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 Martha Jefferson Hospital 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 Martha Jefferson 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 Martha Jefferson 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 Sentara Martha Jefferson, 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. A second major emphasis was preparing for a predicted surge in COVID patients, which, thankfully, has not materialized as of this writing.
All Sentara hospitals, including Sentara Martha Jefferson, 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 Martha Jefferson 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. With her team, Mina Ford, MSN, RN-BC, AOCNS, who oversees nursing education and life support for Sentara Martha Jefferson, developed a redeployment plan for clinical staff—including registered nurses, nursing care partners, administrative assistants and runners—that became the foundation for a Sentara systemwide redeployment plan.
“We trained more than 200 staff members—many of them from outpatient practices, rehab services and the procedural areas, where patient volumes were decreasing—so they could work in or provide additional support to those units that were seeing an increase in patient volumes,” says Ford.
Ford’s team also developed a revised process in the event that COVID-positive and COVID-suspected patients experienced a stoppage in breathing and cardiac function. When this condition occurs, a call goes out to emergency, respiratory and other hospital staff to respond with life-saving cardiopulmonary resuscitation (CPR) and other interventions.
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 Martha Jefferson also began providing in-house COVID-19 testing.
“The expanded testing allowed us to speed up turnarounds on our inpatient and Emergency Department tests, which was a huge help,” says Jeff Willy, director of laboratory services for the Sentara Blue Ridge Region.
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 Martha Jefferson quickly complied.
Following directives of the CDC, the VDH, Sentara Healthcare and Virginia Governor Ralph Northam, Sentara Martha Jefferson also began to restrict visitation in the hospital, with only a few exceptions.
In addition, many Sentara Martha Jefferson office staff team members began working from home, and a majority of 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, hospital president Jonathan Davis 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 have come several times a week from the Sentara corporate incident-command team in Hampton Roads.
Many of these messages contain 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 Martha Jefferson staff members handle the immense anxieties of their work.
As President Davis 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 Martha Jefferson team remains vigilant, continuing to hone plans for handling any future spikes in COVID patients, and providing compassionate and effective care to our patients and their families.