for the likelihood of having an infection with COVID-19. If clinical screening was negative, the patient was allowed to go the floor appropriate for the clinical problem. If screening was positive, a COVID-19 lab test was ordered and the patient was transferred to the unit designated for at-risk patients. We also set up an outpatient exam room near the offices of our obstetricians that they could use in place of their regular offices when pregnant patients known or suspected of having COVID-19 required an office examination.
An early challenge was the lack of a test for COVID-19 that would quickly provide results, forcing us to keep suspect hospitalized patients in isolation for several days, consuming precious resources of personal protective equipment. In recent days, we have procured ample COVID-19 testing that will return results within 24 hours.
Our surgeons met and agreed to postpone surgeries that were considered elective, and our outpatient offices adopted practices meant to reduce the risk of the spread of COVID-19 to include a telemedicine option. Baptist promoted Zoom as the desired telemedicine platform. As Baptist reduced services to save space and supplies for the potential of a surge of COVID-19 patients requiring hospitalization, system leadership decided to reduce executive salaries and furlough a number of Baptist employees not felt to be essential for clinical operations in the immediate future.
With the help and advocacy of Drs. Mark Dougherty of infectious disease and Firas Badin of hematology/oncology, we were able to procure the donation of plasma from a patient who recovered from COVID-19. His plasma was donated at the Central Kentucky Blood Center and was given to two of our patients with adult respiratory distress syndrome (ARDS) on ventilators. We are assessing the results of those donations.
On Mondays, Wednesdays, and Fridays, an hour update of all COVID-19-related news and activities is held. While the focus is on care at Baptist Lexington, physicians and other healthcare workers throughout the Baptist system are invited to call in and participate. Similar frequent update calls are conducted by our system’s quality and safety leadership. Once weekly, Dr. Dan Rodrigue of Lexington Infectious Disease gives a live educational update that is promoted throughout the Baptist system. The Lexington Medical Society publishes a link to these recorded presentations. Our internal internet site “Baptist Educational Network” contains a link to which that all Baptist staff are directed for the latest information on the pandemic.
We instituted a limited hospital visitation policy, ultimately enacting a no visitation policy except in extraordinary circumstances. We closed most of our entrance sites to our campus, leaving only a limited number of entrance area options. Patients visiting our campus and offsite facilities are now subject to entrance screening involving completion of a symptom questionnaire and temperature assessment. Those who screen positive for COVID-19 are directed either to our Harrodsburg Road Urgent Care Center or, if their clinical presentation warrants, our emergency room.
Hospital meetings of all types are now held virtually when possible or otherwise postponed. In recent days, in recognition of community spread of COVID-19, we enacted a universal masking policy that applies to any person entering a clinical area. Prior to the policy, we traced contacts of patients or hospital staff with COVID-19 and enforced a 14 day quarantine policy to hospital staff members proven to have been exposed.
Baptist’s system leadership closed area urgent care centers but one in each market to which Baptist patients with respiratory symptoms are directed to screen for COVID-19. In Lexington, the Baptist Urgent Care on Harrodsburg road is the designated site to send suspect patients. This Urgent Care Center is staffed with personnel protected with appropriate PPE for testing.
Baptist system CMO’s developed a policy to manage the difficult possibility of rationing ventilators if and when our resources are overrun by demand. This policy will be implemented by the creation of triage teams for each of the Baptist hospitals who will make the difficult decisions after considering multiple clinical and ethical factors.
Finally, Baptist is collaborating with all area hospitals and medical centers to communicate and coordinate COVID -19 response efforts. Our next COVID-19 related initiative will focus upon the development of a comprehensive plan to resume normal operations.