One of the toughest parts of being a COVID-19 patient, besides being sick, is being stuck in a hospital room away from your family and friends for a lengthy period of time as you recover.
JPS Health Network leaders have found a way to get patients back home earlier – or in some cases keep them out of the hospital altogether – as they return to health. By sending patients home with an oxygen supply and monitoring their blood oxygen level through the day, not only are patients more comfortable, but 1,200 days of inpatient stays have been avoided, opening hospital beds for patients who need them.
“There are multiple benefits of getting people home as soon as possible,” Dr. Steven Davis, pulmonary/critical care physician and Senior Physician Executive of Internal Medicine at JPS said about the JPS COVID-19 Home Monitoring Program. “Visitors are not being allowed in our COVID units and the caregivers there are dressed in enhanced personal protective equipment. So, there is a lot of isolation both physical and emotional. On the other end of the spectrum, there is a financial component. Lengthy stays at the hospital are expensive, so this is a cost effective way for patients to get the care they need.”
Currently, JPS has about 80 patients staying in the hospital’s COVID units, about 30 people are at home on the oxygen program. At a time when the demand for COVID beds has nearly doubled in a matter of two weeks, the new initiative has increased the number of available beds by more than one-third.
From Case Management, to the medical staff, to third-party vendors, this is something that required a real team effort. Collaboration and coming together for a good cause, it’s what we do best.
As COVID patients recover, Davis said the last thing they need to be able to be on their own again is a little bit of a boost of oxygen. While sending them home with oxygen and monitoring equipment might sound like a simple idea, working out the logistics was much more complicated, he said.
“We learned early on that people with COVID were going to need oxygen for a while,” Davis said. “There were those who didn’t need much oxygen to keep from being admitted to the hospital and those with the only thing keeping them in hospital was they still needed a little oxygen. The problem was their blood oxygen had to be 88 percent or lower to get their oxygen paid for (by insurance.) That’s a problem because 88 percent is getting low enough where you might not have a lot of reserve beneath that before their condition starts to plummet.”
Davis credited the JPS Finance Department with doing a fantastic job in negotiating with insurers and suppliers to secure oxygen for patients with up to a 94 percent blood oxygen level.
“The reason we were able to make this work was because of the collaborative culture at JPS,” said Rory McCrady, Vice President of Revenue Cycle at the health network. We started out with a concept that this was a way to address an urgent need due to a rise in the demands caused by the pandemic. When I got the request, the question was how do we get mobilized?”
McCrady and the finance team worked with oxygen vendors and insurance companies to come up with a plan that helped all the contributors more efficiently and effectively help patients. They then pre-stocked needed oxygen tanks and carts, pulse oximeters and other supplies. While there was some upfront cost, it has more than been offset by the savings realized from having patients in their home instead of a hospital bed.
Dr. Nadia Alawi, Vice Chief-Primary Care Operations, said it was gratifying to see so many people come together for the good of patients.
“From Case Management, to the medical staff, to third-party vendors, this is something that required a real team effort,” Alawi said. “Collaboration and coming together for a good cause, it’s what we do best.”
When they’re set up in their home, patients are contacted at least three times a day to monitor their condition.
“There are so many contacts with patients that if their oxygen needs start to go up, we have a chance to catch it and they’re admitted before things get out of hand,” Davis said. “Since this program started, we’ve had to admit several people. But we did it safely because we have a mechanism to catch people if their condition begins to worsen.”
Davis said the program, only about two weeks old, has worked so well that it will certainly be around to help patients in need of oxygen because of other reasons long after COVID-19 is in the past.
FORT WORTH, Texas (May 21, 2020) – Lockheed Martin (NYSE: LMT), a leader in aerospace innovation, is partnering with JPS Health Network to leverage the use of technology to combat the spread of COVID-19 and its long-term effects on vulnerable and financially at-risk populations in Tarrant County.
