COVID Surge Updates

November 8, 2020

This evening Governor Gary Herbert announced statewide public health orders to slow the spread of COVID-19 and reduce overcrowding in hospitals. Intermountain Healthcare stands alongside Utah’s public officials and healthcare professionals in supporting these measures. We ask caregivers to model safe behaviors that will keep our coworkers, families, friends, and neighbors safe from COVID-19.

Here is a summary of the governor’s announcement. More information from Intermountain will be shared with caregivers on Monday, November 9.

Governor Declares New State of Emergency to Address Hospital Overcrowding, Case Surge

Governor and Utah Department of Health Issue Statewide Mask Mandate, Restrict Casual Gatherings to Households, Pause Extracurricular Activities

SALT LAKE CITY (Nov. 8, 2020) - Following weeks of continued stress on Utah’s hospital networks due to a rise in cases of COVID-19, Gov. Gary R. Herbert has declared a new State of Emergency to address hospital overcrowding.

Pursuant to the State of Emergency, the governor and Utah Department of Health have issued concurrent executive and public health orders designed to curb the surge of cases in Utah.

Both orders are effective Monday, Nov. 9 and will remain in effect until Nov. 23, 2020. The orders:

1. Place the entire state under a mask mandate. Under this requirement, all Utahns must wear masks in public, and when within six feet of anyone they don’t live with. This mandate is also enforceable in business settings, which must require employees to wear masks, promote patrons to wear masks, and post signage to that effect. Businesses that fail to do so will be subject to fines. Please note that even after the orders issued today expire on November 23, the mask mandate will be extended for the foreseeable future.
2. Limit casual social gatherings to household-only until November 23, 2020.
3. Put all extracurricular activities, including athletic and intramural events, on hold for the duration of the order.
   1. This does not limit intercollegiate athletic events, or practices and games associated with high school championships, that follow instructions for testing and limiting crowd size, as detailed in the order.
4. Beginning as soon as possible, but no later than January 1, 2021, students enrolled at public and private institutions of higher education, who either live on campus or attend at least one in-person class per week will be required to be tested for COVID-19 weekly.

Gov. Gary R. Herbert said, “To make a real difference in slowing the spread of COVID-19 and turning around the dire situation in our hospitals, we all need to do more. That’s why we are restricting casual social gatherings for the next two weeks. This means many of us may have to cancel plans with extended family and friends. This is a sacrifice for all of us. But as we slow the spread it will make all the difference for our overworked healthcare workers, who desperately need our help.”

November 4, 2020

Riverton Hospital stopped admitting pediatric patients to the 4^th floor on October 24 and has transitioned to providing inpatient care to adults. The unit started with 10 beds, staffed with a combination of caregivers on mandatory overtime and pediatric caregivers who’ve been trained to care for adults. Just over a week later, all 10 beds are consistently full. 

Starting Monday, November 9, Riverton will open the remaining 14 beds of the pediatric unit to help with the surge. We’ll be staffing these beds with travel nurses, float pool caregivers, and others to provide care to the growing number of patients requiring care in the Salt Lake valley. Riverton’s med/surg and ICU units continue to remain full on the 2^nd floor. 

Only inpatient pediatric services are now paused at Riverton. All other pediatric care, including emergent care and outpatient services for children, will remain active at Riverton Hospital and in the Primary Children’s Riverton outpatient building.

October 20, 2020

Because of the continued rise of hospital admissions and COVID-19 patients needing intensive care in Salt Lake Valley hospitals, TOSH has converted part of the medical tower’s second and third floors to a temporary 10-bed medical/surgical unit. TOSH will begin accepting specified transfer patients from Intermountain Medical Center and LDS Hospital starting Wednesday, October 21. These will be regular med/surg patients, not COVID-19 patients. This change is part of Intermountain’s surge plan created earlier this year and has worked smoothly.

Here are more details about what’s happening:

• Starting Wednesday, October 21, TOSH will begin accepting medical/surgical patients who are transferred from the emergency departments of the Intermountain hospitals in the Salt Lake Valley (SLV). Currently, TOSH will only accept transferred patients who meet an established criteria.
• TOSH nurses, caregivers, and support teams are well-prepared and have received necessary training and education to provide for the needs of these transferred medical/surgical patients. TOSH stood up its med/surg unit in April 2020 for a few weeks to ensure its teams were familiar with the transfer process and delivery of care.
• The transfer process will be coordinated by the Intermountain Transfer Center. Gold Cross Ambulance will transport the patients at no fee to the patients. Intermountain Healthcare will cover this cost.
• Transferring patients to TOSH for care is an effort of load balancing within our Salt Lake Valley hospitals. Hospital volumes and censuses have increased due to patient care and cases as normal, in addition to increasing number of COVID-19 patients. This isn’t an effort of surging strictly due to overwhelming number of COVID-19 cases in our Salt Lake Valley hospitals.
• Intermountain Healthcare is load balancing and surging to ensure there’s plenty of space and resources to care for all patients in our SLV hospitals, both COVID-19 and non-COVID-19 patients.
• TOSH has partially converted its medical tower’s second and third floors to support up to 10 medical/surgical patients at a time.
• TOSH hasn’t cared for any COVID-19 patients during the pandemic and will continue to serve patients who are free of COVID-19.
• TOSH won’t serve as an emergency department during this surge process. The community will be expected to seek emergent care at their closest emergency room and will potentially be triaged according to an established patient criteria.
• The Intermountain Transfer Center (855-WE-ADMIT) uses a digital tracking board that provides a real-time view of patient beds in the Intermountain system. The Transfer Center is staffed 24/7 with experienced critical care nurses as well as Tele Critical Care and Tele Hospitalist physician “quarterbacks” who triage patients and determine bed placement in close partnership with our hospital teams. The Transfer Center also arranges patient transports by ambulance, and where necessary will provide Tele Critical Care consultation when Life Flight is needed.

