DCH to Offer Remote Screening Facility for Coronavirus

<Updated March 26, 2020

Testing and Confirmed Cases

To protect patient privacy, we have established a minimum threshold of five for reporting numbers of inpatients with laboratory-confirmed cases of COVID-19. At this time we have inpatients with COVID-19 being treated, but there are still five or less.

DCH internal counts as of noon today:

10 have tested positive for COVID-19 including individuals from the ED, triage tent and inpatient. These individuals are not necessarily in the hospital.

463 tested negative

N95 Masks Needed

As our Coronavirus team conducts its ongoing evaluation of our supplies, a need is emerging for N-95 masks. We will gladly accept donations of masks sealed in their original packaging between 8:30 a.m. and 4:30 p.m. in front of The DCH Foundation office, located in the Marie Bloodworth Building at 1110 Edward Hillard Blvd., Tuscaloosa, 35401.

Please share all you can – keeping our clinical staff safe is going to be a key issue in West Alabama’s ability to weather this crisis and help limit COVID-19’s damage to our community.

Call 205-759-7106 with any questions, or simply drop off the masks at the above address.

Additional Isolation Area

The Emergency Department at DCH’s Regional Medical Center has added more isolation space to place patients who present with respiratory symptoms similar to COVID-19. A wall was put up to isolate four rooms from the rest of the Emergency Department. Patients who come in with respiratory symptoms are taken through a separate entrance into one of these four rooms until they can be evaluated.

Northport Medical Center and Fayette Medical Center have also instituted isolation areas and practices for their Emergency Departments.

Surge Preparations

We will need the support of all DCH staff should we see the sustained and widespread community transmission of COVID-19. Groups of employees are being identified now that could be redeployed to other areas. For example, since nonelective surgeries are on hold, OR nurses may be called upon to help with patients at the bedside.

To prepare for these situations, staff members are getting updated MEDITECH training on essential tasks like charting, rounding or physical assessment.

Redeployment will only be used when demands upon our system warrant it.

March 25, 2020

Confirmed Cases

To keep our community informed during the COVID-19 outbreak, DCH Chief Medical Officer Dr. Robin Wilson and Dr. Blake Lovely, emergency room physician and regional medical director for emergency department services at DCH, participated in a virtual town hall with Tuscaloosa Mayor Walt Maddox today, March 25. Here is some of the information they shared.

To protect patient privacy, we have established a minimum threshold of five for reporting numbers of inpatients with laboratory-confirmed cases of COVID-19. At this time we have inpatients with COVID-19 being treated, but there are five or less.

• Eight were positive for COVID-19 including tests from the ED, triage tent and inpatient. These individuals are not necessarily in the hospital.
• 405 tested negative

Ventilators

DCH is prepared to handle coronavirus patients who may need ventilators.

We just received 22 new Hamilton ventilators, including one for MRI and one for patient transport. These were part of a plan that began before the COVID-19 outbreak.

The new ventilators are being assembled on-site now. Employee training starts early next week, followed by the ventilators’ active use by late next week or early the following week.

The Hamilton ventilators use the same supplies as our current ventilators, and they automatically adjust to the patient’s airflow needs, enabling a faster recovery.

DCH has 48 existing ventilators. We also have 10 rental units on hand and ready to use.

That brings the total number of ventilators between Northport Medical Center and DCH Regional Medical Center to 80.

Our average daily ventilator use is between 16 to 20 patients. Currently we have 25 patients on ventilators, so we are on the high end of our average but well within our capacity.

Preparing for a Surge

We have taken several steps to prepare for a potential surge in patients.

DCH RMC has at least 20 negative pressure rooms (their air is separated from the main circulation) for patients who may need to be on airborne precautions.

We have been working on two initiatives to expand that capacity.

• First, we are moving as many patients as possible who have symptoms and are waiting on test results to one area. The nurses in these areas receive additional training on protocols to ensure patient and employee safety.
• Second, we have been modifying an area so that an entire unit of 14 rooms will be negative pressure in case additional rooms are needed. This will serve as our primary overflow area for the more critically ill.

Other units are being looked at for similar efforts.

