A line in Bronson Methodist Hospital’s emergency state filing to temporarily add 300 beds epitomizes the main challenge for boosting capacity for an expected surge in COVID-19 patients in the coming weeks.
The Kalamazoo hospital’s ability to put the added beds into operation “will be dependent on staffing,” according to a filing with the Michigan Department of Health and Human Services.
As with every hospital during the COVID-19 pandemic, Bronson has been planning for a patient surge by simultaneously looking at how to add capacity and then staff those beds, if needed.
“In order to care for an increased number of patients, Bronson plans to redeploy staff members who are not currently in clinical roles, but who are clinically licensed. We have many RNs who work in education, quality and safety, management and other departments who will return to a role of providing patient care,” Denise Neely, senior vice president for Bronson Healthcare and chief operating officer and chief nursing officer for Bronson Methodist Hospital, said in a statement to MiBiz.
“We are currently identifying those staff members and will refresh them on current processes before they return to clinical care. We are also calling on retirees who may be willing to return to the workforce,” Neely said.
The temporary beds that Bronson wants to add in Kalamazoo, plus 43 beds at Bronson Battle Creek Hospital, are among more than 1,100 planned by West Michigan hospitals in response to the COVID-19 pandemic, according to a review of emergency state filings. Hospitals in Southeast Michigan also are planning to add hundreds of additional beds.
To adequately staff those beds, hospitals are pursuing tactics such as shifting doctors and nurses to where they are needed most and urging retirees to return temporarily or to volunteer to care for COVID-19 patients and non-COVID-19 patients.
Two executive orders by Gov. Gretchen Whitmer have sought to give hospitals a greater ability to ramp up capacity and prepare to staff additional temporary beds.
An order issued March 20 required hospitals, outpatient surgery centers and state-operated facilities to postpone all “non-essential” procedures as soon as possible and for as long as a state of emergency remains in effect from the COVID-19 pandemic. Many providers had already done so prior to the order.
The cancellation of elective surgeries and procedures gives hospitals greater flexibility to adjust and move care providers, said Julie Bulson, director of emergency preparedness at Grand Rapids-based Spectrum Health, which has 15 hospitals across West Michigan.
“So we have a full team that is looking at how we can effectively redeploy our workforce to be able to care for patients, both in the hospital and maybe in some non-traditional locations,” Bulson said.
Mercy Health Saint Mary’s in Grand Rapids also plans to redeploy staff as needed from non-clinical duties in administration and leadership roles, and from reporting data to insurers and regulators “that we just think can wait,” said President Dr. Hyung Kim.
Mercy Health Saint Mary’s, as well as Mercy Health Muskegon, also can bring in staff from sister hospitals across the country owned by parent corporation Trinity Health, Kim said.
According to a state regulatory filing, Mercy Health Saint Mary’s would add 200 beds in Grand Rapids to handle the expected patient surge.
The hospital has been closely tracking equipment needs and exactly how to use additional beds, from critical care for patients who require a ventilator and a higher level of care, to regular medical/surgical beds and low-acuity convalescent units.
“We’re going to need to be adaptable, because as the need for additional beds goes up, then we’re going to need to keep a close eye on what are the types of beds that are needed,” Kim said. “That’s going to really affect the number and the types of clinical staff that we need to do it, so we’re trying to stay adaptable.”
Metro Health-University of Michigan also is planning to add beds to meet a pending patient surge, as well as identify alternative care sites, “including a collaboration on a central downtown facility if needed,” CEO Peter Hahn said.
“We are closely following predictive modeling and are in regular communication with our fellow West Michigan health care systems. We have devised surge plans that will optimize patient care and best utilize our resources. We have multiple plans being operationalized in parallel,” Hahn said in a statement to MiBiz.
An executive order the governor issued also enabled regulators to waive regulations for hospitals to add beds or locations so they can “construct, acquire, or operate a temporary or mobile facility for any health care purpose, regardless of where the facility is located.” Many hospitals soon afterward began filing emergency applications with the state to add beds. The Department of Health and Human Services has been quickly approving the emergency requests.
The need for additional hospital beds, locations and staff depends on the accuracy of modeling used to predict the pandemic’s spread and peak, and how well people adhere to the governor’s stay-home order and social distancing, Bulson said.
Spectrum Health already has prepared the Grand Valley State University Cook-DeVos Center for Health Sciences across Michigan Street from Butterworth Hospital with 250 temporary beds as an overflow location to care for non-COVID-19 patients. If needed, Spectrum also would add 36 beds and convert 55 medical and surgical beds into ICU beds at Blodgett Hospital in East Grand Rapids.
“As we look at some of these alternative care sites, we’re going to have to use them as a community resource because all of the hospitals are going to surge,” Bulson said. “We certainly are going to have to rely on some of the other health care organizations in the community as well as volunteers to step up and be able to help fill in staffing in some of these non-traditional locations, and just to ensure that we have that backup in case some of our staff gets sick.”
