MUSC Health tri-weekly COVID-19 report (April 6)

CHARLESTON, S.C. (April 6, 2020) –At MUSC Health, the safety of patients, families, care team members, students, faculty and staff remains the number one priority. In an effort to provide accurate, relevant and timely COVID-19 information to news media in South Carolina and beyond, the MUSC Public Affairs and Media Relations (PAMR) department issues regular COVID-19 updates on Monday, Wednesday and Friday of each week. Please read the report in its entirety.

IMPORTANT UPDATES FOR MUSC HEALTH SYSTEM FINANCE AND OPERATIONS (INCLUDES REGIONAL HEALTH NETWORK- FLORENCE, MARION, CHESTER AND LANCASTER HOSPITALS, ALL MUSC HEALTH CLINCS)

Like many other health care systems across the nation and around the world, the COVID-19 virus has placed tremendous financial pressure on MUSC Health. To help flatten the curve of the COVID-19 pandemic, South Carolina government officials encouraged social distancing strategies and urged all hospitals to halt or significantly reduce surgical procedures and other patient care activities that were not urgent or emergent. Since this time, MUSC Health surgical volumes have been decreased by 75%, inpatient encounters decreased by 30% and ambulatory encounters have been reduced by 70%.

As a result, MUSC Health leadership is taking action to fortify the health system and diminish continued financial damage caused by this public health crisis. Every action is linked to maintaining the short- and long-term capability and viability of the health system. Mitigation strategies to address the COVID-19 crisis include:

Transition 80% of ambulatory/outpatient visits to telehealth
Reduce purchased and contractual services
Reduce supply utilization to match volume and critical needs
Delay capital expenditures
Adjust and realign workforce to sustain essential services with compensation reduction and temporary layoffs

Leadership spent the day beginning discussions with care team members, sharing specific information about workforce adjustments for particular areas. Those discussions will continue throughout the week. Team members will be connected to community resources, such as how to apply for unemployment under current COVID-19 conditions.

There are no easy solutions here. No one wants or likes to make difficult decisions that have negative effects on members of our MUSC Health family. It’s important to understand that these decisions impact everyone. Every member of the MUSC Health team will see some impact to their pay, including a 20% reduction for leaders, a 15% reduction for salaried employees and a reduction in work hours for hourly paid employees who do not provide direct patient care. It is also important to emphasize that at this time, frontline health care team members, who have already seen fewer work hours due to COVID-19 response, will not see any additional pay cuts so that MUSC Health can continue to be prepared to face the public health crisis as it unfolds. Unfortunately, MUSC Health must temporarily lay off approximately 900 health care team members at this time.

MUSC Health is reviewing in detail the state and federal fiscal stimuli proposals that have been publicly announced. There are no guarantees on the timing or amount of these funds that MUSC Health may receive. Some of the rules are not clear and not all of the proposed benefits and funds apply to MUSC Health. We are actively engaged in understanding eligibility, timing for distribution and the amount of funds MUSC Health may receive.

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The following information is for the Charleston area only. For information about MUSC Health Florence or Marion Medical Centers, please contact Kim Geiger at geigerki@musc.edu. For information about MUSC Health Chester or Lancaster Medical Centers, please contact Ashley Shannon at shannona@musc.edu.

CONFIRMED AS OF 4-6-2020:

Basic stats

Telehealth screenings through musc.care: Approximately 25,000

Total patients seen at West Ashley specimen collection site: Approximately 4,500

Inpatient pending rule-outs: 10

Total number of completed COVID-19 tests: 4,791

COVID-19 positive cases

Inpatient: 3

Outpatient/community collection site: 292

Total: 295

Health care workforce: 41 (this number is included in the total number above)

The safety of our care team remains of utmost importance to us. At this time, no MUSC Health care team member has developed COVID-19 from hospital or ambulatory patient exposure; our care team members who tested positive for COVID-19 acquired the virus from community and travel transmission. Our care team members are not allowed to come to work if they are experiencing COVID-19-like respiratory symptoms or if they have not completed the testing process when known to have a high-risk exposure in or outside of work. Many of our care team members have fared well and recovered quickly.

MUSC Health has a very conservative COVID-19 specific return to work policy for health care workers that goes beyond CDC guidelines to protect our patients, families and other care team members.

We support our team member's rights to privacy and protection of health information and will not confirm or deny name, role or any other identifying information related to COVID-19 positive cases for our workforce. We have internal notification and tracing protocols in place to contact those patients who may have been at high-risk for exposure from a health care provider.

Surge capacity

MUSC Health has begun collaborating with the Army Corps of Engineers and the National Guard to plan a field hospital/care facility on campus, should it be needed, for COVID-19 patients who do not require critical care. All chain of command protocols will be appropriately adhered to at local, state and federal levels. The Army Corps of Engineers and National Guard will proceed with any plans at the direction and discretion of the appropriate state agencies.

MUSC Health also has plans to use recently vacated, critical care space in the old Children’s Hospital, now known as University Hospital Extension, as well as possible ICU space in Ashley River Tower for approximately 130 extra beds. We are working with our regional health network hospitals in Florence, Marion, Chester and Lancaster to assess and plan for surge capacity in those parts of the state. We continue to assess other options with area partners and organizations.

Supplies / Equipment

General status (green, yellow, red): GREEN

We are not currently out of any items at this time, however, we are centralizing the distribution of certain supplies, such as N95 masks, in an effort to conserve personal protective equipment (PPE) prior to a surge in COVID-19 patients.

