Intermountain begins moving facilities and services to ‘yellow’  

Utah Governor Gary Herbert announced last week that most cities and counties across Utah transitioned to the yellow, low-risk level for COVID-19. The state’s decision to move to yellow comes from the observed, sustained plateau in active COVID-19 cases, a slowed acceleration in new positives, increases in recovered patients, and decreases in deaths in those areas. The Utah Hospital Association COVID-19 Chief Medical Officer workgroup continues to guide these designations for hospitals. That group has determined that all hospitals in the state, including the hospitals in state-designated orange zones, are okay to move to the yellow status at this time. In support of Utah’s directive, Intermountain operations in Utah are moving facilities and services to a carefully planned yellow status beginning Friday, May 22. 

What this means for surge planning and redeployment 

The good news is Utah’s plan has seen encouraging results. We have seen a continued flattening of the curve in our facilities over the past few weeks as our economy has cautiously started to reopen. We’re hopeful this trend continues. We also know a significant surge in one or more communities is still a very real possibility. Our surge plans are flexible, and we’ll continue to prepare for any scenario.  

As we move to the yellow stage, we’ll begin a transition to a sustainable redeployment model to support an agile, flexible, and mobile workforce. This means we’ll focus on cross-training caregivers who would flex to another area quickly during a surge (e.g. nurses flexed to hospital areas; medical assistants flexed to caregiver safety officer roles, community testing sites, and call/triage centers; PSRs to become greeters; sleep and rehab therapists to become Utah Department of Health contact tracers or respiratory caregivers). We also plan to provide “Just in Time” iCentra and appropriate facility training for physicians, APPs, and caregivers to be able to rapidly redeploy to hospital, emergency department, critical care, med/surge, respiratory, and other areas as needed.  

We’re monitoring the situation closely and will make quick adjustments to ensure we have staffing, bed capacity, equipment, and PPE and supplies to support a surge. 

Supporting safety while reinforcing conservation of PPE 

At every color stage, Intermountain requires appropriate PPE for everyone in our facilities. For added safety, we’ll reinforce our PPE protocols with cross-trained and redeployed caregivers—as providers and caregivers are moved to new areas or back to regular areas of care, they will be fit-tested in new masks and PPE as needed.  

Reopening services will require additional PPE for caregivers and patients. We’ll need to reinforce current PPE protocols so that we can conserve, extend use, and reprocess personal protective equipment. This will help us ensure we have enough PPE should we surge in the future.  

Patients and approved visitors who do not show signs of respiratory symptoms and who do not have suspected or active COVID-19 should continue to wear a reusable cloth face covering (do not put face coverings on children younger than two). Caregivers who are not in patient- or visitor-facing roles should also wear a cloth face covering each day.  

What this means for Intermountain clinical services 

Intermountain is shifting our clinical services to the yellow status to support Utah’s directives and to deliver important non-COVID-19 care to patients—across the system in Utah, which maintains standardization where safely possible and reduces confusion. The shift for Intermountain to yellow will begin on Friday, May 22. Idaho facilities (Cassia Regional Hospital and campus clinics), however, are in the green status.  

We are transitioning to yellow but will closely monitor the situation and remain agile to shift facilities and services back to orange if necessary or move patients to other facilities if certain facilities become at risk for a local surge. We’ll transition facilities back to orange should we experience:  

  • The inability to assure the safety of our caregivers and patients  
  • COVID-19 census increases that strain our bed capacity 
  • Insufficient space for non-COVID-19 services in support of social distancing  
  • Inadequate supplies of PPE and other equipment 
  • Insufficient staffing, testing capacity for reopened services, and screening resources  

All clinical services, including the following, will move to yellow:  

  • Hospital services 
  • Surgical procedures 
  • Clinic visits and services  
  • Obstetric services 
  • Physical, Occupational, and Speech Therapy, and Audiology services 
  • Wound & Hyperbaric services  
  • Homecare services 
  • Pharmacy services 
  • Laboratory services 
  • Sleep & Respiratory services 
  • Kidney & Dialysis services 
  • Imaging services  
  • Pain management services 
  • Nutrition counseling and services 
  • Diabetes self-management services

For many of these services, moving to yellow means that individuals who are at normal risk for severe COVID-19 illness, who do not have symptoms and who are not positive, can access these services in person or virtually as appropriate. For caregiver and patient safety, however, even in yellow these services will continue to be postponed for high-risk individuals and COVID-19-positive patients, and only provided for these groups during the yellow classification for urgent/emergency issues.  

Provider and caregiver teams can reference the Ambulatory Care and Clinical Services and Surgical Services decision aids for guidance around specific services and visit types. 

Use this guide to determine which clinical services are available in the COVID-19 pandemic color phases. 

