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Rural hospitals reopen with extra safety precautions in place

Medical laboratory scientist Brandi Fry dons personal protective equipment before testing a patient for COVID-19 at a drive-up testing facility April 13, 2020, at Newport Health Center, which is adjacent to Newport Hospital, in Newport, Wash. Newport Hospital began providing non-essential surgeries last week after Gov. Jay Inslee loosened COVID-19 restrictions on health care providers. (Tyler Tjomsland / The Spokesman-Review)

Hospitals serving rural areas in Eastern Washington are welcoming loosened restrictions allowing them to again offer elective surgery and non-urgent care.

On May 18, Gov. Jay Inslee began allowing hospitals, dental offices and health care systems statewide to provide elective surgeries and non-urgent procedures, as long as they adhere to guidelines ensuring adequate personal protective equipment (PPE) levels and other screening and sanitation standards remain in place.

Hospital officials hope the change will not only help them provide better care, but also help them stabilize their institutions. The drop in patients, combined with the costs of trying to acquire PPE, prepare for COVID-19 patients and purchase testing materials, led to financial decline, at times swiftly, for rural hospitals.

When the governor put a statewide pause on elective procedures on March 19, many hospitals had to make cuts or furlough employees. Two months later, with many rural communities in the Inland Northwest evading widespread transmission of COVID-19, hospitals are scheduling surgeries and welcoming departments back to work.

Lincoln County has two confirmed cases of COVID-19. The county has been in Phase 2 of the governor’s reopening plan for two weeks.

In Lincoln County, 25 employees of Lincoln Hospital and Health Systems, who had gone on furlough voluntarily on April 6, came back on May 11. Lincoln Hospital received a Small Business Administration loan that can be used in part for payroll, Becky Bailey, human resources manager there, said. The hospital employs 265 people, so bringing everyone back to work has been crucial to the community.

“Their No. 1 reason why they’re here working for the hospital is that they care for the community,” Bailey said. “Getting services back up and running provides more support to our community and making sure we are getting care to people.”

Lincoln Hospital operates three community clinics as well as several outpatient specialty clinics in the county. One of those clinics was designated for respiratory symptomatic patients early on in the pandemic, but when numbers began to dwindle, they switched it back.

Now, patients who are experiencing respiratory symptoms will be directed to a trailer, where there will be testing, Jennifer Larmer, chief clinical officer at Lincoln Hospital said.

Patient census counts are starting to rise, and Larmer said physicians are making conscious efforts to reach out to patients and assure them that care is necessary and that the clinics and hospitals are safe.

“I think there are still many patients that are very cautious and don’t want to seek services, so our numbers are down,” Larmer said. “But our providers have been pretty positive about what they’re seeing and encouraging patients to come back in and start seeking care again.”

Reopening means things look a bit different for patients. Many hospitals have set up screening stations at the front of their hospitals and clinics, with limited points of entry. Masks are encouraged for patients on arrival or available at most health care sites once there. Visitor restrictions still will be in place, and the governor’s guidance says only visitors that are essential should be allowed to accompany patients.

Surgeries, which can resume as well, are scheduled with COVID-19 testing in mind. If testing materials are available, patients getting surgery are tested before their procedure and must present negative results before going into surgery.

In Newport, the hospital also has implemented this testing-before-surgery policy.

Last week, the hospital had 19 surgeries on the books.

“We’re moving forward, our providers are working on this on a case-by-case basis, and we want to make sure we’re doing it right,” said Jenny Smith, public information officer at Newport Hospital.

Ultimately, keeping health care moving along will depend on a hospital’s capacity and supply of personal protective equipment.

“It all boils down to PPE,” Smith said, indicating that those supplies, which still are a struggle to obtain from their regular vendors, will determine how many or how few services the hospital will be able to offer.

Statewide, hospitals began a campaign last week to reassure patients that seeking health care is important, especially in urgent cases or in preventative cases like cancer screenings.

Pullman Regional Hospital, which had to furlough staff members for an eight-week period due to drops in volume and revenue, is restarting many procedures, bringing staff back as volumes increase. It also is requiring COVID-19 testing before surgeries. Health care providers are concerned that patients have been delaying care that would be deemed essential, regardless of the governor’s order.

“If you have chronic or emergency health needs, we’re here for you – and don’t delay those things,” said Megan Guido, community relations officer at Pullman Regional.

A coalition of stakeholders statewide helped develop the health care reopening guidelines, including nursing unions and major health care organizations. The Washington State Hospital Association also supported the reopening guidelines.

The governor’s proclamation lays out phases from conventional to crisis care. Those phases define when a hospital should taper back elective procedures and non-essential care if COVID-19 becomes prevalent in a community or PPE supplies and capacity become strained.

In Davenport, the Lincoln Hospital sits across from the health department. Larmer said they are in communication with their counterparts there. Essentially, the hospital has had to be nimble as they make changes to how patients are screened, where they can enter and where appointments are held.

“We went from one end of the spectrum to another and had all the protections in place so we could open that back up and help reassure patients,” Larmer said. “This is a new thing we’re fighting, and we didn’t want patients in there until we could assure we had a comfort level with how we were doing it.”

Arielle Dreher's reporting for The Spokesman-Review is primarily funded by the Smith-Barbieri Progressive Fund, with additional support from Report for America and members of the Spokane community. These stories can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.