How St. Luke’s Confronted the Virus Triple Threat

00;00;01;04 - 00;00;39;08
Tom Haederle
With fall approaching, health officials across the country are once again bracing for a rise in respiratory illnesses, including the triple threat of COVID-19, flu and RSV.  In this discussion, two St. Luke’s Health System experts describe how they pivoted to provide respiratory care during last year's surge, and how the rapid creation of Respiratory Outpatient Clinics across the state made a tremendous difference for their patients.

00;00;39;10 - 00;01;07;06
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. COVID 19 hasn't gone away, and neither has the possibility of dealing with another "triple threat," the confluence of COVID, RSV and influenza cases that sent many young children to hospital emergency rooms not so long ago. St Luke's Health system based in Boise, Idaho, was among those that were quickly faced with a great surge in young patients.

00;01;07;08 - 00;01;38;13
Tom Haederle
In this podcast, two St Luke's experts describe how they coped and pivoted to make room for those who needed care and how the rapid creation of respiratory outpatient clinics across the state made a tremendous difference. This discussion was moderated by Kathy Cummings, former director of communications for AHA's Center for Health Innovation. She is joined by Dr. Allison Gauthier, director of the Pediatric Emergency Department for St Luke's Health System in Idaho, and Julie Snider, director of respiratory therapy for St Luke's.

00;01;38;15 - 00;02;01;01
Kathy Cummings
Alison and Julie, thank you so much for joining us on AHA's Advancing Health podcast. We're thrilled to have you here to help us kind of learn more about this topic around COVID 19 and the triple threat that we've been experiencing over these past few months with that in RSV and, of course, the flu. So I don't think we're out of the woods yet.

00;02;01;03 - 00;02;14;05
Kathy Cummings
It's been, I know, an incredibly challenging time for you guys. So I thought maybe you can start out by telling us about your role at St Luke's Health System, which I know is based in Idaho. And Alison, let's start with you.

00;02;14;08 - 00;02;31;14
Allison Gauthier
Hello. Yes, I am a board certified emergency physician as well as a board certified pediatrician. I work with the emergency medicine of Idaho and I am currently the Pediatric Emergency Department director and pediatric ED trauma director.

00;02;31;17 - 00;02;34;24
Kathy Cummings
Julie, tell us about your role at St Luke's.

00;02;34;26 - 00;02;48;03
Julie Snider
My name is Julie Snyder. I am a registered rectory therapist and I am the system director for respiratory therapy for St Luke's Health System. So I oversee all of the hospitals in our health system for respiratory therapy.

00;02;48;06 - 00;03;04;06
Kathy Cummings
So, Alison, last fall there was so much news coverage around this convergence of COVID 19, RSV, influenza and how it was hitting this nation hard, hitting our pediatric hospital units. What happened there?

00;03;04;09 - 00;03;45;02
Allison Gauthier
Well, I think this kind of goes back to the main reason why we quarantined in March of 2020, because we wanted to try to flatten a large number of patients getting sick at the same time. And that's exactly what we saw this last fall in our pediatric population. When you have a large group of people all getting sick, all requiring medical care, it's going to strain our already strained medical system and while adults can have also gotten RSV, influenza and COVID, it definitely was a huge concern to our children who had previously been masked or not going to school and now just getting exposed to all three viruses at once.

00;03;45;04 - 00;03;49;09
Kathy Cummings
And how did that impact your hospital? How did it impact capacity?

00;03;49;11 - 00;04;13;03
Allison Gauthier
It was a major effect to our hospital and it was a huge impact to the children and families that went through this. So we saw a record number of pediatric visits in our ER in Boise. For example, in December of 2021, the year prior, we saw about 700 pediatric E.R. visits for that month. And then December of 2022, we saw over 1100.

00;04;13;05 - 00;04;41;19
Allison Gauthier
And we are the only children's hospital in Idaho. So we expect to see larger numbers than other facilities. But this was a huge spike in ED visits. We had record number of admissions in our pediatric floor, as well as our pediatric intensive care unit. We were holding admissions in our ERs for a lengthy period of time up to even beyond 24 hours in the emergency department, waiting for a bed to be admitted.

