Many of my friends have described their very positive recent experiences at Sharon Hospital in Sharon, CT, during these last difficult months. Their enthusiastic comments made me realize how fortunate we are to have a local health care facility in our rural area. It made me wonder how the hospital adjusted to this sudden emergency. What were the tough decisions? And what about those tents? Dr. Mark Hirko, who became head of the hospital only in December, generously agreed to take the time to answer some questions.
When did peak COVID-19 virus admissions occur at Sharon Hospital?
The first and second week of April was our peak, but we still maintain a COVID-19 census between three and twelve patients at any time, which is essentially where it was at its peak.
Thinking of the last few months, what are the biggest changes at the hospital caused by the COVID-19 virus?
The change in health care delivery overall has been the biggest change. The use of telemedicine for remote appointments appears to be something permanent. This is very likely to lead to a major shift in the traditional delivery of primary/ambulatory care and the doctor-patient relationship. Right now, virtual visits are crucial to keeping people connected with their physicians for primary and specialty care needs that are routine and proactive, preventative health measures. As a health system, we’ve quickly adapted and ramped up our virtual visit offerings. We’ve converted our outpatient ambulatory services into telemedicine for more than 80% of all visits – and this is in just the last six weeks.
Our inpatient census, normally 20 to 40 patients each week, is lower because Emergency Room visits are down compared to last year, and elective procedures and tests were suspended in the second week of March.
Our Emergency Room continues to provide necessary services for critical conditions like strokes, heart attacks, lacerations, and other emergencies. Everyone should be aware of symptoms that might indicate serious medical conditions and seek attention when needed – don’t delay. When someone is admitted for emergency surgery, they will receive a rapid COVID-19 test using the Abbott machine; however, there are limited testing materials and reagents for this, so it is only used in critical emergency situations.
How did Sharon Hospital prepare for the virus?
Executive leadership at Nuvance Health began contingency planning in January to stay ahead of the curve as the outbreak was progressing overseas. Connecticut’s surge planning required all hospitals to increase their bed capacity by 50% and develop proactive contingency plans. Being a community hospital, we maintained our nine licensed ICU/critical care beds and added six more by restructuring those available in our post-anesthesia care unit. Any patient that required long-term mechanical ventilation was transferred to one of our sister hospitals in Danbury, Norwalk, or Poughkeepsie.
What were the major problems Sharon Hospital faced?
Actually we did not face many significant problems. The Nuvance Health system has been meeting since January, setting up contingency planning in case this grew and progressed rapidly. The proactive measures we’ve taken from the start have made all the difference. This was done in parallel with our health system learning how to connect as a larger group and assimilate our operations across each hospital. For example we were able to centralize all PPE, staffing, and medical equipment through our emergency command structure to ensure everyone was readily prepared and establish fair distribution based on need. As a result, Sharon Hospital did not experience any lack of PPE or necessary equipment.
How many corona virus tests did the hospital conduct?
I don’t have a specific number but it is in the hundreds. If you count outpatients, we are doing 30 to 40 tests a day. We have had many people come to the emergency department as outpatients, and based on their symptoms, they are referred to their primary care physician or to one of our collection sites to be tested. Sharon Hospital does not have an in-house polymerase chain reaction-based (PCR) testing apparatus to analyze patient samples for COVID-19. We send all nasal swabs completed at the hospital to off-site labs for analysis using this test, which detects the presence of the active COVID-19 virus to determine if someone is presently infected. Anyone who presents to the Emergency Room with symptoms that fit CDC guidelines for COVID-19 receives a nasal swab test, as do employees who show symptoms that could be indicative of COVID-19. These samples are then sent to state-approved private laboratories or one of our sister hospitals that have the capability to test them for COVID-19. Most of those who are tested go home because they do not require hospitalization.
What was the average stay at the hospital for COVID-19 patients?
Critically ill COVID patients have been transferred to Danbury Hospital, Vassar Brothers Medical Center in Poughkeepsie, and Norwalk Hospital. These three hospitals are Level 2 Trauma centers with advanced instrumentation, intensive care units, and the sophisticated critical-care tools to treat severely ill patients.
Here at Sharon Hospital we mostly managed outpatient observation, and now our focus has shifted to offering care for patients who need a place to safely convalesce and recover.