March 23, 2020

Testing at DCH has been cancelled for today due to weather. However, our facilities team has continued to work. They are erecting a tent that cars can drive into. This will allow the screening and testing to continue during rain as long as it is not severe.

March 21, 2020

DCH will be offering the screening/testing service tomorrow, Sunday, March 22, from 2-5 p.m. in the parking lot just west of its Regional Medical Center campus. The times are consistent with staff availability and potential poor weather. Only swab tests will be conducted and the supply is critically low. This means only those screened with symptoms indicating a high likelihood of infection will have a specimen collected for testing.

The service will resume 8 a.m. – 5 p.m. Monday through Friday next week as long as supplies remain available and the weather allows for the process to safely continue. Additional measures being taken to improve and continue the effort include:

• Adding a tent that vehicles can drive into which will facilitate continued screening during moderate rain.
• Seeking additional resources including testing with other labs and new sources for supplies. Current supply levels of swabs will only last through early next week so an extensive effort is underway to find more.
• Refining the process for screening.

Feedback from the state lab has indicated that the high rate of rejected sputum specimens was not primarily due to improper transport and spoiling (this was given as one of the reasons for rejected samples statewide). The sputum samples from DCH were primarily rejected due to a lack of testable material (not enough sputum in the collection cup). Visually screening the samples at the collection site has been very difficult due to the protective measures in place so now only swabs will be done so that the provider can better directly control the adequacy of material collected.If you had a specimen collected you can check your results on the DCH portal. It takes about five days for results at the moment. If your record indicates the sample was insufficient for a test and you are feeling worse, please know you can come back and get retested or see/call your doctor. False negatives are not impossible and even if negative you can still get infected later. You should practice social distancing for at least 14 days from the onset of symptoms.

Testing at DCH has been cancelled for today due to weather. However, our facilities team has continued to work. They are erecting a tent that cars can drive into. This will allow the screening and testing to continue during rain as long as it is not severe.DCH will be offering the screening/testing service tomorrow, Sunday, March 22, from 2-5 p.m. in the parking lot just west of its Regional Medical Center campus. The times are consistent with staff availability and potential poor weather. Only swab tests will be conducted and the supply is critically low. This means only those screened with symptoms indicating a high likelihood of infection will have a specimen collected for testing. Feedback from the state lab has indicated that the high rate of rejected sputum specimens was not primarily due to improper transport and spoiling (this was given as one of the reasons for rejected samples statewide). The sputum samples from DCH were primarily rejected due to a lack of testable material (not enough sputum in the collection cup). Visually screening the samples at the collection site has been very difficult due to the protective measures in place so now only swabs will be done so that the provider can better directly control the adequacy of material collected.If you had a specimen collected you can check your results on the DCH portal. It takes about five days for results at the moment. If your record indicates the sample was insufficient for a test and you are feeling worse, please know you can come back and get retested or see/call your doctor. False negatives are not impossible and even if negative you can still get infected later. You should practice social distancing for at least 14 days from the onset of symptoms.

March 21, 2020

DCH will be offering the screening/testing service tomorrow, Sunday, March 22, from 2-5 p.m. in the parking lot just west of its Regional Medical Center campus. The times are consistent with staff availability and potential poor weather. Only swab tests will be conducted and the supply is critically low. This means only those screened with symptoms indicating a high likelihood of infection will have a specimen collected for testing.

The service will resume 8 a.m. – 5 p.m. Monday through Friday next week as long as supplies remain available and the weather allows for the process to safely continue. Additional measures being taken to improve and continue the effort include:

• Adding a tent that vehicles can drive into which will facilitate continued screening during moderate rain.
• Seeking additional resources including testing with other labs and new sources for supplies. Current supply levels of swabs will only last through early next week so an extensive effort is underway to find more.
• Refining the process for screening.

Feedback from the state lab has indicated that the high rate of rejected sputum specimens was not primarily due to improper transport and spoiling (this was given as one of the reasons for rejected samples statewide). The sputum samples from DCH were primarily rejected due to a lack of testable material (not enough sputum in the collection cup). Visually screening the samples at the collection site has been very difficult due to the protective measures in place so now only swabs will be done so that the provider can better directly control the adequacy of material collected.

