WAVERLY, OH (Jan. 12, 2021) – Responding to a pandemic poses tremendous challenges for any health system. Facilities are strained by increasing patient loads, personal protective equipment supply can become stressed and frontline staffing is stretched thin and pushed to the limits of mental, emotional and physical exhaustion.
Such challenges also tend to produce unexpected successes. During the most recent Coronavirus patient surge during December that pushed the COVID-19 unit at Adena Regional Medical Center (ARMC) in Chillicothe to capacity and beyond, Adena Greenfield Medical Center (AGMC) and Adena Pike Medical Center (APMC) in Waverly mobilized to create designated areas capable of caring for patients recovering from COVID-19 but not yet well enough to be sent home. The efforts of those critical access hospitals have helped relieve some of the strain on ARMC’s Coronavirus unit, freeing up bed space and desperately needed resources for those patients with the most severe reactions to the virus.
That effort by the critical access hospitals builds upon ongoing changes that began during Adena’s return to full operational status in the weeks following Gov. Mike DeWine’s month-long shutdown of elective surgeries last spring. With a backlog of elective procedures needing to be addressed once the governor’s order was lifted, those facilities had the opportunity to showcase the services they can provide as the Health System looked for ways to address that backlog as quickly as possible for patients.
“Adena Regional Medical Center needed to leverage their spaces in different ways to make up for some of the more acute procedures,” said Josh McCoy, Senior Operations Executive Officer at Adena Greenfield Medical Center. “Just due to physical capacity constraints of our facilities in general, which correlated with the backlog, we had to utilize the critical access hospitals in Greenfield and Waverly to help expedite and catch-up on that surgery backlog.”
With the most recent surges of Coronavirus cases rolling across the state, the lessons learned earlier last year are coming into play once again. One of those is the capability of the critical access hospitals to take on more of what McCoy calls “the bread-and-butter” care such as less acute surgical procedures to free up the ARMC campus to focus on Coronavirus care and the more acute care procedures.
“(Following the shutdown) we did more pain management procedures in Greenfield in the four weeks of making up the backlog than we do typically in a year,” McCoy said. “I believe we were hovering around 200 pain management procedures during that four-week span, and we typically handle about 100 per year.
“We also had the opportunity to introduce additional service lines, providers and procedure work in our communities because of that backlog. Dr. (Chad) Keller (ear, nose and throat) is a great example of this. He was introduced here in Greenfield on the operating room side of things and did some procedure work here for the first time that ENT hasn’t been done in Greenfield in decades.”
The Greenfield facility also saw a boost in gynecological caseload and general surgeries. Several of those services that received a boost during the ramp up to normal operations have had an ongoing impact on Greenfield and its surrounding communities as providers introduced for the first time to the AGMC facilities chose to expand their own presence there and as community members recognized the quality of care they can receive closer to home.
Dr. Keller is a prime example of this, McCoy said. Not only are his services now being utilized in the operating room at Adena Greenfield Medical Center, but plans call for him to have designated clinic times for outpatient visits in addition to his operating room blocks sometime the first part of this year.
“That’s huge for this region because there’s no ENT presence in Washington Court House, Hillsboro or Greenfield, so having that service available to members of those communities is going to be invaluable and will pave the path for future market capture,” McCoy said. “Pain management is another area where we’ve learned a lot and we’ve been able to provide a more acute offering to the community with Dr. (Mark) Malinowski’s presence.”
David Zanni, Senior Operations Executive Officer at Adena Pike Medical Center, saw the hospital in Waverly go through the same type of evolution in 2020.
“We had to support the huge backlog (after reopening to elective surgeries in mid-May) and surgery (patient) volumes went through the roof,” Zanni said. “Now that the backlog of surgery cases has been eliminated, we continue to see several surgeons perform procedures here at APMC.”
One of those providers is Adena Bone & Joint orthopedic hand surgeon Dr. Roger Wiltfong, who, following a surge of procedures at APMC making up the backlog, continues to do several per month at the Waverly hospital. Zanni said APMC also has seen a significant increase in gynecological procedures from Drs. Scott Morehead and Ronald Lopez, as well as a boost in endoscopic procedures and general surgeries from Dr. Christin Spahn.
Pain management injection procedures at APMC followed a similar trend, going from a single provider doing about 15 to 20 of them a couple times a month to three providers doing 25 or more three times a week while depleting the backlog. Even now, an increase remains evident.
The COVID-19 crisis has shown how well the entire Health System can collaborate and optimize its resources to make for more efficient day-to-day operations, McCoy said.
“The teamwork that was involved with that was phenomenal because we have one surgery staff essentially that oversees the surgery division and both critical access hospitals, and that’s a small group of individuals – we’re talking eight or nine individuals – who do procedure work at both Pike and Greenfield,” McCoy said about making up the backlog of procedures during the reopening. “So there’s a lot of collaboration and teamwork that had to happen with the Adena Regional Medical Center surgery teams so we would have enough staff to operate both facilities at the same time.”
Telehealth services also took a leap forward in the critical access hospitals during the aftermath of the shutdown and took on a new importance. While initially looked on as a tool for primary care, the use of telehealth is now allowing hospitalists in Greenfield and Waverly to connect with specialists based at ARMC for consults – thus allowing patients to be kept in the critical access hospitals for treatment rather than having to be transported to Chillicothe.
Both administrators say the COVID-19 response has helped bring some exposure to what the critical access hospitals can provide, both internally among providers who may not have had much familiarity with their facilities before the reopening and among members of the community who may have previously thought the Chillicothe campus was the only way for them to receive certain procedures they required.
As a process of regionalization of care continues, raising that awareness will be an ongoing effort.
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