20-OPE-1028937_CCCRisk Color Chart_b9

 

We are relaxing our visitor guidelines

Under the yellow status starting May 22 at 7:00am, visitor guidelines will change for all Intermountain hospitals, emergency departments, clinics, and InstaCares facilities.  For the latest details, visit here: https://intermountainhealthcare.org/visitors

What this means for testing  

Intermountain will continue adherence to public health standards and support testing at our 25 community testing sites. Additionally, we’ll maintain our collaborative partnership with local and state health officials to deploy the Mobile Testing Unit in certain hotspot locations throughout the state. Testing for asymptomatic members of the community should take place for patients being admitted, preparing for a procedure, or preparing for induction of labor in our facilities. This will help protect caregivers and patients from high-risk exposures.  

We provide asymptomatic testing for vulnerable populations and other high-risk contacts as referred by state and local health department contact tracing efforts; however, we’re not currently offering asymptomatic testing for critical infrastructure or other business entities. Leadership teams, in partnership with Infection Prevention physician leaders, are thoughtfully considering this issue and its implication for both Intermountain and the organizations and populations we serve. The Executive Leadership Team will make the ultimate decision as to if and when we will proceed with this priority. 

What this means for caregivers and caregiver screenings 

All caregivers currently working from home should continue to do so. The yellow category includes the guideline to “work from home when possible” and “avoid in-person meetings.” Guidance from Employee Health and Infectious Disease supports the state’s direction and guidance. Access information on working remotely and meeting guidelines for more information.  

Caregivers should plan to continue to work from home until the beginning of the green (no risk) phase. At that time, Intermountain will implement a scaled return-to-work plan to systematically open locations, determine which teams should move back to their office spaces, and explore which teams might continue to work from home on a more permanent basis. This plan also addresses facility readiness, PPE standards, extended sanitization procedures, public space restructure, and caregiver safety. Café dining areas will remain closed for now, and carry-out and other food service programs will continue.  

To keep our patients, communities, and each other safe and healthy, Intermountain will continue screenings for caregivers working at our facilities, and patients and visitors who enter our facilities. Screenings include answering a series of questions and checking temperatures. To date, many facilities have chosen to do screenings at main entrances or other high-traffic areas. However, as more Intermountain services start to reopen and many caregivers come back to on-site work in the yellow status, we expect the possibility of crowding at screening areas and fewer redeployed staff available to work as greeters. To alleviate crowding and address staffing challenges, we’re strongly encouraging caregivers to complete their own screenings through the Intermountain Caregiver app (available here in the iTunes store for iOS and here in the Google Play store for Android) or online at this link at least once per day before beginning their shift.   

In addition to answering the screening questions, caregivers must also have their temperatures taken at the beginning of each shift. For information on where to have your temperature taken, please reach out to your manager as this will vary by facility and department.   

What this means for students  

Intermountain will be bringing back medical students, APP students, nursing students, and others on a very limited and incremental basis over the summer months, across the system in facilities both orange and yellow. Many Intermountain physicians and caregivers will be returning to regular work as certain clinical services reopen, providing limited time for cross-training and mentorship.  

We’ll begin bringing back the students who need the course requirements to meet graduation deadlines and advance their medical education (e.g. third-year medical students, nurses completing their capstone projects). The shift of some areas in Utah to yellow has also opened the dialogue to consider plans to bring back other students including lab, physical therapy, and occupational therapy students and medical assistants. We will continue to postpone volunteer programs in our facilities.    

All students should bring their own PPE or Intermountain will provide PPE and fit-test them. Students will not work directly with positive COVID-19 patients or patients under investigation.  

What this means for volunteers 

Intermountain will be reinstating the volunteer program in phases, based on the state’s COVID-19 status. In the yellow phase, a few positions with limited patient and guest interaction are being brought back, including music volunteers, family-to-family support, and volunteers at the Primary Children’s Family Room. All other volunteer positions will continue to be considered.  

Returning volunteers will be subject to the same screening that guests and caregivers are given when entering our facilities. They will be provided appropriate PPE for their shift. Returning volunteers may also be asked additional questions related to any recent travel outside of the state and any possible exposure to COVID-19 individuals, as approved by Employee Health.   

At Cassia Regional Hospital, because they are green, all volunteers except door screeners will be returning to their positions. 

Continued caution, preparation, and flexibility 

Regardless of color classification, Intermountain will continue to monitor the level of COVID-19 risk to our communities so we can be prepared with system and local resources as needed. With your continued support, we’ll work toward recovery and stabilization while sustaining preparedness efforts around all possible scenarios, including any potential surge in patients.  

A reminder to take every precaution for your own safety and for the safety of others. Even when not in patient- or visitor-facing areas, individuals should wear face coverings, which limit the spread of germs from the wearer to others by helping block large droplets from coughs and sneezes. Coverings, hand sanitation, and social distancing can help us stop the spread and prevent infection.  

Thank you for all you do to provide safe, quality, accessible care and extraordinary experiences to our patients and communities.