Responding to the latest COVID-19 spike

We’ve experienced a significant increase in patients testing positive for COVID-19.  This increase is consistent with what is being experienced not only across Houston Methodist, but across all hospitals in the Houston region.  In my video from last week, I discussed how over the past three weeks, the number of patients tested in our Emergency Department has increased from an average of 22 per day to 72 per day, with the percentage who test positive increasing from 14% to 30% over the same period.  We have also experienced an increase in the percentage of patients who need to be hospitalized, the majority of whom are admitted as medical/surgical patients. As a result, we have decided to move forward with additional measures to prepare our organization for an increasing inpatient census. While most of these steps were developed in January as part of our pandemic response plan, some have been developed as we’ve learned more about the virus.

Here are the steps we are taking to better utilize our resources:

• Limiting the number of inpatient surgeries and procedures. We will continue to monitor the inpatient census throughout each day to determine how many patients can be scheduled in subsequent days for surgeries or procedures. For example, we postponed six inpatient surgeries today, July 6. Of course, emergent procedures will continue to be a priority.
• Working on converting our dialysis unit into a COVID step-down unit. This will allow us to cohort patients who no longer need to be cared for in a critical care setting yet still require increased monitoring due to needing increased oxygenation. We have temporarily moved inpatient dialysis services to the Heart and Vascular Center location.
• As of last week, we began using only two cardiac cath labs. This will free up more critical care nursing staff for the ICU’s.
• Recruiting traveling nurses.
• Asking physicians to avoid using the Emergency Department as a holding unit when direct admission is not available.
• Hiring screeners to free up staff to return to their units.
• Transitioning staff with nursing licenses who currently work in non-clinical areas to work in clinical units.
• Requesting a waiver from Texas Health and Human Services to allow us to care for postpartum patients in our existing Labor/Delivery/Recovery rooms in the Childbirth Center. This will allow us to potentially utilize post-partum rooms for non-COVID medical/surgical patients.
• Creating a curbside outpatient COVID-19 testing station at the HMSL Brooks Street location. This will be used for symptomatic patients who have a referral from a physician. We hope this will decrease testing volumes in the hospital’s Emergency Department.

We also have additional contingency plans if our COVID numbers continue to rise, which includes:

• Converting Main Surgical ICU beds for COVID care.
• Transitioning PACU beds to Surgical ICU beds.
• Utilizing 5W and 5E for COVID care (current COVID floors are Brazos 4, 5 and 6).

We believe this plan will help put us in a better position to respond to increasing COVID-19 patient volumes. Our goal is to be as flexible as possible so that we can expand and contract our resources as needed, while still providing care across all service lines.

At this time, we are confident that we can continue to provide outpatient surgical and procedural care, diagnostic testing, infusion services for both cancer and non-cancer patients, and other services needed by our community.

It is also important to communicate to the public that we are open and accessible while we continue to respond to the COVID-19 crisis. This will help us to avoid the situation our medical community faced in March and April, when patients themselves were postponing important, necessary care. I have heard too many real-life stories of patients suffering at home from a heart attack, stroke, or allowing their medical condition to deteriorate because they were fearful of seeking care in a hospital.

Again, I want to thank each of you for your efforts, your dedication and your creativity in the face of great challenges. We will continue to communicate next steps openly and transparently as the situation unfolds.

Stay safe,

Chris

P.S. If you missed last week’s video regarding our response to the latest COVID-19 spike, you can watch it here.