TOSH prepares to receive medical patients if a COVID-19 surge hits Utah

Steve Eaton May 7, 2020

From left to right, Kristin Douglas, Hanna Simmons, Nate Vickery, Al Roosendaal, Dominic Stewart, Dennis Evansen, (Front) Michele Hachiya, Kaitlin Owens are members the TOSH Nutrition Services team. They too would be impacted if there was a surge.

As Intermountain prepares for the possibility of a surge in COVID-19 cases, the team at TOSH - The Orthopedic Specialty Hospital is getting ready to do their part. The TOSH team plans to free up beds in Salt Lake City area hospitals for COVID patients by taking in medical patients who aren’t fighting the virus, if needed.

TOSH only does orthopedic procedures like knee, hip, shoulder and spine surgeries. Ramping up to take medical patients and care for them seven days a week, 24-hours a day, is no small task for a hospital that’s usually caring for patients after surgeries performed five days a week.

The postponement of non-urgent elective surgeries opened up space in TOSH’s 40-bed facility. Even with recent changes allowing TOSH to take some more urgent orthopedic cases, the hospital still has open beds it could put to use. When Intermountain leaders reached out to see if TOSH could help ease the crush if a COVID-19 surge hits Salt Lake City hospitals, leaders at the facility were already discussing the possibility, according to Bob Mazzola, MD, TOSH medical director for inpatient medical services.

“When senior leadership made the call to ask for our help, I think, at least in our heads, we were already on the ground running,” Dr. Mazzola says.

Shifting so the hospital could bring in medical patients involves more than just rolling new equipment into patient rooms. It has been a complex process that’s involved nearly every team in the facility.

“I literally sat down with the TOSH directory in front of me and went line by line through that directory to figure out who needed to know about this and who should be in the meetings where the details would be worked out,” says Lisa Bagley, RN, TOSH nurse administrator.

“We’ve made a lot of changes really rapidly so that we can admit different patient populations,” Lisa says.

Lisa and Dr. Mazzola both emphasize the only way they’ve been able to make such rapid adjustments is because caregivers at TOSH think of themselves as family and work as a team.

“There was a lot of logistical shifting in changing our resources and gearing up for switching to medical-based patients rather than surgical-based patients,” Dr. Mazzola says. “The only way we could do that was to get everybody sitting at the table, from nursing administration to physicians, medicine, surgery, and anesthesia. The list goes on. And there's just no way we would have been so successful if it wasn't for the amazing people on our team.”

TOSH orthopedic nurses are preparing to work with more medical patients. TOSH will have resource medical nurses available on each shift “so if our ortho nurses come across something that they don’t feel comfortable with or have questions about, they have someone they can go to and ask questions,” Lisa says.

Andy Arsenault, RN, says those resource nurses have already been going through their supplies to ensure they have the right kinds of materials handy if they’re dealing with more medical patients. Andy, who started working as a float nurse before moving to Utah, has already been redeployed to work at Layton Hospital, Intermountain Medical Center, and Alta View Hospital and has worked with patients who were being tested for the COVID virus.

She has great respect for the caregivers working with COVID patients daily.

“If we can lighten the load for them, I’m more than willing to help, and if I need to be redeployed to help on a COVID unit, I’d do it. Would it be scary? Absolutely, but I would do it.”

The Nutrition Services team at TOSH says it’s prepared if TOSH needs to take on new medical patients even though that would mean the team would be doing a lot more room-service meals than usual, especially on the weekends, a time that’s usually been much slower at TOSH, says Michele Hachiya, a diet tech. Usually there aren’t many, if any, patients who end up staying at the hospital over the weekend to recover, she says.

The TOSH team has had plenty of challenges recently because they used to get meals shipped to them from IMC but the machine they used to reheat those meals isn’t working. That means they’re preparing meals at TOSH instead of getting them shipped in, on top of gearing up for a possible surge, she says.

“It's been a lot of work getting ready but I think we're on the homestretch now,” Michele says. “We’ve trained three other people, so everybody’s cross-trained now, which will make things easier in case we get a surge of medical patients.”

TOSH would only be taking qualified medical patients, not COVID-19 patients, if needed. TOSH doesn’t have an emergency department or an intensive care unit, so a patient who is critically ill or would require more acute services than we have at TOSH wouldn’t be admitted, Dr. Mazzola says.

A few patients have been transported to TOSH as a test in recent weeks. Once these patients understand why they’re being moved, they’ve been happy to move away from where COVID patients are being treated, he says.

TOSH Administrator Adam Chandio, MHA, says he is proud of the way TOSH caregivers have welcomed this challenge.

"I’m even more proud that the work that the TOSH team has done can be used by others teams across the system when we are faced with similar situations in the future," he says. "TOSH has a legacy of thinking creatively and executing with urgency, and this occasion has been no different. We are thrilled to have the opportunity to support the system’s planning and preparation to care for our community during this time"

“I’ve thought this through multiple times and it just seems scary to think of what it would be like for one facility to try to deal with these challenges alone,” Lisa says. “I can't imagine doing it without the support of Intermountain. I think our One Intermountain focus on doing the best for the community is a theme throughout our facility and throughout this system. And I’m just very, very grateful to have the support of Intermountain and get direction from this system in getting through this.”

“I think Intermountain has done such a great job of being proactive, preparing for the worst and hoping for the best, and that’s what we’ve done,” Dr. Mazzola says. “We haven’t seen a huge surge so far, but it still could happen and we’re preparing.”