00;04;41;22 - 00;05;11;29
Allison Gauthier
We were transferring children across the state to go to critical access hospitals for admission. We transferred children out of state for admissions. We canceled pediatric surgeries to try to limit their use of inpatient beds so we could admit children with these viruses. And we had frequent discussions to activate crisis standard of care for pediatric patients, which was not something I was ever hoping to have true discussions about.

00;05;12;01 - 00;05;18;08
Kathy Cummings
Well, the coordination of that sounds intense. And Julie, what were some of the effects you were seeing?

00;05;18;11 - 00;05;38;09
Julie Snider
Just like Alison mentioned, we were just overwhelmed with admissions and patients, not only on the adult side, but now on the children's side as well. And so that just put a real strain on our whole facilities. I mean, trying to get supplies, beds, staffing, trying to keep up and give, you know, the excellent care that we we pride ourselves on at St Luke's

00;05;38;11 - 00;05;50;13
Julie Snider
and to all of these patients. It was just very, very challenging. And then trying to place these kiddos in a facility where they could get the care that they needed. It was really overwhelming.

00;05;50;15 - 00;05;59;06
Kathy Cummings
Tell us about the young patients who were at most risk. Did they have other medical conditions or were these typically healthy kids?

00;05;59;08 - 00;06;30;23
Allison Gauthier
These are usually healthy kids. The highest risk are neonates. So children one month and less, and then also children less than two are usually the ones that are most affected by RSV. But we saw children up to the age of four still requiring admission for this. And if they those kids typically had some underlying reactive airway disease such as asthma, but they don't have to have asthma to have severe effects from bronchiolitis with RSV.

00;06;30;26 - 00;06;51;13
Kathy Cummings
So when you see rising cases like this, is it a surprise? I mean, how are you able to quickly turn things around, manage it, manage staff, keep your staff going after an incredible, you know, three years of a pandemic and knowing that things have been overwhelming for quite some time now. What was that like?

00;06;51;15 - 00;07;14;15
Allison Gauthier
Well, we definitely watch what happens in Australia because they have their winter prior to us. So we can see in the summer and we do closely mimic them. But typically in Idaho, our RSV season starts in December and this year it started in October. So we were pretty surprised with the timing. I think we were mentally thinking more in December, we would start to see an uptick.

00;07;14;18 - 00;07;26;23
Allison Gauthier
So we had to really kind of change our focus and have, you know, twice a day meetings to make sure we had accurate staffing and that we were prepared to take care of these children.

00;07;26;26 - 00;07;37;11
Kathy Cummings
Are we out of the woods now of this triple threat? Are there precautions that you're taking that your staff is taking to keep numbers down?

00;07;37;13 - 00;08;01;24
Allison Gauthier
I think we are getting better. Obviously, we still mask in our hospital. Hand-washing and stay at home when sick is huge to try to reduce the spread. But we have this flood of pediatric patients and Julie and I work together on creating a respiratory outpatient clinic so that way we could try to offload the burden of admissions as well as ER visits.

00;08;01;26 - 00;08;04;14
Allison Gauthier
And so, Julie, do want to talk a bit about that.

00;08;04;16 - 00;08;25;01
Julie Snider
Yeah, you bet. The respiratory outpatient clinic was just a great resource for our community. It was a respiratory therapy run clinic. It was by referral only because we did want to ensure that these children were seeing a provider and that they were appropriate to come to our clinic. We were able to do the clinic 24/7. It was free so anybody could come

00;08;25;01 - 00;08;49;03
Julie Snider
that was three years and younger and we would do nasal suctioning and an assessment on these patients. We were able to get this up and running in one month, which is just unprecedented for a health system. Our team just came together for everybody from the top down and to get this clinic up and running. These clinics really have shown admission reduction by about 30%.

00;08;49;07 - 00;09;15;29
Julie Snider
So we started off our clinic in our Boise location and then quickly moved throughout the rest of our system to get clinics up and running in every site we have. We saw about 457 encounters with 258 different patients. So we did have patients that came multiple times to the clinic. Of the 258 patients that we saw, 42 of them were referred to the ED after being seen in our clinic, but only about 21 of those were admitted.