Through a $500,000 Lockheed Martin grant to the JPS Foundation, which seeks philanthropic support for clinical care, research and training at JPS, the health system will move to expand telehealth services to include specialty care kiosks in neighborhood health centers and remote monitoring for COVID-19 positive patients whose condition can be managed from home.
“COVID-19 has brought into sharp focus the need for healthcare to maximize technology to serve all patient communities, from veterans and the working poor to people experiencing homelessness,” said JPS President and CEO Robert Earley. “Telehealth is the medical world’s answer to social distancing. Lockheed Martin’s generous gift will allow JPS to adopt methods of care that keep our patients and our team members safe.”
“Lockheed Martin and our nearly 20,000 Fort Worth employees are committed to helping our neighbors in need and supporting those fighting this pandemic on the frontlines,” said Michele Evans, executive vice president of Lockheed Martin Aeronautics. “Through these challenging times, JPS Health Network has not wavered in providing quality medical care to all, regardless of their ability to pay. With this gift, Lockheed Martin is proud to contribute to our shared goals of doing what’s right and protecting the communities we call home.”
Providing access to telehealth visits with specialists from kiosks at neighborhood clinics will not only decrease the need for patients to travel to the main campus, but it will help those patients without smart phones get needed specialty care. The kiosks also will cut down on excessive or non-essential trips to the emergency room.
The development of a remote monitoring program would allow JPS to track the vital signs of COVID-19 patients who are discharged to finish their overall recovery at home.
“Investing in innovation that protects our community is what Lockheed Martin does,” said Tarrant County Judge Glen Whitley. “I am grateful for the company’s support of the vital work our public healthcare system does every day to protect the health of Tarrant County residents.”
While it seems the world is preoccupied with the COVID-19 pandemic, doctors, nurses, and team members at the JPS Oncology and Infusion Center still have a job to do.
Time is of the essence, and their work waits for nothing. Patients who can’t wait for the virus to be defeated before they fight back against cancer in their bodies can still count on getting the care they need, according to Dr. Bassam Ghabach, Medical Director of the Oncology and Infusion Center.
“We’re reviewing every patient’s case and, if someone’s treatment is non-essential, we can postpone it,” Ghabach said. “But, for most people, that’s not possible. The infusion room is as busy as ever. We may be doing things a little bit differently, but we’re making sure people get the care they need.”
While the number of patients treated hasn’t changed, Ghabach said the way they are treated has. Some infusion chairs have been moved out of the infusion room into other spaces – some of them offices vacated by employees sent to work from home, others in break rooms and meeting rooms – to create social distancing buffers. Chemotherapy patients have weakened immune systems that make them vulnerable to COVID-19, so, to limit the number of times they have to leave the house, all their appointments and treatments are scheduled back-to-back instead of scattered across the month. To keep patients from having to go to the grocery store, Ghabach said the Oncology and Infusion Center has even teamed with a food bank to put together some boxes of non-perishable food to send home with people.
“Whenever possible, we’re doing a lot of telehealth meetings as opposed to face-to-face visits,” according to Ghabach. “About 70 percent of our visits are via telehealth. Things are working differently than usual. But we’re not delaying any referrals that are coming to us. At the very least, we are calling the stable patients to reassure them that we’re working on their case and they’re not being delayed or forgotten. We want all of our patients to know that we will continue to be here for them.”
We want all of our patients to know that we will continue to be here for them.
Wendy Reimers, a patient who was at the Oncology and Infusion Center Wednesday for chemotherapy, said her delicate condition has required her to be in quarantine since September. So, she’s very grateful to see all the precautions JPS is taking to protect her – and that she can still get her treatments despite the fact that the outside world seems to be shut down by the pandemic.
“I love these people,” Reimers said. “I really do. Every one of them are wonderful. They’re all so caring. These nurses have a special something that I know I don’t have. I actually look forward to coming here for chemotherapy. Not only because it’s the only time I get out of the house, but everyone here is so nice to me.”