If you had a specimen collected you can check your results on the DCH portal. It takes about five days for results at the moment. If your record indicates the sample was insufficient for a test and you are feeling worse, please know you can come back and get retested or see/call your doctor. False negatives are not impossible and even if negative you can still get infected later. You should practice social distancing for at least 14 days from the onset of symptoms

March 20, 2020

Elective Medical Procedures
The state has issued an order requiring all elective medical procedures to be delayed until at least April 5. All non-urgent/emergent procedures will be cancelled starting Monday, 3/23/2020. We ask you to contact your physician for assistance in determining if a case would be considered urgent/emergent based on guidelines that have been established.

Screening

Unfortunately, some specimens from the screening effort were unable to be tested by the lab. Feedback from the state lab has indicated two main reasons for this. First, reports of insufficient cooling during transport have contributed to specimens that could not be tested. The second issue has been the lack of sufficient material to test. These issues have impacted both the swab and Sputum cup collection methods and DCH and other hospitals across the state have been working to improve their processes as information has come in.

We are working with FEMA, ADPH, and the US Government to get more swab test kits to meet the needs of our community ASAP.

If you record indicates the sample was insufficient for a test and you are feeling worse, please know you can come back and get retested or see/call your doctor. False negatives are not impossible and even if negative you can still get infected later. You should practice social distancing for at least 14 days from the onset of symptoms.

March 19,2020
Screening Tent
The remote screening service will be closed on Friday, March 20, due to a forecast of thunderstorms in the morning and potential heavy wind and hail in the afternoon. In addition, as announced yesterday, we will not be conducting screenings on the weekends. The next time the service will be available will be Monday, March 23, starting at 8 a.m., as long as there is no rain or heavy winds.

Visitation Policy Revision
This afternoon an order was issued by the state health officer mandating the suspension of certain public gatherings. This order will run through at least April 5.

The mandate prohibits hospital visits except for “certain compassionate care situations”. Fayette Medical Center’s Nursing Home is still closed to all visitors. DCH is updating is temporary visitation policy as follows for all of its campuses:

• One visitor per outpatient cancer treatment patient or maternity patient.
• One visitor per patient for end of life events.
• Up to two visitors per patient for the NICU.
• Any visitor must be healthy and at least 16 years old.
• Per the order, no other visitors will be allowed.

Thank you for your patience as we have worked through this unprecedented COVID-19 crisis and how to manage it. Every day has brought new questions. With the help of a highly dedicated staff, excellent physicians and engaged partners such as the city, police, fire, EMS and many more, we have figured out solutions so we could keep screening and collecting specimens for testing.
Today we wanted to let you know about two changes we will implement immediately at DCH’s remote screening site adjacent to its Regional Medical Center. First, the provider’s personal protective equipment is not as effective when wet, so rain creates a potentially unsafe situation for the providers. On days where significant rain is in the forecast, or it starts to rain heavily when not expected, we will close the screening for the day and will work to get the word out. Second, everyone has been working very hard to meet the community need, but our resources are limited and our staff needs rest. To that end, we have decided to not hold screenings on Saturdays and Sundays. Please self-quarantine until the next non-rainy weekday if you feel you need to be evaluated for a test.

This has been an evolving process. These changes reflect an effort to pace our resource consumption at a rate we hope to manage for the duration of the need. Community feedback is critical to our success. If you have any questions or suggestions, please reply to this post or message us directly. Thank you for your understanding.

March 18, 2020
Testing Method at Remote Screening

The nation has a shortage of the viral transport media required to use nasal swabs, there isn’t nearly enough to meet the needs of our community. The Alabama Department of Public Health (ADPH) specifies an alternative method of testing using sputum. Sputum requires a specialized lab and a good sputum sample, but it is an extremely good test.

However, if you can’t get enough sputum up, they can’t test. Please understand that the state lab cannot process inadequate samples. We appreciate our partners at the ADPH lab; they are an extremely sophisticated and competent team. They are working hard to test every sample they can, but please be understanding if your test results are inconclusive.

The good news is that we have obtained hundreds of usable samples. In order to meet the needs of our community, we are using all resources available to fight this disease. This method of collection, mixed with a judicious use of the nasal swabs we have available, has allowed us to keep collecting specimens for testing when others have had to stop due to a lack of supplies. In the first two days alone we were able to screen nearly 800 people and send off over 500 specimens for testing.

