Providence St. Joseph Health, one of the nation's largest health systems, with 51 hospitals spanning seven states, is looking for the peak of another COVID-19 surge to arrive next week.
"For us, after this Thanksgiving weekend, we are predicting that we will be at a very high capacity around December 7," said Ali Santore, senior vice president of government affairs and social responsibility at Providence. "So we're looking out to that date to ensure that we're actually preparing for the beds and the staff that we need."
Easier said than done, given both hospitals and staff are exhausted by nine months of stepping up to meet the challenges of the pandemic.
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Since COVID-19 began another surge across the country, the ability to adjust assets around a particular community's need has disappeared.
"There aren't extra staff or resources to move across state lines. Everybody needs those resources in their communities," Santore said.
CHALLENGES: WHY THIS MATTERS
In response to the staffing shortages, Providence has seen its clinical personnel especially step up to the challenge.
"We've been training our OR staff nurses to serve in an ICU capacity. We've been bringing nursing students coming out of nursing school to start getting on-the-job-training right away," Santore said. "So there's been a lot of flexibility, a lot of ingenuity and just a lot of generous service in terms of clinicians really stepping up to volunteer for an additional shift or to volunteer for cross-training so that we continue to meet the need in our community."
An additional challenge for health systems across the country, including Providence, is the financial strain of the pandemic. Its operating expenses are up and volumes are still down year to date. In fact, Providence recently reported $214 million in operating losses for the first nine months of 2020.
"A big part of those operating losses were due to the mandated cancellation of elective surgeries in the spring," Santore said.
Other contributing factors include the increased costs of labor, supplies and pharmaceuticals needed to respond to COVID-19, Providence said in its report. To ensure that its operating margins don't continue to suffer, the health system has been working with local governments to make sure that elective procedures don't get canceled again, according to Santore.
"Our emergency room visits are down significantly, about 18% from prior years," she said. "And people are really putting off care that's needed, and we don't want to see that happen, because that has a long-term impact on healthcare costs, but also health outcomes of our country."
THE LARGER TREND
Providence St. Joseph Health can be viewed as a microcosm for the rest of the county in its response to the COVID-19 pandemic, according to Santore.
"I'm talking about what's happening at Providence and within our seven states, but it's really emblematic of the larger issue that the country is facing, where we're one national hot spot right now," she said.
In the early stages of the pandemic, Providence was able to respond to specific geographic hotspots by flexing its ability to scale its staff and other resources.
"We have a large multi-state system, and we were able to move resources," Santore said, "so one of our regions would never be left behind. No hospital would be left behind. Whether short on staffing or short on PPE, we had these tools at our disposal that we could really move people and staff around."
Looking back at the origins of the pandemic in the U.S., Providence treated the first COVID-19 patient in Washington State in January. Since then, it has seen about 47,000 patients with confirmed cases, according to Santore.
The system took similar measures as other organizations did, including ramping up telehealth services, rapidly updating COVID-19 screening protocols, assisting in treatment research, creating flexibilities for staff, and furthering its commitment to its most vulnerable communities.
Specifically, before the pandemic, Providence supported about 10,000 telehealth visits a year. It now conducts nearly 12,000 every day, Santore said. It also conducted research into potential COVID-19 treatments, including clinical trials of remdesevir, which has since been approved by the FDA for use.
Before the pandemic Providence made a system-wide social-responsibility commitment to become carbon negative by 2030; further its diversity, equity and inclusion initiatives; and improve the community health of the locations it serves.
"So that was our foundation that we agreed to focus on in February," Santore said. "And that has really grounded us through our response to the pandemic – this commitment to social responsibility, this commitment to the poor and vulnerable, and really reaching out to those at risk within our communities first and foremost."
PREPARING FOR FUTURE SURGES
The biggest tool in Providence's preparations for the current uptick in cases and for future waves is to predict its facilities' capacity ahead of time.
"What we're doing as a system is really challenging ourselves to look at, not just our bed capacity now, and our staff capacity now, but what's our capacity seven days out? What's our capacity going to look like in the next two weeks?" Santore said. "So we're looking seven days out and then preparing to flex our volumes on a 24- to 48-hour basis based on what that is."
Using a system-wide analytic tool called the CoronaVirus Epidemic Registry and Emergency Data platform, or CoVERED, Providence can track COVID-19 admissions and positive test rates in its clinics, and predict outbreaks by tracking people with symptoms before they're tested.
The experiences of Providence are exemplary to those of the rest of the country, according to Santore. "Our experience at Providence really shows the value of scale of a system working together across many different geographic lines and demographic lines – really a microcosm for the country – to really step up and meet patient needs where they are," she said. "Our team is tired, but they are ready to continue this journey in serving our patients."
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