00;09;16;01 - 00;09;51;02
Julie Snider
So when you look at those numbers, I mean, we saved about 216 visits to the ED, urgent care or provider offices that were already overwhelmed with patients coming in from everywhere. So it really was a benefit to our community. Our families were so grateful that they had a place to go and be seen quickly. Our wait times were about 5 to 10 minutes when you came in, so if you brought your child in, we were able to get you in and see you very quickly and then get you the care that you needed if you needed to be seen by a provider.

00;09;51;07 - 00;09;56;23
Julie Snider
So it was it was such a benefit for our community. It's something we plan on doing every season. 

00;09;56;25 - 00;10;07;14
Kathy Cummings
Yeah, I mean, those numbers are massively impressive. I mean, congratulations to you and your team's really, really impressive work. What were some of the best practices that came out of that?

00;10;07;16 - 00;10;32;03
Julie Snider
Well, I think one thing that we were able to do for our section clinic is we were able to do more education when those parents came in on how to suction your kiddo at home and keep them at home. We were also able to get some grant money from our children's institute that allowed us to give what we call nose Fridas, which are suction devices that parents can use at home to do a little bit better suctioning.

00;10;32;05 - 00;10;42;22
Julie Snider
So I think that has been really helpful on our education point to try to empower those parents to keep their kiddos at home. Alison, do you have some more to add to that?

00;10;42;24 - 00;11;08;10
Allison Gauthier
I think it was great because in the ER when we saw these kids that were maybe borderline and we just wanted to have very close follow up for them and giving them the information that they could go to this clinic 24/7 for free just to get reevaluated was huge off the air burden about getting follow up and placement and and just knowing that there was this safety net for these patients was huge.

00;11;08;12 - 00;11;11;04
Allison Gauthier
That was a great thing to have for us.

00;11;11;07 - 00;11;18;28
Kathy Cummings
And when we see hospitals responding like that, I mean, tell me about how that helps build trust in your communities.

00;11;19;01 - 00;11;39;02
Allison Gauthier
Well, because we are the children's hospital, I think that we have some trust already built in. And I think providing this service helps increase that because they saw how much we cared for these families and and what we were willing to provide for them 24/7 just to help further further that trust.

00;11;39;05 - 00;11;53;02
Kathy Cummings
Well, let's talk specifically about COVID 19. For a while now, I know we're kind of still in this aftermath, but as you look back over the last couple of years in pediatric care, how has it changed the way that you deliver care?

00;11;53;05 - 00;12;19;09
Allison Gauthier
Well, hospitals and clinics had to really change strategies. We saw a lot go to telehealth visits, which have benefits, but also there's some difficulties with that without being able to do a proper physical exam or vital signs. Pediatric medicine in general, does not create the same revenue as adults medicine. And so we've seen several pediatric hospitals across the US closed.

00;12;19;12 - 00;12;48;07
Allison Gauthier
And so I think that forces a lot more burden on other pediatric hospitals in those areas. Even in Idaho, we had another hospital system close down their pediatric inpatient area due to cost and health care worker shortages. And so we saw kind of the uptick from that as well. And in order to reduce costs and try to recuperate after big expenditures like COVID, we are trying to reduce ED utilization.

00;12;48;07 - 00;13;00;15
Allison Gauthier
And it's a big focus of of of what we tried to do as well. And so I think we're shifting more out of the ER and more into these clinics and more into urgent care to try to reduce costs in general.

00;13;00;17 - 00;13;07;24
Kathy Cummings
Which I would imagine is very reassuring for your families, for your patients, for your communities that the care is there.

00;13;08;01 - 00;13;08;24
Allison Gauthier
Correct.

00;13;08;26 - 00;13;27;12
Kathy Cummings
We know that we've heard from other hospitals and physicians, particularly in pediatric care, that, you know, they faced a lot of barriers to getting children vaccinated against COVID 19. What was your experience with that? You talked a lot about education. Tell me a little bit more about that.

