Life Goes On

Pandemic Lessons Learned from Our Community Hospital

By: Lauren Kuczka, Marketing Director
Boundary Community Hospital

March 11, 2021

On March 16, 2020, the Boundary Community Hospital (BCH) Auxiliary held their annual pie sale. This almost 50 year tradition is usually a busy event with many in the community stopping to pick up some pies and sit and have coffee with their neighbors and friends. 2020 was a little different. When usually they sell out of the 100 pies and desserts by noon, this time people stayed home due to the fear of the coronavirus. In fact, just a week later the Idaho Department of Health and Welfare issued an “Order to Self-Isolate for the State of Idaho” for all citizens of Idaho. This was the beginning of the pandemic for many.

“We started talking about COVID-19 in some of our meetings, especially our Medical Staff meetings, as early as January 2020, but it wasn’t until mid-March that we recognized how significant this was to our country and community,” says Preston Becker, Hospital CEO. “At that time we went into Emergency Operations and created our COVID-19 Task Force that serves as our Incident Command and determines how Boundary Community Hospital will respond operationally to the pandemic.” The BCH COVID-19 Task Force, made up of key leaders at the Hospital as well as local physicians, continues to meet at least twice a week to review processes, regulatory changes, supply issues and changes needed to keep staff, patients and residents safe.

One of the first changes made by the Task Force was to set up drive up lab testing for routine tests. The phlebotomists had already been doing curbside draws so this process was welcomed by patients who preferred not to come into the Hospital itself. Drive up lab testing for non-COVID testing remains popular and will continue. Once COVID-19 positives in Boundary County started rising, the lab instituted special COVID-19 testing while patients wait in their car to reduce risk of exposure for staff as well as patients.

In March 2020, BCH Medical Director, Dr. Greg Botkin wrote: “Members of our community who show current or recent infection, are the earliest pioneers of an emerging society. Some will be actively fighting this thing, crushing and shredding viral particles day by day, killing this disease, perhaps preventing it from coming to your door. Think about that. These souls will be quarantined, largely unaided by medical science, isolated from the community’s companionship, supported entirely by devoted (and co-infected) friends and family. Some positives will have finished that battle, perhaps effortlessly, perhaps through indescribable pain and struggle, a few having come within heartbeats of death. And some positives we may lose. These will be our most fragile neighbors, lost in that fight, lost in the same way we lose neighbors every year to influenza and norovirus and cold viruses and heart disease.” Dr. Botkin continued “As we do more testing in Boundary County the number of positives will probably rise. This does not signal the end of our world. It does signal the need for unusual courage, careful analysis, and extraordinary compassion. Medical science cannot stop this storm. But it can assist a good community that is determined to gracefully and courteously push through to the other side. And after twenty three years of practicing medicine here I believe this is who we are.”

According to Materials Manager Josh Smith, “As demands for supplies escalated and supply dwindled, we had an interesting challenge. We ended up building relationships with many new or previously underutilized vendors that have been a great help during periods where our usual supply chain was strained near to breaking and many products, including PPE, were very hard to come by, or prohibitively expensive for our small facility. Even still, nearing a year into the Pandemic, many of the goods that were always on our shelves are still hard to come by at near reasonable pricing. We have had to push adaptability pretty hard in our facility. Luckily staff has had few qualms with the sometimes odd product choices (specifically, ordering a case of rainbow colored rain ponchos for our laboratory personnel when proper impervious gowns were completely unavailable comes to mind) we have had to make, only cautioning us when we dared venture into the… flamboyant. I will say however, that they still wore the ponchos!”

Chinna McKechnie, RN, Infection Prevention Director relates “When we introduced Universal Masking, I counted on having staff object but was pleasantly surprised to get very little opposition. Everyone took it in stride and I’m proud of how safe it is to work at the hospital. Since October about 20% of our staff have gotten infected and the majority of the cases were a known exposure outside of the hospital. We have had one swing patient and one ECF staff infected in all of 2020. Considering the 25% Positivity rate in December for our community that is really good.”

Rehabilitation Services continued throughout the pandemic – constantly flexing to meet new requirements and addressing individual patient needs. Other departments were more affected. Surgery Manager, April Bennett, MSN RN says that the reality of COVID-19 was apparent “starting March 19th, when it was decided that all elective surgeries would be suspended due to the COVID-19 outbreak. Pre-operative COVID testing on all surgery patients to ensure that we are decreasing the spread of the virus is now required.” April particularly notes that “the multiple hours that Grant Heald and the lab team have worked to perform tests for the community has helped bring awareness to the virus. Personally, the loss of Rocky B, a longtime community member to this virus has really hit home.”

