Inside look at COVID-19 patient care in state’s smaller hospitals

HURON, S.D. (KELO) — Back in April, the Huron Regional Medical Center was handling coronavirus patients as the pandemic was just getting started in South Dakota.

“I’m pretty sure we have a plan for every scenario,” Lindsey McCaskell said of pandemic planning. That includes a “plan to use every single medical room” in the hospital, said McCaskell, the assistant inpatient services director at HRMC.

McCaskell said hospitals in the state contacted Huron early in the pandemic to learn how it was handling COVID-19 patients.

HRMC hasn’t needed to use every single medical room but it has used its COVID-19 patient medical ward and its COVID-19 intensive care unit (ICU) area.

“We have three patients in the COVID-19 ward now and two in the COVID ICU (area),” McCaskell said on Sept. 24.

There’s been a recent uptick in COVID-19 cases in Beadle County, where Huron is located. According to the South Dakota Department of Health, the county has substantial community spread of COVID. The DOH also lists substantial community spread in Walworth County where the Mobridge Regional Hospital is and in Codington County where Prairie Lakes Healthcare System in Watertown is located.

The three hospitals don’t have hundreds of beds like a Sanford Health or Avera Health in Sioux Falls but they serve a pivotal role in caring for COVID-19 patients in their regions.

South Dakota has 245 ICU beds, South Dakota Department of Health Secretary Kim Malsam-Rysdon said. As of Sept. 24, 101 of those beds were available, Malsam-Rysdon said.

Based on input from the three health care organizations, Mobridge, Huron and Watertown would be part of the total bed count for ICU and general beds.

“Sioux Falls can’t absorb all these patients. We need to care for them here in Watertown,” K.C. DeBoer, the chief executive officer of Prairie Lakes, said.

Prairie Lakes had been caring for zero to four COVID-19 patients for several weeks but the numbers have recently increased, DeBoer said. It increased to six and increased again after that, he said.

As of Sept. 23, Prairie Lakes had 12 COVID-19 patients, DeBoer said.

Prairie Lakes opened one wing of its 30-bed COVID-19 space a month ago. Within the past week, it opened the entire floor in anticipation of increased patients, DeBoer said.

The hospital has 81 acute care hospital beds including general patient beds.

Pandemic planning for all three organizations included determining how patient beds could be used, staffing, personal protection equipment use and other factors. The plans also provide responses to surges in COVID-19 patients.

Mobridge has “a surge plan that outlines how we would handle patients as cases of COVID-19 increase within our service area. This plan outlines where we would place patients with considerations for negative air pressure and other infection control measures to help protect our staff and other patients,” the organization’s disaster preparedness coordinator Darcy Dykhouse said in an email response to KELOLAND News questions.

Mobridge hasn’t yet needed to use much of its surge plan, Dykhouse said on Sept. 24.

Who are the hospitals serving?

Prairie Lakes serves 10 counties, seven in eastern South Dakota and three in western Minnesota.

Patients come from Codington County but also from those other nine counties.

“We are the next largest facility for these folks,” DeBoer said.

Mobridge is a 25-bed critical access hospital that serves five counties with a population of about 20,000 people.

“We are the only hospital that provides full-time surgery and OB within a 100 miles radius or further depending on the direction,” Dykhouse said.

HRMC also serves several counties and works with health care facilities in DeSmet, Wessington Springs, Mitchell, Platte, Armor and Parkston, McCaskell said.

The three hospitals care for patients from areas outside their city borders.

“We view them as our partners,” DeBoer said of health care facilities in the region. “Not just with COVID but all the time. Whether a patient presents in Clear Lake with chest pain or trauma that comes from Webster or Milbank.”

If Prairie Lakes can’t provide care, it will help them find that care, DeBoer said.

Part of the service area can include working with larger facilities including Sanford and Avera in Sioux Falls.

McCaskell said patients in Huron who needed a pulmonologist or cardiologist are examples of those who get transferred to facilities in Sioux Falls.

When those Huron-area residents improve, they often get transferred back to HRMC, McCaskell said.

HRMC is an independent organization and is not affiliated with Avera or Sanford but collaboration with those organizations and others has been key to pandemic response, McCaskell said.

What does COVID-19 care look like?

Isolation is a key in caring for COVID-19 patients.

“Given the pre-work that our staff have done through surge planning, we have the ability to flex rooms and staffing levels to create isolation areas in our facility that can expand and contract to our patient needs at the time,” Dykhouse said.

Using negative air pressure for COVID-19 is part of the plan for all three health care organizations.

DeBoer said a positive air flow area will push air back into other areas. A negative air flow are will suck air into the area and then release it externally.

Negative air flow helps reduce the spread of the coronavirus including for the staff who work with COVID-19 patients.

In some ways, COVID-19 patient rooms will look like other patient rooms but in other ways, COVID-19 has transformed some areas of the hospitals.

The COVID-19 ICU area is separate from the COVID-19 general patient area, McCaskell said. And the COVID-19 medical ward is separated from other patient rooms.

If a COVID patient’s condition worsens, they may get moved to the ICU area, McCaskell said.

Linens are delivered in a separate cart as are medical supplies, McCaskell said. It’s contactless delivery, she said.

“COVID nurses can’t go anywhere but the COVID ward,” McCaskell said.

Nurses wear personal protective equipment while caring for COVID-19 patients.

McCaskell said those working in COVID-19 ICU in Huron look a lot like astronauts.

“Caring for these patients in difficult from that standpoint that you have to be in protective gear for long periods of time,” DeBoer said.

Staff key in COVID care

“If there are COVID positive patients, we will flex our staff for their needs. This all depends on our volume, but we have contingencies in place to handle multiple scenarios,” John Avyoub, the chief executive officer of Mobridge Regional Hospital and Clinic, said.

Malsam-Rysdon said that staffing was a key to the number of available beds in the state. The numbers she shared on Sept. 24 were staffed beds.

McCaskell said in general, nurses in COVID care do it all including the cleaning and drawing blood for labs.

So far in Huron, only about two staff members have been impacted by COVID-19, McCaskell said.

A healthy staff that has a good morale is important because the hospital officials said working with COVID patients is demanding, right down to wearing PPE all day.

DeBoer said part of the Prairie Lakes pandemic plan was to retain staff so no staff was laid off or furloughed to assure that people had jobs. Some staff did different tasks during the pandemic including pulling weeds and painting.

But that also created some sense of teamwork and everybody had jobs, DeBoer said.

Also, all staff has made adjustments during the pandemic even if they are not working with COVID patients, McCaskell and DeBoer said.

“We recently had an employee engagement survey and are proud to share that we have record levels of engagement,” Dykhouse said. “We live and work in a rural area and we understand that our patients are also our friends, neighbors, family and the like.”

What’s ahead

None of the officials said they expected the pandemic to end soon.

Transmission in the regions they serve will impact the future caseload of COVID patients.

“This is going to be with us until vaccination, probably a little past vaccination. And we don’t know just how (vaccination will roll out),” DeBoer said. “We could be doing some of these same things a year from now.”

“We are prepared as best we can,” DeBoer said.

McCaskell and DeBoer said they expect their COVID-19 isolation areas to stay in place for future use.

McCaskell said the area would be an advantage for flu patients, for example.