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Bozeman Health Readies for Surge of COVID-19 Inpatients

Corporate news | Friday, April 10, 2020

Contact: Lauren Brendel, M.S.

Health System Prepares to Safely Care for Possible Peak of 128 Hospitalized Patients during the COVID-19 Pandemic

BOZEMAN, MT [April 10, 2020]—Bozeman Health is proud to be the regional integrated health care delivery system for Southwest Montana serving a primary service area that includes nearly 130,000 people. Ensuring we remain prepared to care for our community during the COVID-19 pandemic is paramount to our mission of improving community health and quality of life, and we are confident in our ability to meet the needs of those we care for and serve.

According to multiple forecasts, it appears the COVID-19 peak in our primary service area, which includes Gallatin, Madison and Park counties, will occur the week of April 27, 2020. At peak, we are anticipating as many as 100 COVID-19 positive patients to be under active care at Bozeman Health hospitals, 83 of them being medical floor inpatient admissions in Bozeman or Big Sky, and 17 of them being ICU admissions. During the same week, we anticipate continuing to provide expert, quality inpatient care to approximately 28 individuals with non-COVID-19 related conditions at both Deaconess Hospital and Big Sky Medical Center.

Leaders within Bozeman Health collaborated with industry experts and academic organizations in building a projection model for short-term COVID-19 forecasting and built the model by accessing the statistical dataset available from the World Health Organization and the Johns Hopkins Center for Systems Science and Engineering. Since Bozeman Health continually tracks, updates and monitors the epidemiological trends in Montana and other rural states, we've been able to tailor our surge plan to ensure that we maintain the highest quality of healthcare delivery.

Based on this modeling, the health system is implementing a surge plan that allows for the accommodation of a 20% daily inpatient volume growth rate until we reach our peak, with a full planning horizon that covers the next eight weeks (April 7 through June 2). This peak and duration anticipate that our communities continue to adhere to moderate containment measures and imply that testing remains limited across the state. Our surge plan is intended to expand the infrastructure, bed count, supplies and equipment, locally available testing capability, and staffing needs for the increase in those requiring inpatient care at Bozeman Health hospitals.

Increasing Capacity
Prior to the COVID-19 pandemic, Bozeman Health has been licensed and prepared to meet the needs of hospitalized patients at Deaconess Hospital with 86 beds, with four inpatient beds at Big Sky Medical Center.

Already, Bozeman Health has expanded inpatient capacity to meet the need to serve approximately 128 non-COVID-19 and COVID-19 patients by utilizing bed space within the post-acute care unit (PACU), Peri-Op, endocrinology and interventional radiology patient care areas at Deaconess Hospital for an increase of 38 beds.

The surge plan includes keeping respiratory/viral patients physically separated within different units than non-respiratory/non-viral patients requiring acute hospital care. Patients at Big Sky Medical Center requiring intensive care will be transferred to Deaconess Hospital.

Procuring Supplies and Equipment
Bozeman Health needs essential equipment and the personal protective equipment (PPE) required to keep our care teams safe in providing these expanded services. Toward that end, Bozeman Health has:

  • 40 ventilators and anesthesia machines, with an additional 10 ventilators anticipated to arrive in the coming weeks.
  • Identified the need for significant acquisition of PPE supplies, and have:
    • Appropriately vetted, tested, and approved reuse policies and sterilization practices for PPE that can be reused and cleaned and/or sterilized.
    • Worked creatively and collaboratively with Montana State University, local partners, designers and manufacturers on reusable PPE, including face shields from Bridger Aerospace and Vision Ascent Technologies, gowns manufactured by Simms Fishing Products, 4M R&D injection-molded respirator masks, and fabric masks from local community group Montana Masks for Heroes, as well as from Mystery Ranch and West Paw.
    • Aggressively and continuously pursued procurement of disposable PPE supplies through multiple traditional and non-traditional channels, while ensuring appropriate FDA compliance.

Staffing
A significant increase in the number of inpatients we can treat means that Bozeman Health must also ensure we have the staff needed to safely care for patients.

Based on careful review and planning, Bozeman Health has developed staffing models that determine the number of nurses, physicians, respiratory therapists, nurse aids and environmental and nutrition services team members needed to care for the anticipated number of inpatients. As just one example, we’ve confirmed our ability to deploy 81 frontline clinical care team members to meet the needs of caring for 128 patients during the anticipated peak.

The suspension of non-essential medical services, procedures, and surgeries has helped to make significant numbers of care team members available to support the needed staffing and anticipated surge. Nurses and providers from those affected areas have been cross-trained and will be deployed to provide assistance to inpatient and critical care teams. The staffing model also ensures we can maintain staffing of our other clinical care sites, including Belgrade Clinic + UrgentCare and b2 UrgentCare Main Street, in order to serve our community needs.

Additionally, members of our Bozeman Health leadership team have established a pool of retired or non-practicing physicians, nurses, and clinicians throughout the region to provide additional assistance as appropriate.

Testing
As part of increasing our readiness and implementing our surge plan, actively pursuing locally available COVID-19 testing at Deaconess Hospital we believe will help us meet our three key priorities during this pandemic:

  1. protecting the safety and health of our workforce
  2. preparing for a surge of local COVID-19 positive patients
  3. supporting the efforts of state and local elected officials, our health department, and community leaders to flatten the curve

While we have ordered and are awaiting delivery of necessary lab equipment to conduct in-house COVID-19 testing at Deaconess Hospital, Big Sky Medical Center, and Belgrade Clinic + UrgentCare , Montana State University has allowed the temporary transfer of its quantitative PCR machine to the Deaconess Hospital lab to attempt onsite testing for SARS-CoV-2 (COVID-19). The qPCR machine, which is a unit about the size of a microwave, acts as a kind of molecular photocopier, amplifying the unique molecular “fingerprint” of the virus to facilitate testing of patient samples. MSU researchers— including Michelle Flenniken, Katie Daughenbaugh, Blake Wiedenheft, Alex Adams, Diane Bimczok, and Steve Martin—have also been working with our clinical lab specialists to validate the qPCR machine’s capabilities and calibration. That calibration and validation work was completed this morning and our teams are submitting the results to the FDA for approval. We anticipate FDA approval, allowing us to begin viral diagnostic testing at Deaconess Hospital, in approximately seven to 10 days.

Testing capabilities remain limited to due to a shortage of testing reagents. The focus of those tests will be our frontline healthcare teams and community first responders so that we can protect the safety and health of our workforce. The secondary focus will be inpatients at Deaconess Hospital or Big Sky Medical Center who meet the testing guidelines so that our clinical care teams can remain safe and provide the appropriate care and treatment of those patients.

As more analyzers, testing supplies and reagents become available, we hope to expand testing to the community for those who meeting guidelines as defined by the CDC.

Conclusion

Expanding testing to our frontline healthcare workers and first responders helps ensure Bozeman Health and our community retain the needed workforce to care for current and future patients, specific to the COVID-19 pandemic and for those patients with non-COVID-19 conditions and healthcare needs.

In the best of all circumstances, these planning assumptions and their associated high inpatient volumes will not come to be realized. Social distancing, including adherence to stay-at-home directives, hand and respiratory hygiene must continue to help flatten the curve and minimize the impact of COVID-19 across our communities. It is our hope the potential impact we’ve shared encourages people to do what’s best for us all. Bozeman Health will continue to plan and be fully prepared for challenges that we may encounter during the COVID-19 pandemic. It is our honor to care for our community, and we’re proud of the work our teams have done to ensure we meet and exceed the expectations set before us.

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