When Royal Jubilee Hospital (RJH) was designated the site for suspected and confirmed COVID patients in southern Vancouver Island in early March, teams of physicians and allied health personnel scrambled to decant the hospital, going from a census of 115% to 70% within weeks. The effort involved in this process is described as “herculean” by Dr. Brian Mc Ardle, Site Director for RJH and an internal medicine physician. Alongside this effort to transfer patients back home or into community facilities, teams worked within the hospital to facilitate necessary changes, such as supporting surgical colleagues to free up beds, and ER physicians and facilities staff to revamp the emergency room to change patient flow.
At the center of the COVID response at RJH was the creation of a ‘COVID ward’ on 5-North. Half the beds (18) were set aside for suspected COVID patients, while the other half (18) were for confirmed cases. A group of hospitalists and internists collectively applied to the South Island Medical Staff Association for support in organizing and implementing this new ward. They needed to design a seamless workflow for transitioning patients in and out of the ward, ensure that the ward was fully staffed day and night by the appropriate mix of staff, and prepare physicians for the anticipated conversations with patients and their families about the morbidity and mortality of COVID-19.
These plans were developed in record speed, resulting in a dedicated internist working alongside a hospitalist colleague and a CTU nursing staff at all times to manage the ward. At the peak of this first wave of cases, there were 4 patients in the ward. The ward was never “slammed by a wave”, says Dr. McArdle, and quite frequently, “we spent more time managing fear than managing patients”. As anticipated, patients and their families who received a suspected or confirmed COVID-19 diagnosis often feared the worst and required extensive counselling about the disease. The group benefitted from their close links with the ICU physicians about Goals of Care conversations, despite being in the fortunate circumstance of rarely needing to employ these techniques in relation to COVID patients in Victoria.
With the slowing down of cases in southern Vancouver Island, the COVID ward has been scaled back to a single side, with both confirmed and suspected cases. Dr. Mc Ardle describes this unit as a nimble and flexible small unit, with the ability to flex up and down as needed”. The hope is that this unit will be able to scale back up quickly in the event of a second wave.
During this reprieve, it is also timely to focus on the opportunities that exist to do things differently in the hospital. Dr. Mc Ardle reflected on the brief time when the hospital census was at 80%, saying “Things just worked better. Patients weren’t in hallways. Tests results were available swiftly. We all got a window into what happens when the hospital is functioning the way it should”. The challenge now is to harness the current openness to change and to do what we can to maximize our ability to care for patients outside of hospital.