Rebuilding America: Patients should expect to see more telehealth, more masks and more temperature screening in health care settings as Arizona reopens.
There will be more virtual medicine, equipment innovations and stepped-up restrictions in hospitals as Arizona reopens, local health leaders say.
Hospitals in Arizona started getting back into a pre-pandemic routine on May 1 by resuming elective surgeries, which had been halted by a March 19 executive order by Gov. Doug Ducey.
But patients will notice many changes, too. Health systems in Arizona have begun innovating to solve supply chain problems that emerged during the pandemic and those creative solutions, such as using 3D printing to make high-grade medical masks, are here to stay, said Dr. Keith Frey, chief medical officer for Dignity Health in Arizona.
“I do think that health systems like ours are going to be much less dependent on things out of their control for equipment, particularly that’s critical to do our work,” Frey said. “We’re less dependent than we were and more dependent on some of our innovations.”
Another change: Anyone having elective surgery will typically need to get tested for COVID-19 beforehand and hospitals have created separate entrances for those patients.
Banner Health, which is the state’s largest health system, is installing no-touch thermometer technology that uses a “thermal camera” to take the temperature of anyone who goes into its Level One trauma hospitals in Arizona and Colorado, chief clinical officer Dr. Marjorie Bessel said.
For some of the larger hospitals, that can be several thousand employees per shift. The technology is made by Sunell, a video surveillance company based in China.
“We have really decreased the number of entrance points that we have in our hospitals. So some of our hospitals are very large and prior to COVID they had many entrances,” Bessel said, explaining how Banner is able to put that kind of screening in place.
“We went through a type of technology that allows us to more rapidly screen. … So far it’s worked really well for us. For those individuals that look like they are above the threshold temperature, we then go through an additional screening process with them.”
Bessel has asked Banner employees to lead by example as the state reopens by maintaining the six-foot social distancing rule, continuously wearing a mask and frequently washing their hands, among other procedures.
As the COVID-19 pandemic took hold in Arizona, half of all visits to primary care doctors within Arizona’s Dignity Health system quickly shifted to telemedicine, Frey said.
Now that so many patients and providers are familiar with the technology, Frey expects some of the use of virtual medicine will stick, and be maintained at a level that’s much higher than it was pre-pandemic.
Health care in Arizona will not ever go back to exactly the way it was, Frey predicts.
“The analogy I’m thinking of is how airport security changed permanently after 9/11,” Frey said. “I think the new normal in health care is going to be just a different way that we try to avoid people being in large herds as they go through the system.”
Members of the public are likely to rethink how to position themselves in waiting rooms, whether it’s in an emergency room or a doctor’s office, he said.
“I do think the crowded waiting room of the past is probably going to go away,” Frey said. “Think about going to your doctor’s office and you’ve got a mix of people there, some are coughing and sneezing. … I think we are going to see that change significantly.”
When patients do go into provider offices, practices have already changed. Some offices have started keeping two containers for the pens patients use to fill out forms at the front desk — one for clean, one for dirty. Frey predicts more spacing between waiting room chairs and more intense sanitizing practices.
Frey says there have been some big lessons learned from the pandemic that has resulted in permanent changes at Dignity Health, which is part of the nonprofit CommonSpiritHealth chain that operates in 21 states.
One lesson was that the supply chain for items such as isolation gowns and medical-grade masks is fragile. As a result, Dignity Health’s Barrow Neurological Center recently began making its own P100 masks with 3D printers, Frey said.
The P100 mask traps nearly all airborne particulates in its filter. The more commonly-used N-95 mask will filter out about 95% of airborne particles.
“This specific invention was borne by a crisis,” Frey said. “We are used to creating cutting-edge things for technology and highly specialized care, but we flipped the switch and focused on what the emergent need was, and they rose to the occasion.”
Another innovation that resulted from the pandemic: Banner and Dignity Health began a partnership with FABRIC Tempe to make reusable isolation gowns for health care workers.
“Traditionally, we buy those, stock them and throw them away,” Frey said. “Now with this new model we are not only fabricating our own, but they are reusable. They can be washed up to 100 times. Not only did we stabilize our need for these supplies, we also are providing a more sustainable, earth-friendly model.”
Innovations were not limited to the supply chain. “Intubation boxes” that Dignity Health began using during the pandemic are now the new norm, officials said.
The boxes provide a plexiglass-like hood over the head and shoulders of the patient who is being intubated.Intubation means putting a tube through a patient’s mouth and into their airway in order to connect them to a ventilator.
The intubation box is an additional layer of protection for health care workers to prevent them from getting exposed to airborne germs, Frey explained.
The boxes are similar to the plexiglass shields that have gone up in front of cashiers in grocery stores, pharmacies and other places of business during the pandemic, he said.
Another outcome of the pandemic is that it raised awareness about the importance of primary care, Frey said. More people are now aware of the drawbacks of using emergency rooms for non-emergency care, he said.
“In a perfect world, we wouldn’t have everyone who is sick running to an emergency room. They would have a family doctor or pediatrician,” Frey said. “We have those in the United States but we don’t have enough of them.”
Frey predicts that COVID-19 will spawn an era of stabilization and expansion in primary care.
“That way we can save the emergency rooms for people who are having emergencies like a stroke or a heart attack and they are not all crowded with people who have coughs and colds, worried that they have COVID-19 and maybe who could have been taken care of with a telehealth visit,” Frey said.
At Banner Health, all employees are doing what Bessel calls “continuous masking.”
That means every employee, whether a patient financial rep, a nurse or a custodial services worker, is always wearing a medical mask.
Support staff at Banner Health are working from home and that is going to continue indefinitely, Bessel said. Other new processes have been put in place, too, including more disinfection of what she calls “high touch areas” in Banner facilities.
“It’s a new virus, it’s a new type of pandemic for all of us and there certainly remain a lot of unknowns,” Bessel said.
How long the mask-wearing and symptom-checking will last remains unclear because Bessel, Frey and other Arizona health leaders are braced for a second and even third wave of COVID-19.
“A worst-case scenario is that we still have a lot of COVID-19 and we next year have a very bad flu season,” Frey said.
It may just be that new practices such as wearing masks become permanent changes for all health care providers and medical support staff.
“I think everybody, of course, is concerned that we may have additional waves second waves, multiple waves, we really don’t know for sure,” Bessel said.
“Given that we don’t know what the future holds, for those that need a surgery, we are really recommending that people come in now. … I would not recommend that anyone delay care.”
Health providers in Arizona suffered devastating financial losses after elective surgeries stopped. Some received federal CARES act funding and small business loans, but others did not. The long-term effects of those losses remain unclear.
An analysis by the Arizona Hospital and Healthcare Association shows Arizona hospitals are reporting revenue losses of 30% to 40% because of the cancellation of elective procedures and a reduction in emergency department visits. Statewide, that equates to a revenue reduction of $430 million to $575 million per month.
- Less dependence on the hospital supply chain. Facing a shortage of personal protective equipment during the pandemic, health systems such as Dignity Health in Arizona have started producing their own protective gear, including 3D printing P100 masks.
- Added safety measures at hospitals. No-touch screening thermometers have been installed at some of Banner Health’s Arizona hospital entrances.
- More hoops to jump through. Patients getting elective surgeries in most Arizona hospitals will first need a negative COVID-19 test.
Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes
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