Caring for the community during challenging times
The global COVID-19 pandemic impacted all of our lives this year, especially those in healthcare-related roles. We convey our deepest gratitude to our physicians, staff and volunteers for stepping up to the challenge. Our team made every effort to protect and serve our community, providing excellent care to our patients in the face of a dangerous virus while adapting to new treatment protocols and regulations, and unprecedented challenges.
There were so many ways our team worked together to deliver outstanding care. Below are examples of how PIH Health navigated new territory to provide excellent healthcare at our three hospital locations: PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, and PIH Health Whittier Hospital, as well as at our Urgent Care Centers, Home Health, and physician offices.
Since January 2020, PIH Health monitored the novel coronavirus (COVID-19) and followed all guidelines. However, once COVID-19 was categorized as a pandemic, PIH Health implemented its Hospital Incident Command Centers on March 19, 2020, to serve as centralized operations, providing education, communication, and logistical oversight to support healthcare providers and patients. The command center structure brought interdepartmental leaders together to make key decisions about employee health and ways to best care for COVID-19 patients based upon direction from the Centers for Disease Control and Prevention (CDC), the Los Angeles County Department of Public Health (LACDPH), and the California Department of Public Health. Stations enforcing screening, universal masking, temperature checks, and hand sanitizing were opened at each facility’s entrances early in the pandemic to create a low-risk environment, and visiting guidelines were changed multiple times to protect our team and our patients. Most non-essential services were temporarily postponed.
As PIH Health began to receive patients with symptoms of COVID-19, emergency shelters (tents) were placed outside each of the hospital’s Emergency Departments to triage patients and separate those exhibiting symptoms of COVID-19. The Urgent Care Centers also implemented processes to triage patients that arrived with COVID-19 symptoms. Additionally, pre-screenings were conducted over the phone before patients made appointments to be treated at the medical offices. New protocols were developed for the safe care of mothers and newborns diagnosed or suspected of COVID-19, and a testing program was adopted for necessary surgeries and procedures. Infection preventionists reviewed and interpreted daily guidelines from the CDC and LACDPH, and developed multiple educational documents to be distributed across the enterprise. PIH Health Whittier Hospital also received approval as one of only 48 hospitals globally participating in a Remdesivir clinical trial during the first surge of the pandemic.
Between March 1 and September 30, 2020, PIH Health tested more than 30,000 people for the virus and treated nearly 1,900. PIH Health Downey Hospital cared for 561 COVID-19 patients, PIH Health Good Samaritan Hospital cared for 721 patients and PIH Health Whittier Hospital cared for 570 patients.
Our People and Key Departments
Everyone who worked at PIH Health took part in the COVID-19 response. A special thank you to the departments listed below that made significant contributions to our organization’s collective response to support the health of our community between March through September, and to the next fiscal year.
Our Emergency Departments rapidly expanded their capacity through the use of screening and treatment tents to address the surge of patients. PIH Health adopted rapidly evolving screening, testing and treatment guidelines from the CDC as well as local, state, national and academic sources. The department separated patients with COVID-19 symptoms from others to prevent and control community spread. To patients who did not require hospitalization, the staff distributed aftercare instructions addressing self-care and at-home treatment and made follow-up phone calls to inform them of COVID-19 test results. Staff also reinforced the need to stay at home while offering options for follow-up if the disease progressed. Patients who entered the hospital through the ED and had severe symptoms of COVID-19 were treated in either the critical care unit or on a COVID-19 medical unit.
COVID-19 Cohort Units
Each of our hospitals established separate inpatient and critical care cohort units dedicated to COVID-19 patients. This means that there were areas in the hospital specifically for COVID-19 patients or those suspected of having COVID-19 to keep them apart from the general patient population, helping to reduce transmission. Frontline physicians and staff caring for patients in these areas were equipped with special Personal Protective Equipment (PPE) and donning and doffing procedures were implemented to ensure staff did not self-contaminate. Strict protocols were adopted allowing only essential workers to enter the COVID-19 units and patient rooms, including PPE stations. Food, medicine and supplies underwent safe transport processes. These strict procedures created strong safety outcomes.
