Sanford facilities in rural areas ready for COVID surge

Assured of regional expertise & supplies, sites focus on preparing for patients

A nurse in full PPE talks to a driver at a COVID-19 test drive-thru station in Fargo, ND

While the largest Sanford Health hospitals have spent weeks preparing for a surge of coronavirus cases, the locations in rural areas have been busy as well.

From Chamberlain, South Dakota, to Halstad, Minnesota, administrators of clinics, hospitals and long-term care facilities in small towns have been working on plans to keep their patients and health care workers as safe as possible.

They knew cases would come to their communities. So they have testing sites set up, surge plans in place and dedicated care teams ready.

In the process, they have experienced the benefits of being part of a large health care system combined with the heart of small communities.

“Our rural communities are an integral part of our plans to care for COVID-19 patients during a surge at Sanford,” said Eric Hilmoe, vice president of operations for Sanford Health Network — Sioux Falls (South Dakota) Region, the health care system’s southern half.

“We host a daily town hall with our rural leadership teams to ensure they are kept informed and have a venue to ask questions. I am confident our teams are ready,” Hilmoe said.

Here’s a look at how dozens of hospitals and hundreds of clinics in Sanford Health have prepared for COVID-19 cases.

Getting ready in rural areas

Dr. Charles Breen, vice president and chief medical officer of Sanford Health Network — Fargo (North Dakota) Region, recalls the beginning of the planning. He said the region sites in rural areas started looking at supply and testing needs in December, in concert with the Fargo hospital.

“We’re very fortunate at Sanford that we currently have good relationships with vendors … to get those supplies,” Breen said.

Meanwhile, in the Sioux Falls Region, Erica Peterson found herself benefiting from that kind of strength.

Peterson serves as senior director of Sanford Chamberlain Medical Center, which also includes a clinic and long-term care facility. She oversees the Sanford Health clinic in Pierre, South Dakota. And she works with the Sanford Health-managed hospital and clinic in Burke, South Dakota, and helps out at times with the Sanford Health clinic in Mitchell.

To say Peterson and her staff have been busy preparing for a COVID-19 surge is an understatement. At the beginning of the coronavirus concern, they pulled out the pandemic plans already on file for the hospitals in Chamberlain and Burke. They held regular meetings that have expanded considerably in frequency and scope.

They keep implementing new safety measures as regulations and recommendations come out. Those have ranged from visitor restrictions to mask wearing to a lot in between. All three towns have COVID-19 testing sites. The 25-bed Chamberlain hospital has three negative airflow isolation patient rooms. It is prepared to treat patients who require a ventilator. The hospital can surge to 40 beds if needed, Peterson said.

‘You’re not just alone in a community’

All the while, Peterson has been working with the region to be sure her facilities have the amount of testing, pharmaceuticals and personal protective equipment they will need. They also can rely on the expertise, guidance and processes that the health system has carefully crafted. Otherwise, they would swim through the vast amounts of information and recommendations about COVID-19. Then they would have to craft their own plans from scratch.

“In situations like this, it’s really great to know that you have a collective whole helping you through this process, and you’re not just alone in a community,” Peterson said.

If she managed staff at an independent facility, she said, they wouldn’t have much expertise about infection control, for example. “We get to have access to infectious disease, infection control, all of those things because we’re part of the larger Sanford system,” she said.

One source of knowledge: incident command

Bruce Viessman serves as vice president of operations for Sanford’s Fargo Region. In a situation like the coronavirus pandemic, with so many unknowns and yet so much information flowing continually, Viessman has valued the strength of the incident command set up in Fargo for facilities in rural areas.

The incident command in Fargo, like the one in Sioux Falls, consists of leaders and experts such as infectious disease specialists, who evaluate the latest information and concerns. They then set guidelines for the region and answer questions ranging from testing to appointments to COVID hospitalizations. “That’s the one place we go for their source of knowledge,” Viessman said. “So we’re not going 10 different spots.”

Each of the sites in rural areas has its own incident command set up as well. If a facility’s incident command has questions, it can ask the Fargo incident command directly. Fargo can then highlight those questions and answers throughout the region. “Because if one facility or somebody is asking, whether it be in Fargo or the network, probably somebody else is wondering the same thing,” Viessman said.