Reducing the overall use of PPE, where safe to do so, is the single most effective strategy for conserving our supply of PPE. These practices are based on the recommendations of the CDC; it is important to note that CDC guidance around PPE use for COVID-19 has been fluid as experts learn more about the virus and its transmission. Hospitals and health systems throughout the state are doing their best to align with that guidance to keep care team members and patients safe, and at the same time must manage supply chain preparation and preservation needs while still uncertain about exactly how much PPE will ultimately be needed. Given those guiding principles, MUSC Health care team members should:

Work expeditiously to transfer non-COVID-19 patients out of airborne infection isolation rooms.
Centralize the supply of all PPE items in a secured area.
Clearly identify essential personnel who will care for any rule out or confirmed COVID-19 patient and limit entry into the patient room to essential individuals.Limit the number of individuals in the room when performing high-risk aerosol generating procedures.
Use face-fitting N95 respirators while in the same room as a rule-out COVID-19 or lab-confirmed COVID-19 patient. Do not wear face-fitting N95 respirators while in hospital common areas unrelated to patient care activity.
Use surgical/isolation facemasks when experiencing minor respiratory symptoms attributable to non-infectious causes (e.g. mild nasal congestion consistent with personal allergic history).

Care team members may now wear a surgical/isolation face mask while in common areas of the hospital and ambulatory clinics.Wearing a face mask while in the hospital does not remove the need for very close self-monitoring, compliance with social distancing (at home and as much as possible at work), staying home when ill and strict compliance with other PPE measures.

We recognize that our care team members are experiencing anxiety and stress as we move closer to a potential patient surge. In asking our local care team members to do things differently than our normal protocols, some individuals may experience even higher levels of anxiety and stress and we will continue to work with those individuals and extenuating circumstances on a case by case basis.

Ventilators:We monitor ventilator use across our system and are pulling in more capacity in real-time. The exact number continues to be a moving target as we double-check current equipment, receive new equipment and pursue new supply chain pathways in the private industry as well as through state and national assistance efforts. We hope to provide more detail soon.

MUSC Health asks that media and the community please take into account that the ability to care for patients who need ventilators involves a number of variables; our current stock is considered adequate as we prepare for a possible surge in hospitalized COVID-19 patients.

MUSC Health is encouraging the community to donate the following supplies at the MUSC Warehouse in North Charleston, located at 4295 Arco Lane Charleston, SC 29418, in preparation for patient surges related to COVID-19:

N95 masks

Surgical masks

Protective eyewear

Face guards and face shields

Sterile gloves

Hand sanitizer

Industrial cleaning wipes

Thermometers (all kinds)

Pharmacy needs:

Hydroxychloroquine

Azithromycin

Ethanol

200 proof USP-grade alcohol

Details are available here: https://muschealth.org/patients-visitors/coronavirus-information/donations-to-musc-health

MUSC Health Operations and Financial Impact – Charleston

MUSC Health, and the entire health care industry, is experiencing unprecedented challenges in the face of COVID-19. Since January, the MUSC Health system has been planning and preparing for COVID-19, creating layers of new process designs and supply chain mitigation strategies. This work must take into account constantly evolving information about the virus, its growing prevalence and best practice recommendations from the CDC and others to protect our patients, health care workers and larger community. It is complex, difficult, and yes, it is imperfect.

We are encountering unprecedented and serious financial deficits generated by the rapidly evolving COVID-19 crisis. We take very seriously the responsibility to meet the health care needs of our state and community, as well as preserve the well-being and capability of our enterprise for the future. Please see the statement at the beginning of this report for an important update.

MUSC In-house COVID-19 testing capability

MUSC Health has fully mobilized its in-house testing capability: https://web.musc.edu/about/news-center/2020/04/02/musc-health-is-first-hospital-medical-center-in-state-to-do-its-own-covid-19-testing. This web article provides a deep dive into how it’s happening, who is involved and the steps MUSC has taken to make it possible.

MUSC Health is no longer sending specimens to DHEC or private labs at the present time. Patients accessing screening and specimen collection through musc.care should see a significant decrease in wait times for test results.

MUSC COVID-19 info for repurpose with permission/credit or follow-up story ideas:

https://web.musc.edu/about/news-center/2020/04/06/musc-students-volunteer-to-care-for-health-care-workers-kids-during-covid-19

https://web.musc.edu/about/news-center/2020/04/01/rnprep-podcast-with-encouraging-messages

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About MUSC

Founded in 1824 in Charleston, MUSC is the oldest medical school in the South, as well as the state’s only integrated, academic health sciences center with a unique charge to serve the state through education, research and patient care. Each year, MUSC educates and trains more than 3,000 students and nearly 800 residents in six colleges: Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy. The state’s leader in obtaining biomedical research funds, in fiscal year 2019, MUSC set a new high, bringing in more than $284 million. For information on academic programs, visit musc.edu.

As the clinical health system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest quality patient care available, while training generations of competent, compassionate health care providers to serve the people of South Carolina and beyond. Comprising some 1,600 beds, more than 100 outreach sites, the MUSC College of Medicine, the physicians’ practice plan, and nearly 275 telehealth locations, MUSC Health owns and operates eight hospitals situated in Charleston, Chester, Florence, Lancaster and Marion counties. In 2019, for the fifth consecutive year, U.S. News & World Report named MUSC Health the No. 1 hospital in South Carolina. To learn more about clinical patient services, visit muschealth.org.

MUSC and its affiliates have collective annual budgets of $3.2 billion. The more than 17,000 MUSC team members include world-class faculty, physicians, specialty providers and scientists who deliver groundbreaking education, research, technology and patient care.