What’s happening in hospitals?

1. We’re adding ICU and medical/surgical beds. 
2. We’ll distribute patients and allocate resources to optimize facilities, staffing, and equipment across our system.
3. Hospitals will keep COVID-19 and non-COVID-19 patients apart and safe. 

Here are more details about our surge plans:

• Large hospitals (Intermountain Medical Center, LDS Hospital, McKay-Dee Hospital, Utah Valley Hospital, Dixie Regional Medical Center, and Primary Children’s Hospital) are prepared to take care of the most critically ill. These hospitals: 
  • Can care for COVID-19 patients as well as patients with other health needs.  
  • Are staffed with highly skilled intensivists, physicians, nurses, and respiratory therapists. Keeping these providers teams together helps optimize staffing resources and preserves PPE and other equipment.
• Community hospitals can convert spaces and/or units currently used for other clinical services as needed, equipping them appropriately.
  • Community hospital ICUs can treat COVID-19 patients with less-severe symptoms.
  • The most critical patients will likely be transferred to larger facilities.  
• Most Rural hospitals can handle small numbers of COVID-19 patients from local communities, using telehealth as appropriate; most COVID-19 patients in rural settings will likely be transferred to larger hospitals.

What about specialty hospitals?

• The Orthopedic Specialty Hospital (TOSH) is designated as a relief-valve facility to treat medical/surgical patients who do not have COVID-19. 
  • Other facilities in the Salt Lake Valley may direct patients to TOSH for non-COVID-19 care. TOSH will be appropriately equipped and staffed for the patients it receives.
• If necessary, we can move inpatient pediatric care to Primary Children’s Hospital.
  • Pediatric units at Riverton Hospital, McKay-Dee Hospital, and Utah Valley Hospital are prepared to reduce inpatient admissions and redirect pediatric patients to Primary Children’s in Salt Lake as necessary. 
  • Pediatric units in these three hospitals can be temporarily converted to provide adult patient care.
  • Primary Children’s is prepared to accept admissions or transfers of young adult patients up to age 30 if necessary.

How will hospitals be supported?

• Clinics will continue to provide COVID-19 testing, urgent care visits, and primary care services.
  • Some clinics can be converted to patient rooms to support inpatient care if necessary. 
• Clinical support services will be expanded: 
  • Telehealth can increase capacity with additional critical care providers.
  • Acute care at home services can be provided.
  • We’re partnering with skilled nursing facilities to extend care to the elderly.
  • We’ll direct care to other community facilities, coordinating as appropriate with local and state government, if necessary. 
• Our Transfer Center (855-WE-ADMIT) uses a digital tracking board to provide a real-time view of patient beds in the Intermountain system. The Transfer Center: 
  • Is staffed 24/7 with experienced registered nurses as well as tele critical care and tele hospitalist physician “quarterbacks” who triage patients and determine bed placement in close partnership with hospital teams. This service enables us to load balance patients with beds and resources across our system.
  • Coordinates with local facilities to arrange ground ambulance transport, and will provide tele critical care consultation when Life Flight is needed. 

Our top priority is to keep caregivers safe, working, supported, and trained to care for patients. We’re adopting new staffing strategies, introducing additional training, and making sure caregivers have the PPE they need to be safe.

• Our surge staffing team of 70 leaders from across the system has developed an agile process that uses real-time reporting and daily huddles to match care providers with facilities, PPE, and supplies.
• Using surge staffing projections, and to relieve caregivers, we’re training, redeploying, and activating physicians, nurses, respiratory therapists and support teams.  
• If necessary, we'll move clinicians in administrative roles or who have recently retired back into practice, and partner with local nursing schools to hire nurses in their senior year.
• Our clinical educators are providing additional training to clinical teams in medical facilities and online. The Intermountain Simulation Center has been fully activated for COVID-19 training

• We track inventories of ventilators, respirators, masks, gowns, shields, and other PPE, and we’re working to increase supplies.
• Standards for safely reusing and preserving PPE have been implemented across the system.
• Live dashboards enable our supply management team to direct PPE, ventilators, and other equipment where needed.

We’ll continue to learn, plan, and evaluate as we prepare for a surge. As we do so, and our surge modeling and plans evolve, we’ll provide ongoing updates and communications.