Like many health systems across the U.S., Palomar Health suspended elective surgeries in mid-March, while seeing a drastic decrease in its inpatient population.
The North San Diego County-based Cerner ITWorks℠ client prepared for an influx of COVID-19 patients, which didn’t arrive as expected. Even without the anticipated surge, people are afraid to return for care, said Bobette Brown, director, marketing and communication.
“Emergency visits are down 40%, surgeries are down 60% and trauma cases are down 70%,” Brown said. “That's the lion's share of where we bring in our revenue.”
Unlike other larger health care organizations, the public health care district does not have significant cash reserves. “We seem to be affected more than other area hospitals because we have a different business model,” Brown said.
As ER visits and surgeries plummeted, the expense and need for personal protective equipment (PPE) rose significantly. Against this challenging backdrop, Palomar Health partnered with the state and county to make sure the San Diego area has enough space for COVID-19 patients.
Managing capacity, ramping up surgeries
With two unfinished floors in its Escondido hospital, Palomar Health leaders worked with the state and federal government to make that facility ready for a patient influx. These two floors became a federally funded medical station, supplementing the hospital’s typical 288-licensed-bed capacity with 202 additional non-licensed beds.
The organization was in the process of closing an older hospital in downtown Escondido for several years, and the state inquired about making the facility available for inpatient services. In response, Palomar Health staff also began preparing space for COVID-19 patients in unused patient rooms.
The state of California has now deemed it safe to start gradually reopening normal business operations, which means Palomar Health can bring some of its suspended services back.
“It's really unique how we're approaching the reopening,” Brown said. “We have to follow state and federal health guidelines, but since the state and our governor approved ‘essential surgeries’ to resume, we are slowly bringing surgeries back online, with the hope to return to about 50% of our normal schedule in June.”
Palomar Health’s reopening includes time sensitive procedures for cardiac events or oncology surgeries for breast cancer, for example. Brown said the organization’s leaders are balancing these efforts with PPE availability and the ability to test patients prior to surgeries to keep all patients and staff safe. Current policy prohibits visitors unless the hospitalized patient is dying or has been in the hospital for an extended period. Visitors must wear masks and are screened at the front door. The organization has also reconfigured the cafeteria for social distancing.
“It's an interesting feeling being in a hospital right now,” Brown said. “It’s usually a hustling and bustling building, and right now it's quiet and empty. Only 50% of our hospital rooms are filled, when normally 90%-95% are occupied. It's truly bizarre to walk down a hall and see so many patient rooms empty.”
Implementing procedures to work from home
While Palomar Health leaders are preparing to reopen, many staff are still working remotely. The ITWorks team had to recast order sets to align with the latest COVID-19 recommendations.
“The first and most important thing we did in consultation with Palomar Health clinicians was making sure all of our PowerPlans™ and order sets were ready to continue adapting in near real-time to whatever the latest guidance and evidence is,” said Mike Vesser, MBA, CHCIO, senior director and client leader.
“We’re making sure we've got the most up-to-date practices built into everything in the electronic health record,” Vesser said.
Perhaps the biggest IT initiative was ramping up the capabilities for Palomar Health staff to work remotely.
“There were a lot of people who never worked from home before, so we did quite a bit of work teaching staff how to use a virtual private network to connect, and we accelerated some upgrades to our virtual private network,” Vesser said. “We gave laptops to some people, set up other remote access tools and trained them how to use those in their homes.”
Other leaders like David Pape, vice president, information technology, say working remotely has helped Palomar Health become more efficient. The organization has three hospitals and several outpatient facilities and staff members used to spend a lot of time traveling back and forth between campuses for meetings.
“I certainly hope, as an organization, we've learned a valuable lesson in that we don't all have to be in the same room all the time for every meeting,” Pape said. “The pandemic forced us to become more virtual, and I think a lot of companies are seeing the benefits.”