We appreciate you getting tested. We are learning about the disease prevalence in our community through this initiative.

Unfortunately, a negative result by any testing mechanism does not rule out the disease. If you are having symptoms, please avoid contact with others for 14 days regardless of your test result or test method.

We have to work together as a community to keep this disease from spreading. Let’s protect each other!

March 17, 2020

Yesterday, we screened 307 individuals at our remote screening facility. There were 267 specimens collected. It will take up to 5 days for the results to come back, and those screened will be contacted only if the test was positive. We will not be contacting individuals who tested negative. If your employer requires a doctor’s note for you to return to work, we recommend you contact your primary care physician and let them know you were screened at our remote facility. He or she can access your test results.

March 16, 2020

Thank you for your patience as we made our way through the first day of screening and specimen collection for testing. We saw hundreds of people. Overall things went fairly smoothly but we also learned a lot and will work to continually refine the process.

While a portion of those screened met the current criteria for testing, many did not. We are doing our best to provide answers and test where appropriate. Please help us manage the limited resources (personnel, supplies etc.) we have available. We will resume tomorrow at 8 a.m. just west of DCH’s Regional Medical Center in the laundry parking lot. Specimens will only be collected for testing if the individual meets the current testing recommendations.

• Flu-like symptoms such as fever, cough, fatigue, shortness of breath, body aches.
• Close contact with a laboratory-confirmed coronavirus patient within 14 days of symptom onset.

March 15, 2020

Please help us manage the limited resources (personnel, supplies etc.) we have available for the remote screening/testing that will start tomorrow, March 16, at 8 a.m. just west of DCH’s Regional Medical Center in the laundry parking lot. Specimens will only be collected for testing if the individual meets the current testing recommendations.

• Flu-like symptoms including fever, cough, fatigue, shortness of breath, body aches.
• Close contact with a laboratory-confirmed coronavirus patient within 14 days of symptom onset.

March 14, 2020

DCH’s multidisciplinary coronavirus (COVID-19) task force is setting up a remote screening facility in the large parking area just west of Dr. Edward Hillard Drive on its Regional Medical Center Campus near the DCH laundry facility.

Starting Monday, March 16, screening services will be offered from 8 a.m. until 5 p.m., seven days a week, until the need diminishes. Community members who think they may have contracted the virus will be able to pull up and speak to a provider directly from their own vehicle. Providers will conduct a verbal and visual screening based on the most recent CDC guidelines including:

• Flu-like symptoms including fever and/or respiratory illness
• Close contact with a laboratory-confirmed coronavirus patient within 14 days of symptom onset
• Travel from an affected geographic area within 14 days of symptom onset

Based on the screening, individuals will either be directed to the Emergency Department or their primary care provider for routine or emergent care or to the tent for additional evaluation which could include coordination with the Alabama Department of Public Health for specimen collection and testing of symptomatic individuals.

“DCH is committed to ensuring the health and safety of the community,” said Blake Lovely, MD, emergency room physician and medical director for the emergency department services at DCH. “DCH felt it was important to offer resources for educating the community, responding to questions and concerns and facilitating the testing process.”

DCH’s COVID-19 task force is made up of leadership, physicians, nurses, infection prevention, safety and other experts and has been meeting several times a week to plan and stay up to date with the latest information surrounding the coronavirus.

Other than limiting patient visits, the DCH campuses remain open and are operating normally.

As of right now there has been one confirmed COVID-19 case in Tuscaloosa County. The individual was not admitted to DCH.

In the interest of public health, DCH suggests a few tips to help stop the spread of this virus.

• Frequently wash your hands and avoid touching your face.
• Stay away from others if you are sick and only come to the hospital if they need medical care.
• Limit visits to individuals in the hospital, even if you think you are well.
• Avoid travel, especially to areas that have laboratory confirmed COVID-19 cases.
• Sanitize high-touch surfaces such as doorknobs, phones, keyboards and desks.
• Look to the Alabama Department of Public Health or the CDC for accurate and up-to-date information.