Avera McKennan CEO offers look at hospital’s plan to handle coming surge

April 13, 2020

Buildings are being repurposed, staff are being newly trained, and Avera McKennan is bracing itself for a surge of patients with COVID-19.

The hospital is the provider for employees who use Smithfield’s health insurance. Whether the employees who have tested positive – 293 as of last week and likely still growing – create an influx of patients in the coming days remains to be seen; regardless, the health system has been making major changes in anticipation of increased demand as COVID-19 moves through the community.

We spoke with president and CEO Dave Flicek, who offered a detailed look at how patient care will be changing.

Beginning with eCARE

The plan for managing capacity within health care facilities starts with virtual health care. Many patients in and outside of Sioux Falls will see a provider virtually before a decision is made about testing or transferring to Avera McKennan or other facilities.

“What this triage model does is it allows people not to come to the ER to put our ER in overload,” Flicek said.

A majority of patients – possibly 85 percent – will be cared for at home and instructed to follow up with their providers.

If patients have a fever greater than 100 degrees, new onset of cough or shortness of breath, they should continue calling 877-282-8372 (877-At-Avera) or their clinic to determine a course of action.

If patients have worsening shortness of breath, blueish lips or face, or conditions such as heart attack, stroke or serious injuries, they should seek emergency care.

Patients can call 911 for emergencies or go to the emergency rooms at Avera McKennan’s main campus, the site at 26th Street and Marion Road or Avera Heart Hospital.

Expanded ER 

The Avera McKennan emergency room typically has 18 patient bays. That’s going to increase to 80 when the anticipated surge hits.

“It’s going to be all hands on deck,” Flicek said. “We’ll have family doctors and specialists trained in to help.”

Avera typically includes two dozen ICU beds. The plan is to have capacity for up to 80 at the height of the surge.

The goal is to concentrate COVID-19 patients on the same floors because of the need for personal protective equipment.

“We’re going to have various floors that fill up first,” Flicek said. “And we’re going to have a new, clean ICU.”

Multipurpose Prairie Center 

One of the first stages of Avera’s surge planning was to identify the Prairie Center, which typically provides cancer care, as an additional 150-bed location for COVID-19 patients. That will include intensive care beds.

Certain functions were moved out last week. This week, the building will be equipped for future patients, so staff who will work there can start training.

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A separate entrance will be used for patients needing radiation oncology and PET/CT services, which will stay at the Prairie Center because of the complexities of the equipment.

“We want to reassure our cancer patients there will be a separate entrance,” Flicek said. “And things will be blocked off so we can keep a separate environment, and most of the cancer patients will be treated at the Specialty Hospital because we’re trying to keep that a clean space as well.”

Repurposed staff

A number of staff are going to be taking on new roles.

“We’re looking at a tiered strategy where higher-end licenses support other licenses,” Flicek said.

For instance, a nurse who typically works in a clinic could be reassigned to work in a hospital and will work alongside a hospital-trained nurse.

Staff will start cross-training this week. Much of that will be done virtually for their protection, with limited in-person training inside the Prairie Center.

“You don’t want to expose more employees into a COVID situation, so we’re being smart about our training,” Flicek said.

Physicians who no longer are caring for patients in nonemergency situations could be working in a hospital emergency room or triage center. They have been told they could be deployed anywhere Avera serves with 24-hour notice.

“Everyone has listed their strengths and wishes, and we’re drafting them into the ER or hospital or outpatient,” Flicek said.

The staff  “want to know we have a plan and how we are going to handle it,” he said.

The health system has had a number of hotels reach out in case health care workers want to stay, he added.

“We have a list of them, and we have been giving them to our employees. When the surge hits, maybe some of our nurses and physicians won’t want to go home.”

Changes at Avera on Louise 

The Avera Specialty Hospital at the new Avera on Louise campus will become the home for infusion and clinics for medical oncology, hematology and bone marrow transplant, gynecologic oncology, breast surgery, breast center and palliative care. Avera Medical Group Integrative Medicine is moving to the Avera Medical Group Internal Medicine Women’s clinic at 116 W. 69th St.

If COVID-19 had hit one year earlier, this would not have been an option. The hospital opened last fall.

“I think God had a hand in some of this,” Flicek said. “That can be our facility to do some surgery still. It can take our oncology patients. It has a kitchen, so we can feed folks, so it is all working out. I just hope we can still flatten the curve and manage this.”

Alternative sites

Not all patients will be admitted to a traditional hospital.

Avera McKennan’s main hospital and the Prairie Center will care for the sickest of the sick. There are going to be other patient beds added at outside facilities where COVID-19 patients who are recovering or who do not have as severe symptoms might receive care.

“Based on your symptoms and maybe age or how you’re doing, you might go straight (to a different facility) on oxygen with therapy there,” Flicek said. “We have to keep looking at where we can keep people. And staff will be deployed and eCARE will be deployed on carts or by iPads.”

Tests and timing

The great unknown is timing. Avera and Sanford Health both had projected a surge in patients could start in late April or early May. The recent outbreak related to Smithfield could accelerate that, Flicek acknowledged.

Complicating projections is testing.

“The tests themselves are a rare commodity, so you really do need to have a physician make sure the right people are getting the test,” he said.

As cases mounted related to Smithfield, people began showing up for testing without a physician referral, which led to long lines.

“I think people got a little nervous and started showing up,” Flicek said.

Because there is not a plentiful supply of tests yet, not everyone who is symptomatic will be tested.

“If you’re a 26-year-old, normally healthy, but you have a fever and cough, we’re probably not going to test you,” Flicek said. “They’re going to say keep checking back.”

Once tests are done, results are coming in pretty well, he said. More tests are being administered than can be processed in a day, so some are still being sent to Mayo Clinic.

And there is a delay from when a patient tests positive and when that person likely could need hospital care. So far, the number of hospitalizations related to Smithfield is small, for example. But the first case was reported March 26.

In other cities, hospitalizations have started small, “and then they get run over,” Flicek said.

A physician practicing in Detroit who also provides service through Avera eCARES’ ICU said “she’s amazed at our planning and how lucky we are to have some time, but she said: ‘It’s coming your way. Just keep doing what you’re doing.’ In Minneapolis, they think in about two weeks is when they’re going to feel the surge,” Flicek said.

“Everyone we talked to says, ‘Good gracious, take this time to plan. Because you’re going to need it.’ ”

Those patients experiencing mental health challenges are encouraged to call 211 to be connected with needed resources.

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Avera McKennan CEO offers look at hospital’s plan to handle coming surge

Buildings are being repurposed, staff are being newly trained, and Avera McKennan is bracing itself for a surge of patients with COVID-19.

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