Muskegon Community College has an agreement with Mercy Health and the state to use the on-campus Health and Wellness Center as a site for 50 hospital beds for overflow and lower-acuity patients.
Mercy Health Muskegon would use the MCC Wellness Center “if we really got a significant surge,” said President Gary Allore.
“At this point, we’ve been pretty stable, but we have it available to us, which is a really nice opportunity,” Allore said last week.
Mercy Health Muskegon would add beds at the Mercy hospital campus on Sherman Boulevard, where it opened a new patient tower a year ago. Space is available on floors that were not previously scheduled to go into operation until the fall, Allore said.
Additionally, Norm Beauchamp, Michigan State University’s executive vice president for health sciences, said the College of Human Medicine has talked about offering the Secchia Center in downtown Grand Rapids as a temporary care location.
In Southeast Michigan for example, the state and the Federal Emergency Management Agency have converted the TCF Center in downtown Detroit into a temporary care location with 1,000 beds. The state also has chosen the Suburban Collection Showplace in Novi as an alternate care facility for up to 1,000 beds.
Bulson said hospitals for years have crafted emergency plans for mass outbreaks that could strain their capacity. A coalition across a 13-county region in West Michigan that’s leveraged federal grant funding has looked at possible scenarios and planned accordingly, she said.
The 23 hospitals in the region also have in place an agreement through a memorandum of understanding to share staff and equipment in emergencies “and we would support each other in situations like this,” Bulson said.
“So we might be able to utilize staff or equipment from a location that’s not hit as hard as maybe another organization. We can share staff back and forth,” she said. “We feel like we are prepared for this. We have been preparing for a very long time.”
Another executive order Gov. Whitmer issued March 29 temporarily suspended scope-of-practice provisions in the state’s Public Health Code for licensed, registered or certified health care professionals. The order allows hospitals and other care facilities to use physician assistants, nurses and other qualified professionals to work without supervision from a licensed physician where they are employed or contracted to work.
“Responding effectively to the urgent and steep demands created by the COVID-19 pandemic will require the help of as many health care professionals as possible, working in whatever capacities are appropriate to their respective education, training, and experience,” according to the executive order.
The state has set up a website for medical professionals and students to volunteer at care providers.
Students step up
The governor’s executive order also allows students enrolled in programs to become a licensed, registered or certified health care professional to volunteer or work in a facility “in whatever roles that are necessary to support the facility’s response to the COVID-19 pandemic and are appropriate to the student’s education, training, and experience.”
The order specifically allows medical students, physical therapists and emergency medical technicians to volunteer or work under the supervision of physicians, respiratory therapists or advanced practice registered nurses as “respiratory therapist extenders” assisting to operate ventilators and other medical devices.
Faculty members at Grand Rapids Community College’s nursing program have volunteered locally at Spectrum Health and other care providers. So have students at MSU’s College of Human Medicine, staffing hotlines for information on COVID-19 and screening staff as they enter hospitals, Beauchamp said.
Hospitals also can expedite credentialing for licensed care providers so they can move “from one location to the next pretty quickly,” Bulson said.
Spectrum Health has been closely watching the COVID-19 pandemic’s spread in the hard-hit Detroit area to learn and better prepare for an expected patient surge in West Michigan that modeling shows will come in early May.
“We really need to watch what is happening over in the Detroit area and the east side of the state, and understand that we had the benefit of time on the west side of the state to more dramatically impact or put into effect some of those processes that are going to help decrease the spread of the disease,” Bulson said, emphasizing the need for people to stay home and maintain social distancing.
“Detroit is looking like Detroit right now because they didn’t have the ability to put into place stay-at-home processes like we have been able to do over on the west side,” she said. “We need to take advantage of that and learn from some of the other locations that didn’t have the insight from those other responses to be able to make a difference.”
Mercy Health in West Michigan has been in daily communication with sister hospitals in the Detroit area who have provided valuable advice.
“From a West Michigan perspective, we’re learning a lot from the surge experience they’re seeing,” Allore said. “We’re learning about how we can better prepare for what’s coming to West Michigan.”
The advice from Trinity sister hospitals in Southeast Michigan ranges from better gauging how much personal protection equipment is getting used to care tactics in treating COVID-19 patients.
Mercy Health’s colleagues in the Detroit area also are “helping us to stay focused on taking seriously what our models are telling us about the volumes that we can expect and the trajectory that we can expect,” Kim said.
“The numbers on the west side of the state do continue to be lower and so it’s easy to see the number here and feel like, ‘Oh, maybe it’s going to be OK,’ but being on the calls reminds us that it used to be like that on the east side of the state, too. It keeps us focused to make sure we’re prepared for the surge here,” he said.
Models as of last week show that the coming patient surge “is going to be lower and it’s going to occur later than the initial models suggested that they might be, so that’s a really good change,” Kim said.
That change reflects the effectiveness of social distancing and staying home, Kim said.
“It seems like it’s making a real big difference, so we hope that everyone will continue to do that,” he said.