00;13;27;15 - 00;13;55;26
Allison Gauthier
Well, Idaho historically has low vaccine rates among pediatric patients. We do have exceptions allowed for vaccines in schools, and their exemptions are used pretty frequently. It's a new vaccine, so sometimes it can take a while for parents to understand the benefits of vaccines. But we had pediatric specific vaccine clinics with our system, and it was more like a carnival with therapy dogs and stuffed animals and stickers.

00;13;56;01 - 00;14;21;18
Allison Gauthier
So we made it more more fun than medicine and vaccines, hopefully in the eyes of children. And then we continue to do counseling on the vaccines in our pediatric clinics. There obviously has been a lot of misinformation out there, widespread about COVID. And so we're just trying to correct some of that. Give them reputable sources, and then we continue to promote this education throughout the system.

00;14;21;20 - 00;14;34;06
Kathy Cummings
And overall, do you think that COVID 19 and all the education that's been done around the COVID 19 vaccine has given a boost just to confidence in vaccines overall?

00;14;34;09 - 00;14;58;05
Allison Gauthier
I think it ebbs and flows. I think I would hope by now that we've had this vaccine for over two years and we have seen how families and and patients have done with it and how safe they are. I think there is still some mistrust that occurs. And so we just have to continue to work on those barriers and reach those patients.

00;14;58;08 - 00;15;11;11
Kathy Cummings
So here's a question for both of you. What challenges still lie ahead of us, whether it's COVID 19, RSV or other respiratory illnesses? Alison, let's start with you.

00;15;11;13 - 00;15;36;09
Allison Gauthier
Well, obviously, we want to keep our patients healthy. So I am a huge supporter of vaccines and handwashing and doing those things because I want our communities to be healthy. I do think that reducing ED utilization will be important because we do not have the staff or we cannot just continue to build larger ERs for the communities.

00;15;36;12 - 00;15;46;29
Allison Gauthier
So I think that's still a challenge. I think continuing to scale up our respiratory clinic and you can speak about this as well to help those families and community.

00;15;47;01 - 00;16;09;10
Julie Snider
Yeah, I agree. I think, you know, just trying to expand some of our outpatient services that do keep our families out of the emergency room is really important. Even with our clinic going up so fast, there are a lot of clinics that do offer medications When you come in and things like that. We weren't able to manifest that this season, just trying to ramp up so quickly.

00;16;09;12 - 00;16;26;10
Julie Snider
We also had some barriers with people that didn't use our charting system, trying to do paper order. So we're trying to expand our clinics to include more things and offer more benefit and help to the community, which I think will be really important going forward.

00;16;26;12 - 00;16;39;00
Kathy Cummings
You know, we're all anticipating the official end of this pandemic or the public health emergency coming, I think is as early as May. Any final thoughts around that? What does that mean to you?

00;16;39;02 - 00;17;03;07
Allison Gauthier
I think the one thing COVID has taught us is to really think outside the box and kind of be ready for the next thing while still taking care of the current issues. And so I cannot wait to have an official end of pandemic stamp on this. I still think that in the health care system, we always have to be ready and continue to provide excellent care.

00;17;03;10 - 00;17;25;25
Julie Snider
I agree. We're much more efficient now at ramping up quickly when we need to take care for those patients that are in our facilities and need our help. But again, just continuing to provide accessible and affordable health care to our community is really important. And if we can find ways to do that that keep patients out of the hospital and out of the emergency rooms.

00;17;25;28 - 00;17;28;05
Julie Snider
That's what we're looking for going forward.

00;17;28;07 - 00;17;37;28
Kathy Cummings
Well, thank you both so much for sharing this time with me, for sharing your experiences and the great work that you've been doing. Truly keep it up. Really amazing stuff.

00;17;38;00 - 00;17;40;04
Julie Snider
Thank you. Thank you for having us.

00:17:44:04 - 00:17:59:09

Tom Haederle

This podcast was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention. The contents of this resource do not necessarily represent the policy of CDC or HHS and should not be considered an endorsement by the federal government.