In the middle of Missouri, a not-for-profit hospital pairs impressive innovation with local connections to lead a community-wide charge against COVID-19.
When the virus began spreading in the U.S., leaders at Fitzgibbon Hospital knew their county could be particularly susceptible. Many residents experience challenges related to social determinants of health, which can hinder health care access and deter healthy living. Multi-family and multi-generational homes are common, and the town is home to large food-processing factories.
As of mid-May 2020, the county leads the state in COVID-19 cases per capita.
Making testing accessible
The hospital’s leaders are working to slow the virus’s spread by focusing on COVID-19 testing accessibility.
“When we became aware of cases, we quickly ramped up testing and removed potential barriers to access,” said Angy Littrell, president and CEO. “In a town of fewer than 15,000, our 60-bed hospital has tested more than 2,470 people so far.”
Anyone with a physician’s order can receive a test, any time of day, with no out-of-pocket cost.
“We’re the only organization in the area, that we know of, to offer 24/7 curbside testing,” said Tom Jones, chief information officer and emergency preparedness officer. “At night, we’ll often have 30 to 50 people show up for testing. We’ve tested people from 29 Missouri counties and more from out of state.”
The organization’s website encourages patients to message their provider through the patient portal if they experience non-emergent COVID-19 symptoms. Those without an existing portal connection can submit their contact information, symptoms and preexisting conditions using Fitzgibbon Hospital’s online symptom assessment form. Providers follow up with patients and order curbside COVID-19 tests for those who need them.
“We realize there are places in our service area that don’t have access or the capacity to test, and we want to help ensure access for our community,” said Amy Weber, business development manager.
As patients arrive at the testing site, they’re directed to numbered parking spaces. Fitzgibbon staff collect their information and use quick registration functionality in the Cerner Millennium® electronic health record (EHR) to create each patient’s encounter. After testing, the patient receives education on precautions to take while awaiting results. They receive a follow-up phone call once results are available.
If an admitted patient tests positive for the virus, or if they’re waiting for test results, an EHR alert reminds staff to use isolation precautions.
“Our biggest focus is protecting our health care workers and patients,” said Jones.
Getting creative with PPE conservation
After learning about strategies used in New York City to preserve personal protective equipment (PPE) and limit staff exposure, Fitzgibbon Hospital’s leaders sought local help to bring innovative ideas to rural Missouri.
“We quickly built plexiglass intubation boxes, that you can put over a patient during the procedure, to try and reduce the amount of contamination in the facility and the risk to people assisting the patient,” said Jones.
A community effort
The hospital’s community supports its efforts to limit transmission and conserve resources.
“A local hog producer gifted us UV lights they weren’t using,” said Weber. “We worked with our maintenance department to craft a UV decontamination room, so we can kill the virus on N-95 masks and use them multiple times.” Fitzgibbon leaders pay that gift forward to Missouri State Highway Patrol officers by offering to decontaminate their masks at the hospital.
There’s a web of connections helping the community combat the virus—and it’s all by design. In addition to his role at Fitzgibbon Hospital, Jones chairs a regional planning council as well as his county’s health care council and a local emergency planning committee.
“We test, educate and train everybody in our hospitals on policies and processes to prepare for any disaster,” said Jones. “But we don’t just drill as a hospital, we drill as a community. Our county is recognized as a leader in emergency preparedness in Missouri because we have the police, sheriff, highway patrol, fire, EMS (emergency medical services), emergency medical dispatch, the hospital and long-term care facilities all working together.”
Every group within the network is sharing what it can to support the fight against COVID-19.
“We received PPE donations and recently I asked for help setting up a tent at our testing site because we expected rain,” said Jones. “Within 30 minutes, we had a fire truck filling water bags to hold the tent down.”
Monitoring the situation with data
From their position on the front lines of COVID-19 testing, hospital leaders track the virus’s spread and share that information to help keep emergency response teams safe.
“Cerner solutions help us access and report on our data,” said Jones. “We pull a daily report that includes every address with a positive or pending test, and we share it with the health department. If EMS is called to one of those addresses, the dispatcher tells them that PPE is required. We work together to make sure we all have protection.”
Hospital leaders also share status updates to help their broader community make informed decisions regarding operations, including when to reopen the city and county.
“We’re part of a weekly call with the school system, businesses, the mayor and county commissioners,” said Weber. “We’re keeping everybody informed on what we’re doing, so they can speak intelligently, react appropriately and help keep people safe.”
Fitzgibbon leaders see every COVID-19 test, local connection and innovative idea as an opportunity to improve the health of their community. But just because the work fulfills the hospital’s mission, that doesn’t mean it’s easy. COVID-19 reduced non-emergent services at hospitals across the country, diminishing revenue and further straining already-stretched budgets. That challenge can hit rural and independent hospitals especially hard, but for Fitzgibbon Hospital, not helping isn’t an option.
“We don’t receive funding to stand up these services,” said Weber. “It’s just the right thing to do for our community, and that’s why we choose to do it.”
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