The extra care the Oncology and Infusion team provides to patients happens beyond the infusion room, even beyond the walls of JPS. Ghabach said cancer care providers isolate themselves from their family members when they’re at home to try to make sure they’re not exposed to COVID-19. At work, team members aren’t able to make individual food orders from area restaurants as they normally would for lunch. They need to keep frontline screeners from having contact with any more people than necessary, which includes delivery drivers. With their break rooms off limits because of social distancing, on most days they have no way to eat a hot meal.
“It’s difficult sometimes,” Ghabach said. “But these are the things we have to do right now to keep our patients safe.”
In recent days, a local business purchased meals from an area restaurant for Oncology and Infusion Center team members, prearranging with JPS Volunteer Services to give the workers a rare treat while supporting another local business. The cancer team has also been treated to a meal donated by a local church and another from Tarrant County Commissioner Roy Brooks.
Velma Rangel, Administrative Assistant at the Oncology and Infusion Center, said team members were very touched by the gestures.
“It’s so nice to know that people appreciate what we’re doing and that we’re here for them,” Rangel said. “The team here has helped so many people over the years, so I don’t know if the people who donated had a family member or friend who we helped with cancer, or if it’s just their way of saying they’re glad we’re here. But we’re glad to be remembered and to be a part of this community.”
Ghabach said Oncology and Infusion team members are committed to continuing to find ways to take care of cancer patients through the pandemic and beyond.
“Although things are a little bit different now, we’re able to do everything we need to do,” Ghabach said. “The only thing that is a problem is when we have to deliver news to patients about what they’re facing. We want to be in the room with the patient to look them in the eye and hold their hand. Our patients are important to us, so it’s hard to have those conversations over the phone.”
Answering a call for more information about the community’s current health crisis, JPS Health Network has created a COVID-19 information line accessible to both healthcare workers and the public.
Starting today, information will be available on a recording updated daily at 10 a.m. In an email to staff, JPS President and CEO Robert Earley said the recording will include information about the number of JPS patients who have tested positive for COVID-19.
“JPS is reporting this information already to various agencies and we’re required to share it in public inquiries,” Earley said. “I want to make sure it’s also available to you, whenever you need it. There’s comfort in knowing the facts, and knowing what our teams are dealing with each day.”
People can access the information by calling 817-702-9500 (or 29500 internally) to hear the recorded message.
Behind the numbers we share are real people… patients and their families with lives and fears and hopes… and we should not lose sight of that as those numbers rise and fall.
While the information may be at times difficult to hear, Earley said it is important to remember that dedicated JPS team members are responding to the challenge daily, working long, sometimes difficult hours to give compassionate care to every person who comes through the doors in need of help.
“The recording may not answer every question you have, but I hope you see it as a big step to keep us all informed,” Earley said. “I want to remind everyone that behind the numbers we share are real people… patients and their families with lives and fears and hopes… and we should not lose sight of that as those numbers rise and fall.”
JPS team members have worked night and day to prepare for the COVID-19 virus.
While a lot has gone on behind the scenes, the most visible part of their preparation is a big, orange tent that appeared Friday outside of the main entrance to the Patient Pavilion.
Lance Lynch, Director of Emergency Management said the temporary structure is a “screening tent” where people coming to the hospital who raise red flags during the COVID-19 screening process can be taken for further analysis by a healthcare provider.
“In the tent, they’ll visit with a provider either in person or in a telehealth situation through an iPad to determine if they need to go inside for further treatment or if they’ll go home,” Lynch said. “It should take about 15 minutes once they’re inside the tent. It will be very quick.”
Chris Cook, Manager of the Emergency Department, said putting these plans in place required team members from all over the health network to pitch in.
This is a challenging situation. But our people have risen to the challenge. I believe we are very well prepared to do our jobs.
