Case Study: Wilson Medical Center Implements Creative Care Alternatives to Address Covid-19

Overview

Rural communities’ patients are typically older than those in metro communities, and with the onset of COVID-19, many seniors are reluctant to leave their homes. Access to providers is strained as people avoid hospitals and clinics, yet are still in need of care.

Wilson Medical Center (WMC) in Neodesha, Kan., has found a solution to this challenge by instituting consumer-conscious caring with its curbside lab and clinics.

With the Kansas governor’s executive order to “stay at home,” WMC is working hard to provide safe care to its patients and help stop the spread of the virus by offering curbside lab care for well or sick patients and curbside clinic care for the sick.

“It is our goal to offer people safe alternatives for treatment,” explained Dennis Shelby, CEO at WMC. “With these new options, medical professionals can see patients from their vehicle and limit contact with others.”

The curbside lab is located at the hospital and does not require an appointment; patients may simply drive up. The only requirement is a lab order furnished by their provider or one that has been faxed to the hospital. When patients arrive, they are directed to a safe curbside lab location.

Alternative services provided by all three of WMC’s family medicine clinics – Neodesha, Cherryvale and Independence – are curbside visits and telehealth appointments.

Curbside visits resemble office visits, but from the safety of the patient’s vehicle. The patient may call any of the WMC family medicine clinics to schedule an appointment. When a patient arrives for their appointment, they call to notify the clinic of their arrival. Within minutes, a staff member wearing personal protective gear meets the patient at their vehicle. Clinic nursing staff check the patient in and take their vitals. Staff can then inform the provider that the patient is ready for their curbside scheduled visit.

Telehealth is another option for patients to safely see their provider from their home via their smart phone, iPad or computer. At WMC, patients must call the clinic to schedule an appointment. A medical assistant then contacts the patient to arrange the video connection procedure and connect them with a provider.

Some patients – most often seniors – lack the necessary technology to connect with a provider via telehealth. WMC accommodates these patients by sending a nursing assistant to the patient’s home with an iPad. This type of visit can be conducted in private and assists the patient in avoiding unnecessary travel.

Impact

Prior to the COVID-19 crisis, WMC’s well-established rural health clinics averaged 35 visits per day. After the governor’s executive order and the Centers for Disease Control and Prevention issued their COVID-19 recommendations, visits dropped by 70%. Currently, with the implementation of curbside visits and utilization of telehealth appointments, daily visits have increased to nearly 80% of WMC’s pre-COVID-19 levels.

Telehealth represents a new service for WMC clinics, enabled by Centers for Medicare & Medicaid Services waivers issued by President Trump as part of the national emergency, and helps meet a growing need to care for patients quickly. Health care leaders trained staff internally, and the clinics used a variety of options, including Skype and FaceTime to increase access.

Treating patients curbside still requires staff to protect themselves from this deadly virus. Like most hospitals, WMC lacked a sufficient supply of personal protective equipment to handle the demand.

WMC leaders resolved this in three ways:

1. WMC collaborated with Independence Community College’s Fab Lab to manufacture face shields. Using its 3D printer, ICC was able to replicate the design and produce reusable shields for $5 each with replacements. WMC also partnered with a local industry – Neodesha Plastics – which was able to make face shields for around $3.50 per unit.
2. With the shortage of gowns and medical masks caused by the COVID-19 crisis, WMC staff and several members of the Cobalt Engineering and Upholstery team worked together to provide WMC with 127 face masks and 65 hospital gowns. In addition, they provided 400 reusable face masks for clinics and nursing homes in Independence and Cherryvale. TLC Nursery supplied WMC and Cobalt (who supplied labor) with fabric usually used to protect vegetation from frost. The result was durable gowns that are reusable after washing.
3. Volunteers from across the region have applied their sewing skills to stitch hundreds of cloth masks and head covers for health care heroes on the front lines.

Lessons Learned

Change is inevitable, so prepare for it.

WMC added flexibility into their daily process. The absence of rigidity resulted in fresh ideas. “Everything is changing every single day,” Shelby said. “Don’t be afraid to step outside the box and, as a team, think creatively.”

Communication is key.

Using Zoom, Heather Hyler, chief nursing officer (CNO), coordinates WMC COVID-19 task force meetings with staff, including the CEO, public information office, physicians, nurses, infection control, materials manager, environmental services and others. Together, they brainstorm interventions one day and review the outcome the next.

Shelby also sends e-mails and communicates directly with staff, answering their questions about safety, security and emotional wellbeing. His team plans simple employee events to raise spirits and build morale.

Don’t sweat your missteps.

It is possible that WMC closed some of its services prematurely, Shelby admits, but that’s when its leaders got creative. “It’s ok to make mistakes and adjust,” Shelby said.

Future Goals

WMC medical providers have tested 41 patients for COVID-19 in Wilson and Montgomery Counties with no positive cases. Wilson County has tested total of 134 patients for COVID-19, which, of those, 50 came from an assisted living facility.

“The experience with curbside lab and clinics has been very well received by the community,” Shelby said. He will continue conducting these testing and outreach protocols in the future explaining, “I am encouraged by the number of people who are comfortable with telehealth.”

WMC has applied for, and received, accelerated and advanced payments from Medicare. However, it will use those funds judiciously. “We will attempt not to use these payments,” said Shelby. “The hospital inpatient volume has remained strong. The improvement in curbside lab and clinic volumes will hopefully minimize the use of the accelerated Medicare payments and the CARES ACT funds.”

Shelby and senior staff have been in constant communication with their senators and representative in Washington, D.C. to encourage support for additional CARES ACT funds.

“We are also hoping for more funding to be made available through the Small Business Administration for public hospitals like WMC,” Shelby said. “Our COVID-19 task force’s current focus is on reinstating routine surgeries and specialty clinics utilizing recommended guidelines outlined in phase one of the President’s ‘Opening up America Again.”

Moving forward, Shelby says WMC will adapt as necessary to continue providing high-quality care for patients. “We will continue to evaluate and adjust our services as needed through the upcoming months and prepare for a second round of COVID-19 that may arrive in the fall flu season.”