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In January, St. Claire Regional Healthcare System was bustling with activity. Three months later, the hospital would be eerily quiet, the parking lot nearly empty, with visitors and some contractors a thing of the past.
Headquartered in Morehead, Kentucky, St. Claire’s main hospital was like its own little city with food service, vendors, contractors, medical students, employees, and visitors walking through the halls, said Donald H. Lloyd, II, SCH President and CEO.
St. Claire provides health care services to those in eastern Kentucky. Covering eight counties, the system has one hospital in Rowan County, and four clinics in Frenchburg, Olive Hill, Owingsburg and Sandy Hook, Kentucky. The healthcare system also provides mental and behavioral health services, palliative care, aesthetics care, dental care, and pharmaceuticals.
As Covid-19 struck the country, St. Claire had to adapt, fiscally and physically, to serve the needs of its patients, both inside its hospital and out.
At the end of 2019, Lloyd said, St. Claire was restructuring its financial picture. After finishing the prior fiscal year about $ 9 million in the red, the hospital did a reduction in force, eliminating some positions and offering early retirement buyouts in order to reduce expenses.
“It was a short-term pain to get to long-term viability for the organization,” Lloyd said.
By February, there was positive cash flow, he said, and the hospital’s financial picture was $5 million better than it was before. And then, the global pandemic came to Kentucky.
On March 13, Kentucky Governor Andy Beshear started shutting down the state. Elective surgery procedures were canceled. Businesses and schools were closed. Stay-at-home orders were instituted.
“We had seen very substantial growth and things were going well and then Covid hit,” Lloyd said. “We virtually wiped out all of our gains in March.”
By the end of March, St. Claire spokesperson Amy Riddle said, it was clear that changes needed to be made. The loss of revenue from elective surgeries, which account for 90% of the hospital’s surgeries, forced the hospital to make personnel changes.
“With all the restrictions placed on us, these were necessary measures,” she said. “All of the staff that have been furloughed are not on the frontlines of Covid-19. If we do get a surge, some of those employees may come back, if their skills can transfer to the clinical settings, and they understand that.”
The employees were split between the hospital’s Foundation, or non-profit arm, and its education department. Most of the employees were administrative and not clinical, she said.
By April, the hospital was quiet, and the hospital’s visitor parking lot was empty. Except for the police.
“There was virtually nothing in the visitor parking areas because nobody was allowed to be here,” Lloyd said. “But there was a strong law enforcement presence around the hospital which created kind of an eerie effect.”
Brought it to handle an anticipated surge of Covid cases, the state police and national guard units were authorized by the governor to give extra protection to hospitals and their employees.
The first case of Covid-19 showed up in Rowan County in March. The hospital had by then converted into two separate areas – a hot zone and a cool zone. Hot zones had Covid patients or those suspected of having Covid.
“You would walk down a corridor and you would see this huge barrier that you had to don and doff protective equipment and then zip through a series of barrier walls in order to enter where the actual patients were,” Lloyd said. “It was just so surreal. It was like from a science fiction movie.”
With quieted halls and empty parking lots, Lloyd said he and his staff noticed something else. Patients weren’t coming into the ER with heart attacks.
“On the video calls with my colleagues, not only here in the Commonwealth but across the United States, we were all asking ourselves ‘Where are the heart attacks, where are the strokes?’ We all thought the coroners must be extremely busy,” he said. “My chief medical officer and myself had numerous conversations with our coroners and a realization came that if we did begin to see a spike in deaths in the general population that our coroners would actually be the first to observe them.”
In fact, many patients stopped coming to the hospitals out of fear – a development that left Lloyd and his team concerned about patients with continuing medical conditions who were missing out on their treatments.
“We aggressively worked to contact these patients, especially those that we knew have chronic conditions and reminded them that it was imperative that you know they needed their conditions to be monitored and managed,” Lloyd said. That meant identifying which of the healthcare facilities 200,000 patients had chronic conditions that could be exacerbated by lack of treatment and contacting them to urge them to come in for treatment.
He estimates hospital and clinical practice staff reached out to more than 25,000 people in the area by phone, social media, or other ways, to urge them to come in for treatment.
The fallout from untreated chronic conditions became the real surge, he said. Patients with chronic conditions, untreated, became patients with acute exacerbations coming to the hospital’s emergency room.
Still helping those patients get the care they needed called for yet another adaptation – access to telehealth services.
In many cases, Lloyd said, patients were able to see doctors via telehealth services. But for many of the patients in the rural areas of the eight counties the hospital serves, high-speed broadband wasn’t something those residents had.
Instead, the hospital used its empty parking lot to set up an area where patients could come in, park, access the hospital’s WiFi, use the hospital’s tablets and visit their healthcare provider through telehealth.
“Our patients have really embraced that, and we perceived that people that you know that maybe live at the margins, or that maybe have a lower education level would be intimidated by the use of that technology. On the contrary, they have embraced it,” he said. “Many of our patients (in outlying counties) can’t afford to travel to Morehead or they have very limited transportation ability. It is amazing to me how effective this technology and the use of telemedicine has been for us to connect with them now.”
Since mid-May, Lloyd said, the hospital has started to come back to normal. While still below what it was prior to Covid, hospital visits are increasing, surgeons are catching up with the backlog of elective procedures and some of those furloughed have been brought back.
But some of those necessary adaptations, he said, are in his mind, here to stay.
“I think [telehealth] is part of the new reality going forward in the way we deliver care and that there is going to be, for Saint Clair healthcare and our enterprise, at least 25 percent of our future patient encounters will be virtual,” he said.
Other changes, like hot and cold zones, personal protective equipment, and dealing with Covid-19, are here to stay, he said. “Covid-19 isn’t going away,” he said. “It’s with us to stay. And we’re going to have to adapt and learn how to live with and treat it, just like we do other conditions.”