Marcus Daly Memorial Hospital (MDMH) has been closely monitoring the evolving situation of COVID-19. The Hospital’s Incident Management Team began meeting before any known cases in Montana. According to Alida Merritt, RN, MSN, Infection Control Director for MDMH, “In response to COVID-19 surge in the State of Washington, and before the first presumptive positive case in Montana, Marcus Daly Memorial Hospital held a tabletop meeting to discuss Ravalli County’s preparedness for an infectious disease outbreak. The hospital, Ravalli County Public Health, and County Board of Health, as well as other MDMH leaders, attended this session. This was the beginning of a collaborative effort to address COVID-19 in the state.”
John Bishop, CEO of Marcus Daly Memorial Hospital, continued, “That tabletop exercise marked the start of what would become a series of decisions and steps to prepare our community and hospital for the coming months. Our decisions are made based on careful assessments of CDC guidelines, community health needs and usage patterns, and data around the pandemic. These steps are a part of an ongoing effort to ensure our team remains whole while providing the appropriate care, at the right time, in the right place.”
COVID-19 has forced the government, hospitals, essential workers, businesses, and citizens around the world to think and behave differently. “Ravalli County has been fortunate to have had only a few confirmed cases of COVID-19, and to date avoid community spread. This is due to the efforts put forth by the residents, the state, county, and your hospital,” said Bishop. “Slowing down the spread of the COVID-19 takes a village. Our community has proven we are in this together. Your healthcare providers and hospital team are very thankful for your commitment to follow the CDC guidelines and for the multiple donations of personal protective equipment; these efforts have given us the time to prepare.”
The Hospital’s Incident Management Team guides the hospital’s COVID-19 preparedness efforts. This team consists of physicians, nurses, respiratory therapists, administration, and other key stakeholders who bring decades of experience and knowledge. According to William Torres, EMS Director, MDMH Incident Commander, “Everyone on the team is an expert in their field and brings the best to the table daily. We have held a relentless focus on complying and implementing all guidelines proposed by the CDC in a timely and often advanced timeline, from this group of experts, hundreds of key decisions have been made.”
Below are some of the many countermeasures that have been implemented.
Daily Monitoring of Key Resources
Dashboards summarizing all testing, results, personal protective equipment, capacity, and other resources are monitored twice daily.
Visitor Restrictions and Controlled Access
Two phases of visitor restrictions have progressed with the presence of COVID-19 in our community.
• Phase 1: March 14, 2020 – Temporary Visitor Restrictions went into effect.
• Phase 2: April 1, 2020 – No Visitor Policy went into effect.
These visitor restrictions include closely monitoring and controlling entry to the hospital and outlying clinics through the use of robust screening algorithms. All people entering hospital facilities, including all patients, medical staff, and essential visitors, have temperature monitored and asked if they have respiratory symptoms if they have traveled recently, and if they have been in contact with people with suspected or confirmed cases of COVID-19.
Proactive Postponement of Elective Procedures
Effective March 20, 2020, safeguards were increased at Marcus Daly Memorial Hospital to include the postponement of non-essential procedures and surgeries, to preserve necessary personal protective equipment (PPE) and ensure adequate in-patient capacity, for a potential surge in COVID-19 in-patient volume.
Pre-Appointment Phone Screening
Scheduled screening protocols have been developed and implemented before each patient’s appointment. Patients and caregivers receive specific instructions regarding their upcoming visit, to better protect patients and staff.
Coordination with Community Health Experts
Marcus Daly Memorial Hospital has continuously worked in coordination with the Ravalli Public Health Department and other key stakeholders through its hospital Incident Management Team. Additionally, Marcus Daly Memorial Hospital participates in coordination calls with other western Montana hospital incident commanders to better coordinate resources and ensure the best care possible for every patient.
Support for Public Health
Marcus Daly Memorial Hospital has partially funded Public Health Officers and other incident command roles filled by Marcus Daly Memorial Hospital staff.