“It took a lot of work from a lot of people to get to this point, a great team effort,” Cook said, mentioning Emergency Department team members who brainstormed and planned, nurses who work screening stations and maintenance workers who had to remove benches and install traffic barricades to set up the screening process. “This is a challenging situation. But our people have risen to the challenge. I believe we are very well prepared to do our jobs.”
Jesse DeWaard, Executive Director of Emergency Services and Emergency Management, said JPS leaders prepare for unusual circumstances regularly, drilling for everything from natural disasters to emergencies like the COVID-19 outbreak. He said the practice has paid off.
“It builds confidence to practice and I have all the confidence in our team,” DeWaard said. “This is what we prepared for. So, it’s very inspiring to see everyone jump into action.”
Patients never see their faces. But they play a key role in helping people who need surgery get care at JPS Health Network.
Called patient care coordinators, their job is what the title implies: They’re responsible for choreographing the complicated ballet of making about 1,000 surgeries a month fit into the 13 operating rooms at JPS.
“Their work is invaluable,” said Dr. Carlos Rodriguez, a general surgeon who operates at JPS. “We literally could not operate without their assistance. They are constantly juggling the operative schedule to allow for optimal utilization of time. It’s a demanding job and they handle it skillfully.”
Rodriguez said he is grateful for the small group of nurses who work inside an out of the way office on the second floor of the Outpatient Clinic Building. They play a vital role in making sure people who need surgery get taken care of as soon as possible and, by handling all details large and small, they allow surgeons to focus on the big job of fixing bodies.
Coordinators are constantly getting surgery orders from the doctors they assist. They have to act quickly to keep the schedule moving. Then they have to check back on the cases repeatedly, making sure pre-op procedures are being handled on time.
“There are a lot of things that factor into it when surgeries are scheduled,” said patient care coordinator Teresa Dekleva. “It’s not just filling up the time slots. There are a lot of phone calls that happen to make sure everything that needs to be done before their surgery gets handled when it’s supposed to be done.”
Not only do the surgical suite hours and the schedules of surgeons have to agree, Dekleva said patient care coordinators have to check all the boxes to make sure patients have had all their required testing and preparation for their operation. That can include making sure they have someone in place to help care for them afterwards if they’re not going to be able to take care of themselves, that their financial arrangements are taken care of, even that they still want to get the procedure and plan to show up at the agreed to appointment.
It’s really complex to manage so many surgeons and so many patients with limited OR time
When any of the items on the pre-surgery to-do list don’t get taken care of and an operation is postponed, that’s not only wasted time. It’s a lost opportunity to help someone else. So the patient care coordinators have to make sure all the puzzle pieces fit together just right.
“The patient care coordinators work magic by finding or creating time in the schedule to get patients treated sooner,” said Dr. Fayette Williams, Division of Maxillofacial Oncology & Reconstructive Surgery Director at JPS. “It’s really complex to manage so many surgeons and so many patients with limited OR time but they always manage to make things happen.”
Cases range from only minutes for some eye operations to 13-14 hours straight for a surgery Williams performs to remove a patient’s tibia, turn the straight bone into a horseshoe shape with a series of precise cuts, and use it to replace their lower jawbone.
How do the patient care coordinators anticipate all the needs of surgeons and requirements of patients before they can have an operation? The answer is simple: Through experience. And lots of it.
“I’ve been a nurse for 33 years,” Dekleva said. “I worked at Parkland Hospital in Dallas in labor and delivery and in the operating room. I worked overseas in a primary care setting, working with everyone from adults to infants.”
She came to JPS working in IV sedation and Orthopedics. After three decades as a nurse, she was ready for a change. Once she made the switch, Dekleva said she never looked back. Becoming a patient care coordinator has rejuvenated her career.
“It might seem like a boring job because there is a lot of looking at computer screens and there are a lot of phone calls,” Dekleva said. “But you can tell in the patient’s voice how grateful they are for the help. Knowing that you helped them get the care they needed, that’s what makes me feel good about my job.”