Linda Manley, RN, Acute Care Manager relates that her staff are feeling the loss of the “personal touch.” Human interaction, the touch of a hand, being close, are an essential part of healing. The nursing team in the Hospital do everything they can to help their patients, screening and allowing essential visitors for the health of the patient in their care.

Boundary Community Hospital is unique in the state of Idaho because they have an extended care facility/nursing home contiguous to the acute care facility/hospital. Federally-mandated regulations on nursing homes restricts access and adds special conditions to the entire facility including acute care. COVID-19 positive patients are often treated in the Emergency Room. Acute patients who test positive for the virus and require hospitalization are generally transferred to other hospitals in the region. Many patients are sent home to recover under the supervision of their primary care provider. “One of our top priorities has been, and continues to be, protecting our nursing home residents,” says CEO Becker. “This is their home and we do our best to respect that. Limiting visitation has been one of the most difficult things we’ve had to implement. Our teams have worked hard to continue to allow for visitation in a safe manner when circumstances allow for it. In regards to care, our staff have not changed their compassionate approach to caring for our residents. We continue to be recognized as a 5-star facility providing 5-star care to our residents and their families.”

It wasn’t until July 9 that the Boundary Community Hospital Laboratory had their first positive COVID-19 test of a resident who currently lived in Boundary County. According to Laboratory Medical Director, Dr. Greg Botkin, “The Hospital’s Clinical Medical Laboratory has put together a set of instruments and reagents that are as accurate and fast as any testing platform in the country. The results merit a high degree of confidence. When we inform patients about the presence or absence of active disease we believe we are providing the most accurate report that medical science can now provide.” From April 2020 through March 10, 2021, the lab has taken 7,781 samples and reported 600 positives for Boundary County residents and 245 positives for out of county residents.

The Hospital received funds from several programs, both State and federal including the CARES Act. The money received from the PPP Loan program was intended to allow the Hospital to maintain normal operations and help avoid layoffs or workforce reductions. “These funds were needed so that we could not only continue to provide quality care to our community, but also to provide jobs to people within our community,” said Mr. Becker. “Additionally, we purchased many items that created a safer environment within the organization including protective barriers in public registration areas, medical supplies that allowed for a safer delivery of care and reduced exposure to infectious disease such as COVID-19, cleaning and sanitation supplies, etc.”

Some of the purchases, you may see when you come to the Hospital include:

• • Upgraded lighting in the Ambulance Bay
  • Communication equipment for Emergency and Lab personnel
  • Powered Air Purifying Respirators (PAPRs) for all patient care departments at a cost of $1,100 for each unit. PAPRs provide enhanced protection for the nurses, doctors, and other healthcare team members working with COVID-19 positive patients.
  • New Lab equipment that can be used for not only SARS Cov-2 virus detection but other respiratory illnesses as well.
  • Remodeled and improvement to an outbuilding to facilitate drive up testing.
  • Computers and hardware upgrades for telehealth options as appropriate.
  • Overtime for staff members covering other shifts and providing employees with opportunities to learn new skills so they could help in other departments.

The Hospital Executive Team and Board of Trustees have been careful to be sure they are learning from their experiences so that they can make the best decisions going forward and truly understand what the Hospital needs are and where to put their dollars.

The Board of Trustees voted to move forward in February 2021 with some key equipment purchases using COVID-relief funds, including:

1) New Security Monitoring System covering the entire hospital campus – inside and outside.
2) Negative Air Pressure System for the remodeled Lab
3) Replacing carpet in the Rural Health Clinic with new, more sanitary flooring
4) Badge controllers at the Clinic exterior doors and interior doors between the waiting room and the exam areas.
5) Washing and Disinfecting Equipment for Central Sterile Supply to increase capacity and streamline sterilization of equipment
6) Large Power Tools, Saw, and PPE Hoods for Surgery (current equipment is borrowed from the Surgery Center)
7) Portable X-Ray Equipment for Emergency/Acute Care

In 2021, Dr. Botkin relates “I would add one thing to what I wrote last year. The comment ‘unaided by medical science’ became less true as the weeks rolled by. Clinical trials and grassroots trial-and-error efforts gave us reasons to try specific therapeutic interventions for Boundary County residents who were the most ill. I think it fair to conclude that some of these efforts had real and beneficial effect.”

We are thankful for the personnel and infrastructure in our medical community, for the heroes we work with, nurses and lab technicians and physicians, support teams, rural health clinic and outpatient services staff, all those with families at home, putting on their gear and going out to do the exam, collect the samples and ascertain the extent of a patient’s illness, every time, every case.

Life goes on as the pandemic continues. Vaccines are being administered and cases continue to fluctuate. And the Hospital Auxiliary is planning to continue their community tradition by holding the annual Pie Sale to benefit the Hospital on March 12, 2021 at the VFW Hall.

The spirit of community continues to withstand the storm and the Hospital team continues to take care of our community every day.