We are at another important juncture of Nashville’s COVID-19 pandemic journey, having cared for hundreds of patients, learning a great deal more about how to manage the situation and experiencing how diligent hand hygiene and physical distancing can help prevent transmission of the virus. Tennessee is ranked as one of the top states for COVID testing and has been acknowledged as performing enough tests to be successful with public health surveillance initiatives necessary to help manage the pandemic.
Two months after we postponed scheduled procedures and moved many clinic visits to telemedicine to create capacity for a potential first wave of COVID-19 patients, both our mayor and governor are gradually lifting Safer at Home orders. This signals -- through cautious steps -- we can begin to resume a broader range of activities in what leads to a ‘new normal’ until a vaccine can be available. In accordance with these orders, on May 1, we announced VUMC’s intention to eventually resume all scheduled services.
With all we’ve accomplished at VUMC and in Tennessee, we are now facing a different challenge with the pandemic and we are not alone. Patients who are sick, need medical care or need follow up for chronic illnesses and conditions other than COVID-19 aren’t always seeking evaluation and treatments they need. National health insurance claims data indicates a decline in activity across a spectrum of specialties for both scheduled procedures and care for acute conditions.
An overcorrection of sorts, some are referring to this as the pandemic’s secondary health crisis, predicting that soon we’re going to see large numbers of very sick patients who have, out of fear of contracting COVID-19 in a health care setting, delayed necessary care to the point they have placed themselves at risk. A recent poll indicates as many as 2 in 3 Americans are delaying medical care for fear of COVID infection or because of a change in insurance circumstances due to job loss. Our own pediatricians are expressing growing concerns that parents are not bringing their children to clinic for routine vaccinations.
The results of an Advise Vanderbilt survey, from our own focus group of VUMC patients, demonstrate that many patients are ready to re-enter the health care space, but over half reported delaying health care due to concerns about becoming infected.
The highest level of concern was the perceived risk of getting sick from other patients. To a lesser extent there was concern regarding cleanliness of facilities, risk of getting sick from hospital staff, and availability of proper protective equipment (PPE). Importantly, the Advise Vanderbilt survey also said, of all potential sources of information regarding the safety of resuming health care, respondents felt by far the Medical Center and their doctor were the most important.
With all those concerns in mind, I want to take this opportunity to reiterate the steps we have taken to make the environment in our hospitals and clinics as safe as possible for you, our workforce, as well as for our patients.
- We have aggressively limited visitors.
- All employees, patients and visitors coming to our facilities are undergoing temperature and COVID-19 symptom screenings.
- All patients, visitors and staff are now required to wear masks in clinical care and public areas, including hallways, elevators, lobbies, meeting rooms and cafeterias. Those without masks are provided one upon arrival. We have been able to sustain appropriate supplies of PPE and fully anticipate continuing to be able to do so.
- Most recently, we instituted testing for all asymptomatic patients prior to undergoing scheduled procedures or being admitted to our hospitals. Testing protocols are established and working well. Because we can perform in-house testing, we can know the COVID status of admitted patients within hours and not days to weeks.
- Chairs in hospital and clinic waiting areas are spaced to fulfill physical distancing requirements.
- We also offer “virtual waiting rooms” at many of our offsite locations allowing patients to stay in their vehicles rather than in waiting rooms until time for their visit.
- Cleaning—our exam rooms are cleaned between each patient visit and waiting areas are also cleaned throughout the day using a log to record the frequency.
- Our Environmental Services team does a deep clean every evening that includes medical grade products that will kill any virus. Cleaning includes walls, floors, tables, chairs, counters and stairwells.
- Unlike other industries, we are constantly managing infectious diseases in the workplace and are well prepared to sustain these practices to prevent the spread of COVID-19. For COVID positive patients who are admitted, we have created dedicated areas to isolate and care for these patients. We are fortunate to have physicians and staff who volunteer to serve in these areas and who are experts in the use of PPE and other techniques of infection prevention.
- Our infection prevention and safety efforts are guided by an amazing, internationally recognized team of Infection Prevention and Infectious Diseases experts. These efforts will continue for months to come and until we can be sure that your safety and that of our patients will no longer require such steps. Exhaustive protocols, while at times cumbersome, demonstrate a commitment to the safety of patients as well as the entire health care team. If you know of or see any deficiencies, please let your supervisor know.
- Finally, there have been no documented transmission of the virus to patients at VUMC.
Our people are the very best spokespersons for VUMC in the community, as the Advise Vanderbilt survey reinforced. If you are speaking with friends or family about receiving care in our hospitals and clinics, please let them know about all these measures that have been taken to make our environment as safe as it can be. When patients know appropriate risk reduction measures are in place, they are willing to re-enter the health care space and resume accessing routine care. By sharing VUMC’s efforts, you could impact a friend or family member’s health. Thank you for all you do each day to support safe care to our patients and families.
C. Wright Pinson, MBA, MD
Deputy CEO and Chief Health System Officer