In addition, Viessman considers it important for health system leaders to reach out to the rural sites.

“We want to make sure that our workers are taken care of, feel confident that they have the right equipment, the right PPE to work with and have the support system that they need,” he said. He spends part of his day, then, reaching out to clinic directors or other senior directors of network facilities. He reassures them and answers any questions they might have.

‘Education has been key’

Justin Stromme oversees the clinic operations for Sanford Health clinics in Thief River Falls, East Grand Forks and Halstad, Minnesota; and Hillsboro and Mayville, North Dakota.

In preparing for the pandemic, Stromme has found especially valuable the COVID-19 information the Sanford Health Network has compiled and distributed — particularly elements of the Facts Over Fear campaign. He used that to help educate his staff and the public and to try to combat inaccuracies people might see on social media.

“From a clinic perspective, that education has been key,” Stromme said.

“Having the experts, having the information, having the regular updates of what’s happening in the region is essential to us feeling prepared for whatever happens,” he added. And having Sanford Health’s supply chain experts projecting the PPE needs for the region comforts Stromme.

His clinics also have benefited from Sanford Health’s pivot toward telehealth visits, to limit patients coming into clinics if they don’t need to.

“How quickly that was instituted in our footprint is extremely impressive and effective,” Stromme said. He has seen both patients and providers embrace it.

Adapting long-term care

 A top priority for Peterson’s early preparations: the long-term care center she oversees, “securing our residents and making sure that they’re safe in the very vulnerable population with this pandemic.” The facility suspended group activities, delivered meals to patients’ rooms and began a careful screening process for staff members.

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smudging-ceremony-3-RESIZED
Roland St. John conducts a socially distanced smudging ceremony outside among staff and residents of the Sanford Health Chamberlain, S.D., Care Center. The ceremony occurred before recommendations were updated to include face masks for long-term care workers. 'Smudging is to purify the facility and the individuals' mind, body and spirits. ... We are just praying to God for protection against this virus,' St. John said. (Photo by Sanford Health)

This has contributed to some creativity in filling needs. As an example of giving staff members additional training to work in other areas, Peterson said that a Sanford Health athletic trainer who suddenly couldn’t work with students in school anymore shifted to working with nursing home residents doing one-on-one exercises. Technology such as Skype and FaceTime help the residents stay connected with family as well.

And being part of a smaller community has been a bonus. One day, Peterson said, high school boys stood outside with signs to greet the residents while sending in a balloon for each resident. And Peterson happily granted the request of one resident who is Native American. He had asked if he could hold a smudging ceremony outside the residence, where about a third of residents are Native American. He wanted to bless the facility along with the health care workers.

“It was very special,” Peterson said. “He printed the prayers out in Lakota and then in English for us, that we could see what they were saying.”

The feeling of community

People in the community have reached out to help as well. For example, many have offered to make masks. Peterson said Agtegra, an agricultural cooperative, donated N95 masks to her facilities, and hunting lodges offered N95 masks as well.

“It’s been really lovely,” she said.

Sanford facilities also work with other health care entities in communities to plan for testing and patient surges. And they work with public health officials to help provide “that one source of truth” for each community, Viessman said.

As often as possible, unless COVID patients need more complex resources that require a transfer to Fargo or Sioux Falls, they will be hospitalized in their hometown facility, Viessman said. The hospital staffs in rural areas have run through practice scenarios and workflows and are well-prepared.

So health care workers in small towns may find themselves taking care of people they know well. Maybe a neighbor across the street, their child’s teacher from two years ago or a server at their favorite restaurant.

Melodi Krank, senior director of nursing for the Fargo Region, considers those relationships to be a small-town strength. “We not only take care of them as patients, but we go to basketball games and see them,” she said.

Sanford Health staff, she said, will “give great care to them in the communities where they currently work and live.”

Stromme feels confident about his health care workers as well. “I feel really good about the morale and the commitment and so proud of all of the various employees that I get to work with on a daily basis.”

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Posted In Chamberlain, Coronavirus, Mayville, Pierre, Rural Health, Thief River Falls

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