The cohort teams cross trained all registered nurses (RNs) in respiratory inhalation treatments to prepare for potential reductions in respiratory therapists, in the event staff became ill and needed to quarantine. In fact, all RNs trained to various skills outside of their usual duties to care for different patient populations.
The cohort teams also developed remote visitation for patients to help them stay connected to their families during hospitalizations. RNs stayed at the bedside during patient emergencies and ensured that end-of-life patients were not left alone and that the family was involved remotely whenever desired. RNs were the last people at the bedside to provide human touch to the dying COVID-19 patients.
Intensive Care Unit Response
Intensive Care Units (ICU) across the enterprise sponsored a rapid critical-care orientation for non-ICU RNs to cross-train them and ensure the continuation of excellent care for COVID-19 patients. Staff created overflow capacity to manage the large number of COVID-19 patients needing dedicated critical care. PIH Health Downey Hospital created an additional 10-bed COVID-19 ICU, PIH Health Good Samaritan Hospital reserved a 28-bed ICU for COVID-19 patients and PIH Health Whittier Hospital expanded to a 48-bed ICU for COVID-19 and non-COVID-19 patients. The ICUs successfully navigated continuous new workflows and process changes mandated by various government agencies to ensure he best care for patients. ICU staff also provided iPads to allow COVID-19 patients to stay connected with family and friends.
The Respiratory Care team was integral to our efforts. 5% of patients with COVID-19 could not sustain normal breathing, and had to be intubated and placed on a ventilator. The respiratory therapists determined the appropriate ventilator settings to match the needs of the patient and constantly monitored patients. The department also developed a process that allowed some COVID-19 patients to avoid ventilators. Additionally, staff took training in cardiopulmonary care to help people who suffer from pulmonary diseases and also trained in mechanical ventilation. They worked extra shifts and went above and beyond to ensure our COVID-19 patients were provided with the support they needed to make a full recovery.
PIH Health’s Enterprise Supply Chain team worked tirelessly to procure and increase PPE inventory levels to keep our staff and patients safe. Normal distribution channels were unable to keep up with the increased demand for PPE, hand sanitizers and disinfection wipes as healthcare organizations, PIH Health included, were placed on monthly allocations by distributors based on pre-COVID rates that were not sufficient. Our Supply Chain department responded by negotiating deals for PPE at an increased cost per unit (1,084% market increase according to the CDC) to maintain ample supplies to provide all frontline employees with CDC-approved, critical PPE since the pandemic began.
As the COVID-19 pandemic and associated PPE shortages continued, our Supply Chain department developed a 90-day PPE strategy to procure enough essential PPE to sustain the enterprise, with inventory replenished monthly.
The Supply Chain department also graciously accepted and tracked donations of PPE, cleaning supplies, and other items from community members, and worked with the PIH Health Foundation and Marketing Communications department to thank the public for their contributions.
Our Environmental Services (EVS) teams across the enterprise put in extra effort to maintain cleaning standards. They oversaw the opening and closing of COVID-19 units (nine units at PIH Health Whittier Hospital, three at PIH Health Downey Hospital, three at PIH Health Good Samaritan Hospital).
EVS staff worked collaboratively with Infection Prevention to implement and educate staff on CDC guidelines to ensure compliance, achieving 100% compliance on safety training using our vendor, Sodexo’s, safety program, which encompasses 18 mandatory subjects annually. Staff received additional training on policies and procedures related to COVID-19 through our vendor Crothall, including safety precautions, cleaning procedures, and personal protective equipment (PPE). EVS worked with its vendors to procure drop shipments of disinfectant and bleach wipes to maintain inventory and secured a shipment of 10,000 N95 masks.
EVS adopted quality assurance protocols to ensure that nurse stations, break rooms, elevators, and waiting rooms were constantly cleaned and disinfected, and they worked with Supply Chain to provide scrubs and isolation gowns for staff in the ICUs.
Department staff were provided with well-being resources available to them to help with stress, anxiety, and emotional support during the uncertain times.
Medical-Surgical/Telemetry staff across the organization redesigned nursing workflow to provide the best care possible for COVID-19 patients, developed new competencies for ventilator management, developed ongoing communication channels with employees and management, and created remote work policies.
