The Phoenix-based Banner Health system encompasses 28 hospitals, 18 of them in Arizona. Early on in the emergence of the COVID-19 pandemic, the leaders of patient care organizations in Arizona began preparations for an anticipated surge in cases statewide, at a time this spring when the virus was surging in New York and in Washington state, but hadn’t yet begun to do so in Arizona. A collaborative of health systems was able to stock up on personal protective equipment (PPE), and to set in place plans for eventual surges in patient volume.
In the past two weeks, COVID-19 has now surged dramatically in Arizona as well as in Texas, Florida, and a few other states. In that context, the leaders at Banner Health have prepared well for the current situation, in which their health system is managing an enormous surge in patient volume because of COVID-19.
As a news update published to its website on June 25 and which incorporates quotes from Marjorie Bessel, M.D., Banner Health’s chief clinical officer, notes, “At any given time, Banner Health is treating about half of the patients in Arizona hospitalized with COVID-19. Throughout the pandemic, teams have been load balancing across the system's network of hospitals so no single facility is overwhelmed. Dr. Bessel said Banner Health is doing all it can to avoid exceeding its surge capacity, and that is why the public's help in curbing the spread is paramount.” And it quotes Dr. Bessel as stating that "We are absolutely experiencing a surge of COVID-19 patients that are coming in for care, and we are starting to get full. We do have plans, however, to continue to increase our capacity so that we can meet the demand of the communities and all the people that we serve in there. But we do ask everybody to follow all the things that we can do to try and reduce the curve of spread."
This week, Healthcare Innovation Editor-in-Chief Mark Hagland spoke with Charles A. (Charley) Larsen, R.N., senior director of transfer services at Banner Health, regarding the current moment. Below are excerpts from that interview.
How is your health system handling the current surge in COVID-19 patient volume?
Right now, it’s all about trying to align the resources with the needs. Normal processes are accentuated ten-fold. We’re going into creative and innovative staffing plans. And I work with the transfers area; we’re putting into place a lot of policies and procedures, as best as we can, and trying to get visibility—trying to understand how particular regions of our service area in Phoenix and Tucson are doing, and how particular hospitals and departments are doing, and getting resources aligned.
The scarcest resource right now is staff. We’re having to bring in supplemental staff. And we do have some folks who are getting sick. And it becomes a whole different game when you’re starting to care for staff, who are now caring for their own colleagues and friends now.
And within that staffing scarcity, what are the titles or job functions that are scarcest?
Our scarcest resource right now is nurses, but it depends on the day. Today it might be nursing and tomorrow physicians, or support staff; the cleaning staff are more important than ever. Each presents its own challenges. And maybe it’s just because I’m a nurse, but it’s very present now.
In that context, you must be engaging more agency nurses, then correct?
Yes, we’ve been bringing in crisis nurses, as New York did; inf act, many of those same folks who were caring for people in New York, are here now. And given that we’re at a level three crisis—there’s normal staffing for each department and service area. Now, we’re going into different staffing models, to move nurses from telemetry into ICU, for example. I’m an ICU nurse, and I went through 12 weeks of training before I touched a patient in the ICU. But we don’t have time for that now.
So this is like MASH unit-type or field hospital-type training, then?
It’s a modified form of training, with shorter time frames, yes. The nurses are going through a much quicker training. We’re not training them to engage in every single task; rather, we’re training them to perform certain specific functions. A normal ICU nurse load might be two patients; but a telemetry nurse modified to work in the ICU might have three or four patients to care for, under the supervision of an experienced ICU nurse.
What have been some of the other challenges?
We’re closely monitoring our PPE. We’re blessed that we had time to get some equipment in. So we’re monitoring that closely, we’re monitoring the ventilator use and trends, so that if we need to activate some things. But outside staffing, most of it is preparing and maintaining and elevating things. We expect that it will only be getting busier over the next month, and are preparing for that ongoing increase in patient volume.
How are you managing the fullness of your ICUs and of your facilities?
We’re monitoring it very closely. Normally, this would be our low season. We normally would not be very busy at this time, which is a blessing. Hopefully, this will get under control before the normal flu season. There’s a little blessing in disguise that that’s happening now. Our ICUs are full, and our nurses are tired. We’re using stretch assignments. Our ICUs are full, we’re expanding our ICUs, creating ICUs in alternate care sites. More than anything else, we’re working with what have become COVID ICUs.
Would you say that your ICUs are currently 90-percent COVID?
I don’t want to put a percentage on it, but COVID is helping to fill our ICUs. And we had all creating plans to expand our ICUs, with the state government, and so we just keep expanding our ICUs.
Is patient transferring more complex now with COVID-19?
It absolutely is. It’s added so many elements. We partner with a local transportation company to actually move the patients. I help to organize the transfers, and so the ambulance companies we contract with are having to get PPE, make sure their rigs are wiped down and cleaned after each transfer, all those elements. They have to take the rig out of service each time and clean it after a transfer. But as far as finding the bed, getting the physician on board, making sure we have an adequate corps of nurses, is so important, ad is more challenging.
And I helped to stand up the statewide surge line for Arizona. That helped all of the hospitals in the state. We went live in April. I was there for the month of March and the beginning of April—when everything was happening in New York.
And you’re seeing younger patients, correct? And are patients having longer stays?
We are seeing younger patients, yes; I don’t know if they’re staying any longer. It doesn’t really change the care delivery patterns for us, per their age. Certainly, the physicians are a bit more aggressive in the lifesaving therapies, like ECHMO, their bodies are more resilient, so there are more clinical options.
Are you concerned about the fact that many Arizonans are resisting mandates to wear masks and to socially distance?
Absolutely. There is a lot of political and social unrest around all the measures being implemented. And it’s not perfect that we’re all walking around wearing cloth masks in stores, and such, but it’s better than nothing. And we’re learning as we go. And because we don’t know all the specifics, that sometimes incites unrest, with people perhaps thinking that there are alternate agendas. And that’s unfortunate.
What do the next two months look like to you?
It’s going to be a long two months. We did shut things down in Arizona except for essential services. And the rates were going down, and we reopened, and now we’re in the place where we are. The masking just went into effect just a week and a half ago. Yet we still have restaurants open; we’ve got some gyms suing the government to stay open, and we’ve got some nail salons still open. We’ll know in the next couple of weeks, some of the impact of it; but it’s only going to get worse for a while.
