The health system at ground zero of the U.S. novel coronavirus epidemic is taking a three-pronged approach to clinical care for the viral disease.
Providence St. Joseph Health, which cared for the first U.S. novel coronavirus (COVID-19) patient, is sharing how the health system has responded to the crisis.
Since December, COVID-19 has spread from China to 118 countries and territories, with more than 124,000 confirmed cases and more than 4,600 deaths, according to the World Health Organization. As of March 12, 1,336 cases had been confirmed in the United States, with 38 deaths, worldometer reported.
The first U.S. COVID-19 patient was admitted to Providence Regional Medical Center Everett in Washington State after testing positive on Jan. 20, Amy Compton-Phillips, MD, EVP and chief clinical officer at Providence St. Joseph, said yesterday during a HIMSS webinar.
Providence St. Joseph operates healthcare facilities in seven states, including Washington, Oregon, and California.
Compton-Phillips' webinar presentation included the Renton, Washington-based health system's three-part clinical response to the outbreak. "We have to prepare to triage patients, test patients, and treat patients," she said.
With little room to increase primary care visit capacity, virtual care has been a crucial element of Providence St. Joseph's triage efforts for COVID-19, Compton-Phillips said. "We worked with our digital innovation group and with Microsoft to build a chatbot to help people go online."
The chatbot on the health system's website engages people by asking questions about symptoms, travel history, and possible exposure to the COVID-19 virus to determine the risk level for infection. Through the chatbot, people at highest risk of infection are directed to seek immediate care. Other at-risk patients can be connected with the health system's nurse line telephone service or schedule a telemedicine appointment on Providence St. Joseph's telehealth platform, Providence Express Care.
In addition to triaging patients in emergency departments, urgent care centers, and online, the health system is planning to roll out "fever clinics" by the end of this week.
"To reduce community transmission for in-person visits, we are now working on setting up fever clinics separate from regular clinics as pediatricians have done for years. During flu season, they might have afternoon hours for people with a fever so that you minimize the contamination of other patients," Compton-Phillips said.
Inadequate testing capacity has been one of the most daunting challenges since the beginning of the U.S. COVID-19 outbreak in January, she said.
"Because of the very stringent criteria we had initially, we could only get people tested if they had traveled and had all three symptoms—fever, shortness of breath, and cough. It was incredibly frustrating for even our caregivers who thought they might have been exposed. They might have two out of the three symptoms, so we couldn't get them tested."
Testing capacity has been insufficient, but since the Food and Drug Administration issued a key emergency use authorization on Feb. 29 "opportunities have definitely opened up," Compton-Phillips said. "Pretty soon we think the pipeline will improve so that we can significantly increase our testing capacity."
Providence St. Joseph plans to ramp up testing as soon as more kits become available, she said. "The tents are ready to go and deploy as soon as the testing capacity increases. We will be running drive through clinics for testing in the same way they have done in South Korea."
The health system has developed its own COVID-19 test, but necessary reagents are unavailable from their European suppliers, Compton-Philips said.
As is the case with patient triage, telemedicine is playing a crucial role in treating patients, Compton-Phillips said.
Patients who are identified as likely positive for COVID-19 in an emergency department but are not admitted are being sent home with a thermometer and pulse oximeter to monitor their symptoms at home under the supervision of the health system's telehealth team, she said.
"Patients can be OK for a while, then decompensate rapidly. So, having this capacity to monitor at-risk patients at home has made a huge difference and made our clinicians much more comfortable to leave patients at home rather than admitting them for observation in our acute care facilities."
In addition to the virtual patient monitoring, virtual grand rounds have been conducted regularly to foster "rapid learning" for Providence St. Joseph clinicians who are caring for COVID-19 patients, Compton-Phillips said.
Patients who are admitted to one of the health system's hospitals are under strict isolation protocols and cannot have visitors, she said. This is particularly problematic for older patients, who can develop delirium and other complications while in isolation. To ease the isolation burden on quarantined patients, they are being given iPads to stay in touch with friends and family, Compton-Phillips said.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
The first U.S. COVID-19 patient was admitted to Providence Regional Medical Center Everett in Washington State.
A new coronavirus chatbot has become a pivotal component of triaging patients at Providence St. Joseph Health.
Limited testing capacity has been problematic at the health system.