Daily Coordination of Critical Resources and Capacity
Twice daily reporting of all resources and supplies through the state established “Juvare” tracking system.
Cross-Training To Allow For Increased Patient Volumes
Existing nursing and clinician resources are cross-training within the hospital setting. For example; Marcus Daly Memorial Hospital clinic and surgical nurses have received additional training on managing hospital patients in the in-patient setting.
Increased Ventilator and ICU Capacity
Marcus Daly Memorial Hospital has taken steps to increase respiratory therapy resources and ventilator management capacity within the Intensive Care Unit and other hospital-based units. In most cases, this capacity has doubled in response to this event.
COVID-19 Surge Plans
Marcus Daly Memorial Hospital’s COVID-19 Surge Plans continue to be modified as necessary to ensure the safety of patients and staff. In the event of a COVID-19 surge, in-patient surge plans have been enacted. These plans include holding patients in areas of Marcus Daly Memorial Hospital not traditionally used for hospitalizations.
Community Heroes – Personal Protective Equipment and Hand-Sewn Facemasks
As part of its COVID-19 surge planning, and due to the US shortage of PPE, on March 20, 2020, a Facebook post went out to the Bitterroot Valley community asking for help shoring up supplies for Marcus Daly Memorial Hospital frontline staff. In just four weeks, thousands of dollars’ worth of PPE and thousands of additional masks for caregivers and patients have been collected.
Marcus Daly Memorial Hospital has developed a COVID-19 specific Medical Ethics Committee. The purpose of this oversight committee is to monitor the use of hospital materials to ensure that most lives are saved in the most efficient and effective ways possible.
Increase in Clinician Workforce
Marcus Daly Memorial Hospital enacted tier levels to allow for Temporary, Disaster, and Emergency privileges, Streamlining the onboarding process for retired and other community clinicians who may respond to a patient surge.
Creation of Safe Surgical Environment for COVID-19
The Marcus Daly Surgery Center has created a Negative Air Pressure Surgical Suite (traditionally, this is a positive pressure environment) for necessary lifesaving surgeries on presumptive or confirmed positive COVID-19 patients.
Creation of a Dedicated Birthing Suite for COVID-19 Patients
Marcus Daly Birthing Services created a Negative Air Pressure birthing suite in the event of a presumptive or confirmed COVID-19 positive birthing scenario.
In-Vehicle Patient Swabbing
Marcus Daly Memorial Hospital continues to perform nasal swabbing for confirmatory testing of patients in private vehicles. This process ensures that the procedure of unmasking the patient does not contaminate critical healthcare facilities.
Cohorting of Patients
As part of the Marcus Daly Memorial Hospital COVID-19 Surge Plan, positive patients will be separated from traditional patients. Dedicated spaces have been established for the assessment and treatment of all COVID-19 presumptive and confirmed positive cases, thus ensuring the safety of caregivers, traditional patients, and facilities.
Daly Connect Telehealth
Daly Connect is a virtual service that allows patients to practice responsible social distancing without sacrificing their healthcare needs. Through the use of a mobile phone, tablet, or desktop computer, Daly Connect telehealth offers a simple to navigate browser-based platform for patients to set up virtual appointments with their healthcare providers, anywhere they have access to the internet. Patients should contact their medical providers to ask if Daly Connect telehealth is right for them.
Marcus Daly Respiratory Services
On April 15th, 2020, Marcus Daly Respiratory Services, an extension of the Bitterroot Physicians Clinic, officially opened. This medical triage location serves patients experiencing acute respiratory symptoms. It is to help control the spread of communicable diseases, such as influenza, pertussis, and COVID-19. If you are experiencing a fever or respiratory symptoms, call (406) 375-4762 so that they can determine if Marcus Daly Respiratory Services is appropriate for you.
In closing, Bishop said, “Much about COVID-19 remains uncertain. We are planning for the worst, but hoping for the best and ask that the community do the same. Please continue to social-distance and frequently wash your hands. We promise to continue to work to provide a safe working environment and quality and appropriate care to our patients.”