How VJH Reinvented Itself to Fight COVID-19
In hours, and then in minutes, everything changed.
Over and over and on the greatest scale the Vernon Jubilee Hospital had ever experienced. Every step anyone took – literal and figurative – had to be understood, reimagined and simulated.
It began when the Interior Health Medical Health Officer (MHO) warned of an atypical pneumonia spreading rapidly. Then the news hit that a novel coronavirus, referred to as COVID-19, could be on its way, and the hospital needed to get ready along with the rest of Interior Health (IH). Now!
In our region, at a high level, Richard Harding, Executive Director – North Okanagan Acute, noted that in responding to this urgent need, Interior Health created an Infectious Disease Emergency Response Steering Committee. On January 30th, this evolved into IH’s Emergency Operations Centre. “Over the next six weeks, the potential impact of COVID-19 evolved.
Then, on March 17th a formal Incident Command structure was initiated across the region. Our North Okanagan Incident Command assumed responsibility for all clinical services throughout Vernon, Salmon Arm and Revelstoke.”
Harding continued: “One of the most pressing questions our teams faced was this: How do we create the capacity in the hospital to enable us to manage a surge of respiratory and critically ill patients, while ensuring we still have the capability to provide care to the regular population? We still had people coming to the hospital with trauma or other life threatening healthcare events that were requiring emergency care. At the same time, we needed to ensure we were meeting the emerging – and evolving – infection prevention and control standards.”
The Emergency Department layout had to be addressed immediately. Since emergency patients typically all wait in one area, staff had to turn patient flow upside down and divide the department, more than once, into zones, each with their own workflow and staff.
Sarah Kohlman, ER Clinical Operations Manager, said ER staff met all challenges head-on. “I always knew they were great with change, it’s the nature of the job here. They’ve been great with supporting the changes while supporting education and each other. What helps is that it hasn’t been just one department or one group. Everyone is in it together, and everyone has similar challenges.”
The Level 7 Acute Medical in-patient unit became the respiratory isolation floor, ready to accept suspected and confirmed COVID-19 patients and meet containment measures. Within hours, Level 7 completely overhauled every way of existence staff had known: workflow and processes were quickly adapted, and patients were either discharged or placed in other areas. Fortunately, with the addition of Polson Tower and its state-of-the-art equipment, negative pressure rooms were readily available to support infection control practices.
“There were plenty of questions, but when it came to asking everyone to be there and show up, they came together and did what they needed to do. I think one of the most humbling things I saw, when the chips were down, was just how everyone jumped in and how willing they were to work together,” said Jenna Dietz, Clinical Operations Manager, Inpatient Level 7.
In those early hours and days especially, all staff showed great resilience and bravery as they overcame inner worries: Will I get infected? Will I infect my loved ones?
Protecting staff was no small feat. While lead technicians managed the Medical Device Reprocessing (MDR) department, which ensures sterility of surgical instruments, supplies and equipment, MDR Supervisor Shona O’Connor stepped out of her regular role to help Purchasing Clerk Jody Thiem with Personal Protective Equipment (PPE) distribution, including restricting stock to a 24-hour supply.
“With the support of Administration, the team quickly established a supply hub for PPE. Thanks to our relationships with all the units at the hospital, we were well positioned to preserve our PPE supply. Staff knew if they needed something, they’d be taken care of in the best way possible,” said O’Connor.
Areas at higher risk of spread were stripped of all products that could become contaminated by aerosol generated droplets, all cupboards were emptied, anesthesia resources were scaled back to a minimum, and all paper was removed.
Throughout this period, two operating theatres remained open for emergency and urgent surgeries and trauma services. Day surgeries were cancelled while 65 per cent of elective surgeries were postponed.
To stay open, operating theatres had to adjust every step in a new environment of negative air.
“Every 18 minutes, 99 per cent of the air was exchanged in the operating rooms, so the surgeons had to wait until the air generating process was over to enter the room and begin their positioning for
surgery,” said Chad Rideout, Peri-operative Services Clinical Operations Manager.
“Surgical scheduling, as to when staff entered and left the operating room, became based on the air exchange cycles in the OR, and not just when the surgeon was ready to begin or when the patients were awake. It involved science- based mathematical calculations of air exchanges,” Rideout said, adding these
steps significantly increased the duration of each surgery, but did not negatively impact patient outcomes.
When the provincial order was issued to suspend all routine and elective cases, including X-ray exams for orthopedic patients, this had a significant impact on VJH’s Ortho clinic as it’s typically open Monday to Friday. Surgeons and the entire Ortho team had to figure out how they were going to remove casts and staples and provide follow up x-rays to check on patients’ bone alignment and healing.
Together with other departments, a creative solution was sought to relocate the Ortho clinic and the OR’s mini C-arm to Priest Valley Physiotherapy.
As the mini C-arm deals with patients that have smaller body part injuries, a plan was made to send those with larger injuries to the Vernon Radiological Associates (VRA) clinic, while trauma injuries continued to be treated in the Emergency Department.
“A process was set up for all three sites to accommodate patients’ needs,” said Travis Thompson, Medical Imaging Professional Practice Lead. “Open-mindedness and willingness to find innovative solutions
in an unprecedented time delivered great results. I am happy to have been a part of a group committed to work in an atmosphere of restrictions and change and to come up with new ideas on how to continue to provide service to patients.”
In delivering this innovative change, it created an opportunity to create a separate Emergency Department, a minor treatment area for patients screened as non-COVID-19 suspected patients. This enhanced the flow of patients through emergency procedures.
Up in the maternity ward, babies continued to come into the world and families were cared for. “What changed were the processes,” said Leslie Murphy, Women’s and Children’s Health Services Manager. All patients were screened at the site entry doors, and a separate triage area was
placed outside the department for mothers and support people. Ongoing simulations were conducted with OR team members, including anesthetists, physicians, educators and unit staff, to prepare in the event mom presented with COVID-19 and needed surgical intervention.
“We worked very closely with OB’s and pediatrics, and pulled in anesthetists and Dr. Bosma to look at the department layout on how we were going to put together a standard work process,” said Murphy.
Helping cancer patients safely access their treatment was another priority that had to be addressed, and quickly.
With eight to 12 ambulatory oncology patients visiting the hospital pharmacy department to receive their oral and injectable cancer treatments every day, the pharmacy department minimized patients’ risk of exposure and promoted social distancing and self-isolation with a delivery service.
“Pharmacy staff provided phone consults for our patients to ensure that the same level of care was maintained during the pandemic,” said Greg Egan, Pharmacy Manager.
On the frontline, the “unsung heroes of the unsung heroes,” Support Services, including Housekeeping and Food Services, were essential in keeping work environments clean, safe, and operational. Cleaning staff went above-and-beyond to make sure all high-touch areas, from elevator buttons to hand railings, were thoroughly and continuously disinfected.
“One of the best things the hospital did was to draw on Chris Crawford’s JOHSC experience as a Safety Advisor to help us navigate all the questions around staff safety,” said Jennifer Diemer, Support Services Manager. “He has been a huge asset and resource for Vernon Jubilee. Having peer-to-peer conversations with Chris’s knowledge and health and safety background made all the difference.”
Looking back, change at this pace and scope could have only been successful with hospital leadership guiding proactive preparation as well as consistent responsiveness to staff needs. This time saw unprecedented site-wide levels of collaboration and teamwork from every single person, regardless of their role.
“As our province continues its slow and steady reopening, VJH continues to adapt and change. We will continue to be nimble, creative and be as prepared as we can to continue to help flatten the curve,” said Dr. Peter Bosma, VJH Chief of Staff.