Living and Learning through COVID-19

Members in Action Case Study

On June 4, Lincoln County Public Health (LCPH) recorded an outbreak of confirmed COVID-19 cases in Newport, Oregon, located about 85 miles southwest of Salem, Oregon. Five of these cases were connected to Pacific Seafood and they immediately began working with LCPH to get their employees tested.

The county is served by Samaritan North Lincoln Hospital, a 16-bed critical access hospital, and Samaritan Pacific Communities Hospital, a 25-bed critical access hospital. Both hospitals are part of Samaritan Health Services, which serves a threecounty region. Lesley Ogden, MD, CEO of both hospitals, had been preparing for COVID-19 since March and immediately launched their emergency disaster plan for a medical surge.

Background

Samaritan Health Services expanded COVID-19 testing for all patients with symptoms of coronavirus on April 22. They established drivethrough testing at Depoe Bay and Waldport for those who lived on the outskirts of the hospital service area. A clinician’s order was required and could be obtained via telehealth. The test was free to the patient.

Leading up to the spike in June, like many other health systems, Samaritan Health Services found themselves in need of personal protective equipment (PPE) and testing equipment and supplies. The biggest PPE need was hospital gowns. Samaritan Health Services became very creative soliciting help from a company in Salem that worked with fabric and patterns supplied by Samaritan Health to manufacture thousands of gowns for clinicians and others.

Samaritan Health Services also worked with a local not-for-profit organization, “Shield Me, Please,” to manufacture hundreds of face shields. “We became very resourceful building new relationships and finding new suppliers to meet our needs,” said Dr. Ogden.

Regarding testing equipment and supplies, rural hospitals always seem to be at the end of the supply chain. This was the case for Samaritan Health Services. They initially had difficulty sourcing and purchasing necessary volumes of nasopharyngeal swabs, M4 viral transport media and test kits. They next experienced long COVID-19 test turnaround times with contracted labs and incurred significant courier costs to get tests to and from urban centers where testing equipment was located.

Samaritan Health Services provided testing once the Lincoln County outbreak was confirmed in June. They learned that over 50% of those testing positive were Hispanic, many of whom lived in congregate housing without personal transportation. The proximity of the residents to one another combined with the need to carpool or walk to work together accelerated community spread.

Samaritan Health Services quickly found themselves at a disadvantage when they discovered they lacked cultural awareness to meet the needs of the influx of Hispanic COVID-19 patients including indigenous Guatemalans who migrated to the area and carry their traditions and dialect to their new community.

“This is an opportunity for us,” said Dr. Ogden. “We should have been prepared and COVID-19 exacerbated the situation, but we recognized it as an opportunity to accelerate a solution to the problem.”

The learning curve was steep and they quickly joined forces with the LCPH and Centro de Ayuda, a center for cultural awareness, education, service referrals, and language support, to understand the disparities in care and fill the gaps. Today, Samaritan Health Services participates in bi-weekly meetings with Centro de Ayuda, LCHP and residents to review and discuss disparities in access and how they can be eliminated. Samaritan Health Services has prioritized improvements in cultural competency and improved access to care for non-English speaking residents.

Staffing during a COVID-19 surge is difficult. Coincidentally, during the COVID-19 surge Samaritan Health Services had a vacancy for its chief nursing officer at North Lincoln Hospital. So, the CNO at Pacific Communities also served as interim at North Lincoln. He soon discovered that being responsible for both hospitals helped him understand staffing patterns that allowed him to share staff between the hospitals to meet demand and give relief to fatigued nurses. Ultimately, this arrangement became permanent.

As of July 31, LCPH has reported 7,000 tests of which 391 were positive. Samaritan Health Services estimates that they have performed over 5,000 of these tests. Fifteen people have been hospitalized and the county has recorded nine deaths.

Takeaways

Forewarned is forearmed: Samaritan Health Services proactively implemented its emergency disaster plan for a medical surge well before COVID-19 arrived in Lincoln County. Collaboration with the county public health department and others is a major component of this plan.

Personal protective equipment remains scarce: Although we are several months into the COVID-19 pandemic, the supply chain still lags and PPE remains scarce. Creative solutions are required to meet the demand for PPE.

Flexible staffing allows for better care and a safer work environment: Being able to flex staff between the two critical access hospitals allowed managers to monitor changes in scheduling to accommodate shifting demands in coverage, keeping patients and staff safe.

Cultural awareness is necessary for cultural competency: Lincoln County has a diverse demographic including indigenous Guatemalans who have introduced their dialect and traditions to their new community. Knowing this has made Samaritan Health Services better able to meet the needs of these residents.

Testing is the crux of managing COVID-19: With the support of the broader Samaritan Health Services system, Samaritan North Lincoln Hospital and Samaritan Pacific Communities Hospital were able to get ahead of the surge. Without these resources they may have not been so fortunate.

Conclusion

Presently Samaritan Health Services’ coastal hospitals have gone over a week with no hospitalized patients. Positive tests have declined and admissions have dropped to zero. Although the pace has slowed the effect of the surge on staff has taken its toll. Samaritan Health Services has mobilized its Wellness Council and has designed a wide array of options such as meetings, a mindfulness app, virtual yoga and an employee assistance hotline, and they allow employees to pick from among the solutions that work best for them.

Lincoln County is a tourist destination on the central Oregon coast of the Pacific Ocean for many who reside in Portland, Salem and Eugene. This summer has been busy despite the COVID-19 pandemic. This makes Dr. Ogden nervous. “The ER has been busy and we resumed elective surgeries. We could spike again at any moment,” she said. “If we can get through the summer, then maybe we can put the surge behind us.”