Have you ever wondered what it would be like to keep a hospital running? The answer is, it is a lot like managing your own home—if your home had six floors, 191 bedrooms with attached bathrooms, a really large kitchen and several common spaces.
The Facilities crew at IU Health Arnett Hospital keep the house running by doing preventive maintenance, routine improvement projects and making repairs when needed. Filters get changed, belts get tightened and leaks are repaired. Team members often work above ceilings and outside in the cold.
Clinical engineers keep the equipment involved in patient care working smoothly. Beyond the televisions in each of the 191 rooms are monitors that check vitals and pumps that deliver medicine. There are nurse call buttons and mobile medical equipment like AEDs to maintain, and much like your home computer and iPhone, there are always updates to run and occasional glitches to solve.
Now add in a pandemic.
COVID-19 put a strain on the “house.” Each surge brought different issues with little to no warning. At one point during the latest surge, the hospital was serving 230 patients—that is, 39 more people than available rooms.
The first COVID-19 challenges
In March 2020, the first challenge for the Facilities team was to create negative airflow rooms, which prevents the air inside a patient room from pushing out into the hallway and other shared spaces. Negative airflow minimizes an airborne virus from traveling to other indoor spaces.
How does one create a negative airflow room, essentially on the fly? The team’s first thought was to remove the window in each room and put in a machine that would circulate air in and out. However, gaining access to those extra-large windows beyond the first floor was an issue.
A trip to Tractor Supply provided a solution—huge exhaust fans like those found in barns. Facilities could shut down the return air exchange and use the oversize exhaust fans to run air to the outside. This worked in some areas. It was discovered larger system exhaust fans needed to be changed out to achieve the needed volume of air movement. All this had to be done via the roof, which involved several vendors, an engineer and a crane, but it quickly provided an avenue that produced 12 negative airflow rooms.
The pressure in those negative airflow rooms must be continuously monitored—from outside the room. The solution was a combination of difficult to procure electronic gauges and some basic magnehelic pressure gauges installed outside each room, allowing team members to simply walk up to the door and check the pressure gauge.
“Each step was so deeply collaborative. It was awesome to see it all come together,” shares Ben Stauffer, director of Operations.
With everyone putting their heads together and conversations with outside vendors, the Facilities and Clinical Engineering teams eventually transitioned 30 total rooms in the Intensive Care and Progressive Care units, plus two permanent Emergency department rooms, into fully compliant negative airflow rooms.
As the number of patients increased during the delta variant surge, so did the need for space. The ambulance bay and conference room areas near the ED were turned into holding areas for patients. Carpets were removed and replaced with concrete floors in the conference rooms. The ambulance bay, which is essentially a large garage, needed heat to keep patients warm and enough electricity to run the medical devices needed for each patient. Temporary dividers to create more private patient “rooms” were built and large tents erected so patients could be transferred safely and privately from ambulances to the hospital, shielded from the weather.
Creative solutions to support caring for the critically ill
Inside the hospital, the most ill patients are cared for in the 14-bed ICU. To care for a COVID-19 positive patient, team members must don personal protective equipment (PPE) including gowns, gloves, masks and face shields before entering a room, which can take a minute or two. To save time and preserve precious PPE supplies, patient monitors and care carts were moved into the hallway so that medical staff could monitor patients without entering their rooms. (Picture provided by Kelli Kirkman, RN)
Still, for patients on ventilators, frequent trips into patient rooms were needed; for example, to adjust oxygen flow if a patient experienced breathing issues. Could ventilator monitors also be moved to the hallway to allow the healthcare team to pump oxygen to patients while donning PPE, instead of the patient having to wait until the team was fully geared up and inside the room—a move that could potentially save lives?
The challenge with this idea was that ventilator monitors are large and there was no obvious space for them or their cords and cables.
Melissa Sorrell, BSN, RN, ICU clinical operations manager, reached out to the Clinical Engineering and Facilities teams for a solution. The group put their heads together, took some measurements and again reached out to vendors for help. The solution was a custom metal stand created specifically for the ventilator monitors. The healthcare team now has a wall (head to toe) of easily accessible monitors and pumps for each patient. And all those cables are bundled into a protective sleeve.
“They [facilities and clinical engineering] had so much going on, but they took the time to listen to what I needed,” shares Sorrell. “In two years, we have not lost a cord or broken a ventilator.”
As the number of COVID-19 patients surged, the ICU had to expand out of its usual confines and into PCU space. Although both units are on the second floor of the hospital, they are not equipped the same.
For example, in the ICU, monitors are available outside each patient room to monitor heart rate, oxygen level and blood pressure, and all 14 rooms can be monitored from the nursing station. The PCU did not have these capabilities and needed to function like the ICU.
A whole new monitoring system comes with a large price tag—and a lot of time, a precious commodity as patient numbers increased. Drawing inspiration from a previous project in which Clinical Engineering worked with the Internet Information Systems department to help cardiologists monitor patient stats from afar using web-based software, a creative backdoor solution was born; additional computer monitors were placed on the walls outside each patient room and web-based software installed.
“You ask ‘what do you really need,’ then you work the problem,” shares Jon McCoy, director of Clinical Engineering.
Sorrell also identified another issue—not being able to see the patients. The hospital was built with windows for monitoring off to the side. With a full house and the need to don PPE for each entry, this care model was not working. Very ill patients get confused and pull at their tubes or try to get out of bed. Doors could not be left open because many of the rooms were negative airflow rooms. Nurses needed to see their patients.
Sorrell wanted glass doors. Facilities provided the solution by creating large windows in the doors. It may reduce patient privacy, but it saves lives.
“The first day the new doors were in place, we had a registered dietitian walking down the hall who saw a patient trying to get out of bed and called for help,” explains Sorrell. “It could have been detrimental for that patient to fall, pulling out his tubes. She saved his life just by walking past his room.”
Coming together in a time of need
Nothing has been easy for anyone in healthcare during the pandemic. Like their colleagues throughout the hospital, the Facilities team just kept doing what needed to be done, modifying the work schedule to provide 24-hour coverage.
“Sometimes you have to stop routine maintenance to jump on a project to improve patient care and safety,” explains Dirk Hepworth, Facilities manager. “My team has been flexible and industrious to meet the clinical requirements and continue excellence in operations. I could not be prouder of their efforts.”
Debbie Williams, senior administrative assistant, Operations and Facilities, agrees. “They take the impossible task and make it happen.”