The Lab teams across the enterprise focused on ensuring testing equipment and supplies were available for all areas of PIH Health. They oversaw the installation of COVID-19 analyzers for rapid and same-day testing and contracting with multiple external reference labs for COVID-19 testing.
PIH Health Pharmacies anticipated potential medication and PPE shortages. They responded by ensuring that we had a three-month supply of essential medications and a six-month supply of PPE. All three hospital Pharmacies worked together to share ideas and develop plans to procure medications and equipment before distributors put purchasing restrictions in place or ran out of product. Pharmacy staff researched the impact of the spreading virus, made medication recommendations, and made a special effort to ensure ample supplies of essential medications were on hand, especially for critically ill patients. Their efforts enabled our hospitals to have ample inventory to treat both COVID-19 and non-COVID-19 patients.
PIH Health Physicians
PIH Health’s medical group, PIH Health Physicians (PHP), adapted to the challenge at the medical clinics. All staff and practitioners were provided education on recognizing the symptoms of COVID-19 and other risk factors. Every clinic location implemented masking and COVID-19 screening protocols as well as ensured that hand hygiene products were readily available.
For those patients who were not comfortable seeing a physician in person, PHP swiftly offered a new service—telemedicine—to sustain patient access. More than 90,000 patients were seen virtually and had their healthcare needs met with the help of technology. Patients were also able to request medication refills without having to physically visit clinics.
Urgent Care Centers
Many of the protocols implemented at our hospitals, such as screening before entering and wearing PPE, were also adopted at PIH Health Urgent Care Centers (UCC). Patients were able to be tested at the UCCs if they met the criteria set forth by the CDC and LACDPH. Over, 10,000 patients have been tested for COVID-19 inside of our Urgent Care Centers. UCC staff stepped up to the challenge to best treat patients as new protocols were established and modified as the pandemic progressed.
Home Health and Hospice
Home Health and Hospice is unique in that these departments care for patients in the comfort of their homes or in PIH Health’s Hospice houses. With COVID-19, we continued to see all Home Health and Hospice patients amid changing workflows, and even increased the census by 42% in one quarter (Q2 average census 669, Q3 averages census 948). Employees of this area adhered to all precautions including screenings and were provided with PPE packs when out in the field. Communication tools were put in place to keep off-site staff informed of the ongoing changes throughout the pandemic. Hospital nurses were also cross trained to the Home Health environment to assist with the surge of patients and expansion of service area.
Patients were also offered telemedicine phone or video appointments when requested. Home Health staff educated patients on proper hand hygiene and how to take extra precautionary measures for living with someone who has COVID-19. To ensure patients had access to all of the resources they needed, additional community assessment questions were asked by staff at each visit to ensure patients had access to food and water and information about how to pay bills and deal with household income loss. If necessary, social work involvement was coordinated to assist the patient with resources and needs.
PIH Health’s Food and Nutritional Services department also worked with Home Health to expand the number of meals provided through the Meals on Wheels program to support isolated individuals in their homes.
Acute Rehabilitation Center and Transitional Care Unit
The Acute Rehabilitation Center (ARC) and Transitional Care Unit (TCU) staff followed all other hospital protocols to best protect themselves and patients. As in many other areas, the staff had to adjust to rapid changes, almost daily, all while supporting one another during a difficult time.
A COVID-19 communication board was launched in all post-acute care areas with daily postings and updates to ensure staff had the most current information. In the ARC and TCU, real-time education was conducted regarding: COVID-19 transmission, patient testing, donning and doffing of PPE, proper procedures for patients needing aerosol generating procedures, and nasopharyngeal swab specimen collection. COVID-19 testing was also implemented for all TCU patients and staff.
Human Resources, Gift Shops, and Marketing Communications
Human Resources (HR) ensured that employees working in COVID-19 units received specialty pay as well as meals and refreshments, and that staff lounges were equipped with all necessities so that staff would not have to leave restricted areas. PIH Health paid for hotel rooms, housing support, and childcare, as needed. We also offered expanded benefits, such as unpaid personal leave for childcare and school closures.
