Hospital leaders look at how Wichita responded

In Affiliates by admin

Wichita’s two acute care hospital systems – Ascension Via Christi and Wesley Healthcare – combined treat roughly 60,000 patients a year, are licensed for up to 1,400 beds and field hundreds of physicians with privileges in the organizations’ five area hospitals. And that doesn’t include freestanding ERs, surgery centers, behavioral health facilities, senior living facilities and other related services that comprise the state’s largest health systems.

So when the coronavirus pandemic hit the United States hard in March, Via Christi and Wesley became leaders in COVID-19 management and protocol, determining how patients were treated and tested, when and if visitors could come to the hospitals, and how to keep thousands of physicians and hospital staff safe through it all.

“I think the hospitals did well,” said Sam Antonios, MD, chief medical officer for Ascension Via Christi. “We were early on, taking it very seriously – we started doing what we could based on the evidence we had.”

This month, the Medical Society of Sedgwick County asked hospital leaders Antonios and Lowell Ebersole, DO, chief medical officer for Wesley Healthcare, to reflect back on the medical community’s response to COVID-19 in Sedgwick County.

Dr. Antonios

Sam Antonios, MD
Chief Medical Officer, Ascension Via Christi

Reflecting on the response to COVID-19, Kansas earns high marks, Antonios said. The swift actions from local and state officials has helped keep COVID-19 numbers comparatively low in Wichita and allowed hospitals and health officials to do what needed to be done to minimize spread of the virus.

Antonios said the fact that the governor was the first in the country to cancel schools was a big step and that Sedgwick County quickly followed suit with business guidance and stay-at-home orders. What people take for granted is how these swift and early actions impacted the success of Sedgwick County’s COVID containment.

“Unfortunately, neither Sedgwick County nor the government will ever get credit for the limits on the loss of lives because people don’t see the alternate trajectory that could’ve happened,” Antonios said. “It looks like we didn’t have a whole lot of cases, hospitalizations or deaths, so people will focus on this and will not realize there was another trajectory that could’ve occurred that was averted.”

As a result, Antonios said, people will misread the low numbers and think all is fine, that COVID-19 does not exist in Wichita. And that’s what worries him.

“Here’s the thing. More people know someone who has lost a job or has had a pay cut or has been furloughed than they know individuals who have become very ill – or died – from COVID-19,” Antonios said. “It all comes down to people’s perception of risk Ö we really don’t know how to look at ëriskful’ events.”

So, many people aren’t paying attention to social distancing. A majority of folks do not appear to be wearing masks in public anymore. The fact that Sedgwick County isn’t under a lockdown seems to be interpreted that the pandemic is not an issue here, Antonios said.

That’s why it’s up to the medical community to model good behaviors.

“The No. 1 thing we’re asking physicians is to be understanding of the changes, to be patient, and to model good behavior,” Antonios said.

Moving forward, Antonios said the medical community can learn a lot from what’s happened over the past few months. There could be better collaboration between acute care and post-acute care facilities. There could be more and better conversations across the community of physicians on issues such as adopting plans to accept patients, delaying or continuing surgeries and other health care services, administering testing, and distributing PPE and important equipment such as ventilators.

For today, the community as a whole needs to focus on how to control the virus and prevent a potentially worse surge in cases or even deaths. The medical community needs to have as much testing as possible, Antonios said. Physicians play an important role in underscoring how important it is to take safety precautions, even when there is no official lockdown or mandatory masking.

“Right now, the only tool we have is social distancing and behaviors that reduce transmission,” he said. “People need to behave reasonably – washing hands, wearing masks, not going to work if you’re sick. If people don’t do that, we’ll never get out of this.”

Dr. Ebersole

Lowell Ebersole, DO
Chief Medical Officer, Wesley Healthcare

Coming off of last year’s full throttle response to a Joint Commission survey under new rules, Wesley Healthcare found itself well positioned to respond to this year’s pandemic crisis.

It was crisis-ready. It was fast. It was efficient and organized in a way that only trial by fire brings an organization, Ebersole said.

