Hospitals making triage plans, preparing for uptick from rural counties

By Updated: March 14, 2020 5:56 PM CT | Published: March 14, 2020 4:05 AM CT

Editor’s note: Due to the serious public health implications associated with COVID-19, The Daily Memphian is making our coronavirus coverage accessible to all readers — no subscription needed.

Confirmed cases
Tennessee
32
Shelby County
2

No one is currently hospitalized in Memphis-Shelby County with complications from coronavirus. As of Saturday morning, there were two cases in Shelby County and 138 people under public health monitoring. Statewide, there are 32 confirmed cases.

Hospitals across the region are ramping up for a mass uptick in the number of people needing to be tested.

Baptist has converted a mobile mammogram unit into a coronavirus test site in the parking lot near the emergency room entrance at Baptist Memorial Hospital-Memphis.


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“It’s only appropriate for people who are showing symptoms,” said hospital spokeswoman Ayoka Pond. “What we don’t want is for people to see that and assume, ‘Oh, great. I can get a test,’ if they don’t really need to be tested.”

It is open only during peak times in the emergency room; it is intended to take pressure off emergency resources. 

Baptist has also converted more patient rooms to negative-pressure rooms to increase its capacity to isolate patients. It is adding more extracorporeal membrane oxygenation units for severe respiratory cases. The machine circulates blood through an artificial lung back into the bloodstream.

It will also be triaging patients through its patient placement center, located at its headquarters in East Memphis, to any of its 22 hospitals in this region.


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In a database, the hospital keeps track of every bed and will be able to send patients to the nearest hospital where a bed is available.

“We presume the sickest people will come to Memphis, but there’s no question that over time there needs to be coordination even among hospital systems about how we can best do this within the community,” said Dr. Stephen Threlkeld, infectious disease expert at Baptist.

Hospital closings in the state have left 20 counties with no hospitals. This is significant here because Shelby County is surrounded by counties that have little or no hospital capacity.

Neighboring Fayette and Haywood counties have no hospitals. In Tipton County, there is one bed for every 1,227 people, according to the Tennessee Health Care Capacity Dashboard created by the Sycamore Institute in Nashville.

Doctors here are preparing for an onslaught of cases from surrounding areas.

“We  lack surge capacity to deal with a large number of critically ill individuals at once,” said Dr. Jon McCullers, chair of the department of pediatrics in the University of Tennessee Health Science Center’s College of Medicine and pediatrician- in-chief at Le Bonheur Children’s Hospital.

“Hospitals are pretty much at capacity at present even without the virus.”

If need surpasses capacity, elective surgeries will be put on hold, freeing up both beds and ventilators. People who are not critically ill will be treated at home or in other facilities. Hospitals could have more stringent admissions criteria or discharge sooner or both, he said. 

“Many local hospitals staff many fewer beds than they physically have in the building; the problem would then become how do you care for persons in those beds if you use them?”

The Tennessee Hospital Association says plans are in place to use temporary beds in clinics, expand care to outpatient space and refer patients who do not need emergency or hospital care to clinics or urgent care centers.

“From what is known now, most people who become infected with COVID-19 will not become seriously ill and, therefore, will not need hospitalization,” Kelly Insana, a spokeswoman for THA, told The Daily Memphian late Friday. “However, those with serious illness may need hospital care, including respiratory support.”

Most hospitals in the state do not have extra capacity and are not holding beds for possible COVID-19 patients, she said.

“However, this is not a static situation, and hospital space can and will be made quickly available in an emergency or with a surge of critically ill patients.”

While the mass cancellations of public gatherings, from sporting events to concerts and large meetings, probably are not going to keep people from catching the virus, Threlkeld says they very likely will slow the spread, taking a load off the health care system.

“If, say 1,000 people are going to get sick, it’s much better for that to happen over six months than it is over one month. It taxes the system much less,” Threlkeld said. “There are more beds available, there’s more manpower. Part of the problem with these things is having enough doctors, nurses and other people to get the job done.

“We’re hopeful that’s enough, but the reality is that this is a new time and a new virus, and we have to plan for the worst.”

In a statement, Methodist Le Bonheur Healthcare said, “Like the CDC, we are also encouraging patients with mild respiratory illnesses to stay home. Patients with COVID-19 have had mild to severe respiratory illness with the symptoms of fever, cough and shortness of breath.” 

While physicians and researchers are getting a better understanding of how long the virus can live outside the body, there are no answers yet about long it remains viable in fluids, including sweat and semen.

“This is all new. There just isn’t any research yet on these issues,” Threlkeld said.

Topics

Dr. Stephen Threlkeld Baptist Memorial Health Care Corp. Tennessee Hospital Association
Jane Roberts

Jane Roberts

Longtime journalist Jane Roberts is a Minnesotan by birth and a Memphian by choice. She's lived and reported in the city more than two decades. She covers healthcare and higher education for The Daily Memphian.


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