Pop-up grocery stores were opened in our gift shops and cafeterias so that employees could conveniently purchase essentials without the need to shop after their shifts.
Effective communications both internally and externally were an integral part of our COVID-19 program. A COVID-19 communication page featuring new and updated information was added to our employee intranet; while a newsletter, email, posters, flyers, and other communication channels were used to ensure all staff received new and updated information in a timely manner. The public received updates on COVID-19 inpatient numbers via PIH Health’s social media channels, our website and via the mainstream media.
Our Information Solutions (IS) team provided integral technology services to our community by rapidly implementing telemedicine capabilities, which enabled remote patient visits with hospital as well as outpatient clinicians. Social workers and chaplains continue to use telemedicine technology to provide virtual sessions to staff and patients needing emotional and spiritual support.
IS also developed a COVID-19 dashboard viewable on the employee intranet showing daily cases, ventilator capacity, and PPE availability. This system has analytics built in to curate data from across the enterprise to increase staff awareness and contribute to real-time local, state and federal data collection.
To better serve patients, IS provided Apple iPads® so patients in restricted units could connect with loved ones at home. IS also collaborated with HR to develop an online concierge that enabled employees to access COVID-19-related benefits and helped to expand work-from-home capabilities by creating virtual application pools for many functional departments.
Community/PIH Health Foundation
Our commitment to the community during the pandemic was supported by local officials who worked with us to provide local residents with access to COVID-19 testing. PIH Health worked jointly with Los Angeles County Supervisor Hilda L. Solis to create and staff Los Angeles County COVID-19 mobile testing sites at PIH Health Good Samaritan Hospital in downtown Los Angeles and in the city of Bell, and with Supervisor Janice Hahn to offer drive-up testing at PIH Health Whittier Hospital.
Additionally, PIH Heath partnered with local law enforcement and fire officials to ensure transport of potential COVID-19 patients was safe. We also thank our first responders for honoring our “Health Heroes” at each of our hospital sites with physically distant drive-thru parades.
Thank You to Our Community
The efforts of our physicians, staff and volunteers were supported by the overwhelming generosity of our community. For that, we say “Thank You!” PIH Health is deeply appreciative for the $1.3 million raised in support of our physicians and staff in the face of the pandemic. This funding has gone toward securing critical medical supplies to keep our professionals safe, and to providing resources, such as child care and personal protective equipment, so they can continue providing excellent care to our patients.
We also received generous donations of medical-grade masks, gloves, hand sanitizers, sanitizing wipes, isolation gowns, and numerous other equipment and supplies. Residents and organizations crafted homemade masks and laundry bags for soiled scrubs, and our neighbors shared words of encouragement and prayers in the form of cards, letters, and even sidewalk chalk art. Local restaurants and businesses donated food or delivered meals for our hospital workers to help fuel them during their shifts.
The support we received from the community during the COVID-19 pandemic has been overwhelming. We are so appreciative of all of the donations over the past several months. Thank you! Our full list of generous supporters is available at PIHHealth.org/ThankYou.
Business Recovery and Response
When news of the pandemic first broke, we had to rise to the challenge and find a new way to manage business operations. To do so, we swiftly revised our business models so that we could continue to provide care in a time of uncertainty.
In March 2020, many elective surgeries and medical office visits were put on hold. This significantly reduced PIH Health’s volume. To match the lower in person demand, we established a COVID-19 hotline, staffed by nurse practitioners, and reallocated staff to assist with other tasks such as pre-visit screenings.
To reassure PIH Health’s patients that we were still operating and that their care should not be delayed, we communicated all the measures we were taking to keep patients safe. We continued outreach to our community via marketing channels including social media and one-on-one phone calls to inform patients that we remained open to care for their health needs. In fact, we placed approximately 100,000 calls to community members.
The implications of the pandemic on PIH Health were substantial, but by September 2020 patient visit volume was back on track and in some areas volume was even higher than before the pandemic. The telemedicine strategy that was implemented has yielded nearly 60,000 visits since March.
As we continue to function with COVID-19 as part of our daily routine, our highest priority remains patient, physician, staff, and volunteer safety while providing the quality care the community counts on and trusts.