“Because of lessons learned from Joint Commission last year, I really found myself drawing on that experience,” he said. “It came down to, here’s things we know, here’s what we don’t know, let’s prepare. And that’s what we did. We adapted quickly and rolled with the things we didn’t know.”

While the COVID-19 scare is far from over, Ebersole is at a point today where he can look back at the past few months, take a deep breath and analyze how his hospitals did and what they could do better going forward. He credits a team of leaders who worked endless hours mitigating a large health system’s medical response to a largely unknown and deadly virus.

It meant rallying physicians and staff under a new playbook that turned business-as-usual into something topsy-turvy, the battle against invisible germs that threatened patients, services, supplies, and personnel. It redefined grace under pressure.

“We didn’t panic,” Ebersole said.

Ebersole also credits the leadership of Wesley medical staff, which he said “stepped forward in a big way.” Medical staff officers, medical directors, infection prevention experts, emergency staff – all had to respond to a tremendous amount of rapidly evolving changes. Health experts and hospital systems across the nation recorded and adapted to new information as it came out, sometimes from one minute to the next.

Many physicians and nursing staff worked first-access points. A lot of people put themselves at risk on the front lines, Ebersole said. Countless others toiled behind the scenes trying to protect the physicians and staff and others who kept the hospital running. Some practically lived at the hospital – leaders working nonstop in one of the most intense and stressful situations imaginable, as pictures of hospital patients in body bags in other parts of the country drove them.

“Lessons learned for me were communicate, communicate, communicate,” Ebersole said, who met daily with key stakeholders – both in the hospital, with the parent company, HCA, and with local, state and national health officials – to plan the clinical and operational tactics to COVID that would define hour-by-hour response at Wesley in the first half of 2020.

“It was surreal to think back on the plans we made and how we would implement them at some point,” he said. That included where to put extra beds if needed – do they convert the lobby? – and how to handle increased capacity should Wichita begin to resemble New York or Seattle or even Denver. “They were plans you’ve never really thought about before,” he said. “We had a master plan to increase our capacity to over 700 patients if needed, if it got to that.”

Thankfully, it didn’t, Ebersole said, but now those plans are in place for the future. He tried to record minutes and notes during the crisis so that at some point he can look back and document everything they learned, identify strengths and improve on weak areas.

While it’s hard to find levity in the COVID situation, the hospital system did identify one change that brought more than a few knowing smiles: quit implementing changes on a Friday afternoon. “We did, like, four Fridays in a row of things, then that meant everyone was here over the weekend,” Ebersole said. “Some things have urgency and need to get done, but reflecting back, we had leaders here for 30-40 days in a row or more.”

Ebersole said the pandemic and the health system’s response to it was the most intense experience of his life, both professionally and personally. The weight of responsibility shrouded him like a grim cloak, driving him to prepare, analyze, and prepare some more.

“That’s our job – to prepare for the worst and hope for the best,” he said.

Today, Ebersole remains on alert. Wesley has celebrated having zero COVID patients for a few days one week, and an uptick in positive cases the next. Like many health leaders in Sedgwick County, he worries about the lack of responsibility so many people are exhibiting in the community for protecting themselves and those around them. Without that, “our numbers are unfortunately going to keep climbing,” he said.

The problem, he said, is that it’s not personal enough

“You see behavior change when it becomes personal,” Ebersole said, who fears a second wave is imminent. “Most people are saying ëThis isn’t going to impact me’ because we’ve only had about 240 deaths in Kansas. The lack of following guidelines is my biggest concern. Because of that, I’ll remain on alert for the hospitals.”

Wesley’s priority is to continue to be able to accommodate a surge, Ebersole said. The hospital system is in a solid place with PPE, testing platforms and supply chain. But flu season is coming, and COVID-19 is still around. There are still many unknowns surrounding the coronavirus. The only thing hospitals can do is be diligent and systematic about preparing and managing for the future, he said.

“I don’t think any of us will ever forget this,” Ebersole said. “Hopefully this is the only pandemic in our lifetime that we live through.”