Where do your patients come from?
Some cases we see are local to this area and neighboring towns, while others have been non-critically ill patients who have been stabilized at our sister hospitals and brought here to recover. We are all interchanging patients depending on what level of care we can offer. It’s working very well and we are doing our part by accepting patients from other parts in the system who had no place else to go.
How many COVID suspected patients have come to the hospital?
Most days, we have between four and seven patients coming in who are evaluated and anywhere from two to three are positive. However, most of these patients go home because they do not require hospital care.
Has the tent actually been utilized for patients?
The site is under ownership of the State of Connecticut and the office of Governor Ned Lamont. It will only be used at the discretion of the Governor in the event of a statewide surge in COVID-19 cases. It has not been determined what type of patients would receive care in the field hospital, but so far it has not been utilized.
Have any staff been infected?
As of May 11, 2020, no employees have been knowingly exposed to COVID-19 at Sharon Hospital. If you have symptoms such as fever, sore throat and a cough, you are not able to come to work until you return to good health. We are screening all staff and patients who come into the hospital every day to ensure a safe environment for all.
Are COVID-19 tests available now?
Testing nationwide is in a quandary. We have capacity for the traditional nasal swab tests at four testing sites within the health system. If we discuss rapid testing (Abbott test), our entire system has been allotted approximately 200 tests per week to be distributed across all seven hospitals. We would love to test everyone, including our employees, with this modality, but there are limitations to testing materials and reagents to this day, so we remain limited. At this time, we are currently validating the serology antibody test that can help determine the antibody status of patients who are known to be COVID-19 positive and could possibly donate blood plasma for convalescent therapy.
When will elective procedures restart at the hospital?
All Nuvance Health Hospitals have stopped elective surgeries, procedures and outpatient services that are not essential system wide. They will begin again as instructed by the state.
Were any employees furloughed?
We experienced no shortage of staff here and have not suspended any employees. Physicians, nurses, and other personnel were cross-trained in specialty areas, such as intensive and emergency care, to enhance our work force. Our system developed a centralized pool of employees and we placed them based upon their skill set and patient needs in each location.
Does the staff feel appreciated for their work and dedication?
On a weekly basis, we receive an outpouring of small acts of kindness from the immediate community and region at large. This has included donations of personal protective equipment, food, flowers, letters, and artwork. The staff members are very grateful for this generosity, and it has been an honor to serve alongside this team. My own experience leading the hospital during this time has been an exercise in trusting your team, forgetting about pride, asking for help, and remembering that every patient is a statistic of one. COVID-19 has brought unexpected challenges for everyone, but it’s also presented an opportunity for our communities to come together and help one another.
What will be the impact of the virus going forward?
It’s changed our society. Our social network, places of employment, and interactions, which are second nature, are now being redrawn to fit an environment where we are coexisting with COVID-19. As an inpatient facility, we are now looking at the extended forecast to prepare and develop work flows to limit the impact and spread of COVID-19 in the future. On the positive side, the silver lining, the virus has reinforced the ties and bonds all of us share with family and our homes.
What about the $1 million challenge grant?
An anonymous donor from the region has offered to match up to $1 million in philanthropic support for COVID-19 emergency preparedness efforts at Sharon Hospital. In other words, every donation will be matched, dollar-for-dollar, to help us enhance and invest in technology, supplies, equipment, to safely care for individuals affected by COVID-19 and to prepare for potential future health emergencies. Significant gifts like this strengthen our ability to advance patient care and meet the health care needs of this region.
FOR YOUR INFORMATION:
Sharon Hospital is part of Nuvance Health, a family of award-winning nonprofit hospitals in the Hudson Valley and western Connecticut – plus multiple primary and specialty care physician practice locations, including The Heart Center. In addition to Sharon Hospital, Nuvance Health hospitals include Danbury Hospital, New Milford Hospital, and Norwalk Hospital in Connecticut; Northern Dutchess Hospital, Putnam Hospital, and Vassar Brothers Medical Center in New York. Dr. Mark Hirko was named president of Sharon Hospital in early December 2019. A board certified vascular surgeon, he has been a physician and health care leader for over 25 years.