RAHC Adapting In Age Of Pandemic

RAHC Adapting In Age Of Pandemic

PATIENTS of the Rockbridge Area Health Center have been given the option of tele-health since the early days of the pandemic. Here nurse practitioner Laura Simpson is communicating with a patient through a smart phone.

RAHC Adapting In Age Of Pandemic

MEDICAL CARE at the Rockbridge Area Health Center is being provided to patients both in-person and through a tele-health option. Nurse practitioner Laura Simpson is shown here examining a patient during a visit to the center.

Safety Steps Continue As Patient Visits Pick Back Up

“Adjust, pivot, adapt.”

Suzanne Sheridan, chief executive officer of the Rockbridge Area Health Center, has continually referred back to this threeword mantra with each new challenge she and her staff have had to face during the pandemic.

“We started tracking COVID-19 on Feb. 24,” recalls Sheridan. “That was our last normal week.”

The lives of everyone associated with the health care facility were upended in early March when it became clear that no place, including the rural Rockbridge area, was going to be immune to the devastating effects of the novel coronavirus.

RAHC began hearing from patients who were evincing COVID symptoms and wanted to be tested as well as from others who wished to avoid routine care out of fear of contracting the extremely contagious virus.

“We dusted off our emergency plan,” said Sheridan, for what to do in the event of a pandemic. Measures were undertaken quickly to protect staff and patients from exposure while still allowing the facility to provide all kinds of regular medical care.

“We [began] using a separate entrance and separate part of the building to test and treat COVID symptomatic patients,” she explained. “Patients wait in their cars and health care providers in full gear see them. There’s separate everything [from RAHC’s other services].”

Introducing Tele-Health

Non-COVID patients who were uncomfortable making an in-person visit were given the option of tele-health. RAHC hadn’t done this before but rapidly embraced the practice. Patients use their smart phones or computers to communicate with health care professionals.

“When the pandemic was declared we had to ramp this up very quickly,” said Sheridan. “Up until March, we couldn’t do this. All of the accommodations we’ve made – it will be interesting to see what sticks. Some of these measures started out as temporary but may well become permanent.”

RAHC has had 1,466 tele-health visits since mid-March, compared to 6,665 on-site patient visits during the same time period. One of the factors making it difficult for some patients to visit RAHC in person was lack of transportation, as the Maury Express bus service was discontinued for a time. Sheridan noted that behavioral health has been more easily adaptable to tele-health.

Dental services have taken the biggest hit. For a while RAHC was only able to offer emergency dental care. “Now that we’re back to offering all of our dental services, we’re not running all of our chairs because of social distancing,” said Sheridan. “Prior to the pandemic, in a typical week we would see 240 dental patients. Now we’re seeing 165. We’re not using equipment that produces aerosols. We were able to purchase new equipment with CARES Act funding.”

Patient Visits Declined

Patient visits overall declined significantly for a couple of months. Prior to the pandemic, RAHC was averaging 520 patient visits a week, but this dropped off to around 350 per week for seven weeks. Visits started climbing back up in May, and have now returned to prepandemic levels. “We had 522 the week of July 13,” said Sheridan.

RAHC is encouraging patients to catch up on their vaccinations and wellness checkups. “Usually this time of year kindergartners who are starting school are coming in for their vaccinations and children are getting their sports physicals,” she said. “Those numbers are down this year. As a community, we need to be concerned. We have to be cautious going into the flu season. People need to be vaccinated against the flu. … The last thing we want is to not have people avail themselves of preventative health care services.”

Strategies within RAHC for maintaining immunization services and encouraging check-ups and sports physicals have included scheduling well-visit exams in the mornings and administering care to sick children in the afternoons. The health center has also reduced the number of patients on-site at any one time, changed office workflows to minimize contact between patients, properly distanced and labeled waiting area seating, and families who have been especially nervous about bringing their child into the building have been able to receive vaccinations while in their vehicles in the parking area.

Sheridan wants to assure patients that every precaution is being taken so that in-person patient visits are safe. Everyone is screened for COVID symptoms before they’re allowed to enter the building. These procedures are continuing as the pandemic isn’t showing any signs of abating.

More Positive Cases

“The pandemic is not over,” emphasized Sheridan. “We’re seeing cases rise. We have to be prepared for if it becomes more widespread.”

“The calls from patients with questions and the phone screenings have increased,” attests Amanda Morgan, registered nurse and patient care manager who speaks with all patients who call to make inquiries about COVID. “People are concerned about the latest increase in cases in the area.” Morgan screens and assesses patients over the phone for the virus, then coordinates with the RAHC medical team all COVID testing.

Laura Simpson, an RAHC nurse practitioner, advises patients that it’s especially important during the COVID-19 outbreak to make staying both physically and mentally healthy a priority. “A focus on wellness will help to build your immune system,” she said. “And equally as important is to prioritize your mental health. We’re seeing patients who are being incredibly emotionally impacted by the pandemic.”

She added: “Find ways to stay in touch with your support system, like family and friends. And nurture your resilience by getting outside and staying physically active, because the pandemic is not going to magically disappear.”

RAHC’s professionals are well aware of the emotional toll the pandemic is taking. “Our medical team is seeing a fair amount of anxiety in our patients,” said Janet Beebe, RAHC director of development. “Our staff is trained to reassure them, to promote wellness, to encourage them to utilize preventative care.”

RAHC’s pediatricians talk with children about their thoughts and feelings. “Children may be upset about seeing people wearing masks, hearing anxious conversations, having their routines disrupted, unable to see their friends,” said pediatrician Dr. Percita Ellis. “Reactions will vary, but what’s important is observing children’s behaviors while listening to what they say.”

Mobile Testing Coming

Testing for COVID-19 has become more available since the early days of the pandemic, and is slated to become more so in the weeks ahead. Between March and June, only 54 tests were conducted at RAHC. During July, 66 people were tested. Later in August, RAHC is to introduce a mobile testing program that will allow newly hired staff to go out into the community and conduct 75 tests per week.

“We’ll be partnering with other community organizations such as the sheriff’s office and nonprofits,” said Sheridan. “We’ll be hiring five new people for this program. We’ve already hired a coordinator. We’ll be looking at different community places to offer testing, such as fire stations, wherever people are.”

RAHC received a grant for this testing program, which had been sought by the Central Shenandoah Health District. “We welcome the community’s support for our testing program. We’ll be working with the hospital and other organizations, the health department. We’ll be going out weekly into the community.”

Details such as how much insurance will cover of costs for the tests, which carry an average cost of $150 each, have yet to be determined. The length of time it has been taking to get test results back varies from 2 to 10 days, with the average being 4 to 6 days. The quicker the results are back, the more easily contact tracing can be conducted, which is a responsibility of the health department.

RAHC has benefited from federal CARES Act funding. It’s allowed the health center to buy personal protection equipment and offer new services like tele-medicine and mobile testing. The hope is that the mobile testing program can, later, transition into providing immunizations, should they become available in the months ahead.

These are unprecedented times for RAHC but Sheridan believes the center’s health care professionals are meeting the daily challenges they’re facing. Everyone, she said, has become adept at adjusting, pivoting and adapting.

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