Stories: A new normal

Chris Dale

A conversation about COVID-19 and patient safety with Chris Dale, M.D., MPH, Chief Quality Officer, Swedish Health Services

After nearly two months of lockdown, we’re inching toward a return to normal—or at least a new form of normal. This week our Swedish Edmonds Family Birth Center and NICU—both temporarily closed to make room for a potential surge of COVID-19 patients—reopened. And on May 18, the statewide moratorium on elective procedures is expected to lift. As we take our first cautious steps forward, Chris Dale, M.D., MPH, our chief quality officer, took a few minutes to explain how we’ll do it safely.

We reopened the Family Birth Center and the NICU in Edmonds this week. What factors went into making the decision to do that now?

Several factors go into any decision about starting and stopping different clinical operations or services. One of the challenges we faced early in the COVID epidemic was that we anticipated needing two and a half times the number of ICU beds as we had available. In order to open up space, we took advantage of the opportunity to move birth center services elsewhere so that we could potentially use that space to care for patients with COVID-19. Now that the pandemic seems to have peaked, we felt that it was safe to shift that space back to labor and delivery, so that we could meet the community need for OB services.

With the moratorium on elective surgeries that runs through May 18, how did we decide which surgeries could proceed?

There are things you can’t control, like strokes and heart attacks. And there are things you can, like knee replacements for osteoarthritis. But what about cancer surgeries? What if you delay and the tumor grows too big to be resected? So we said, “Let’s have the experts figure it out. So Marc Horton, M.D., and Arooj Simmons, M.D., who are the executive medical directors of our Surgical Services Division, set up a review committee. And for each case the committee would get together and decide, “Can this one wait, or does it need to go now?”

What are we doing to maintain patient safety as we go through the reopening process?

That's a super important point because we've gotten survey data that shows people are delaying care right now. I heard a story in one of our meetings today about a woman whose father-in-law had stroke-like symptoms but didn’t come to the hospital because he was afraid he might get COVID.

Paradoxically, the hospital is one of the safest places that you can go right now. Everyone who comes in has their temperature taken. Everyone who comes in gets asked about their symptoms. Everyone who comes in is asked to put on a mask. And our data shows that our hospitals are extremely safe. You're more likely to get COVID from a coworker or a neighbor than from somebody you encounter walking into the hospital.

What benchmarks will we use to determine how and when to open different service lines?

There are two perspectives to consider: safety and volume. As far as safety is concerned, we've relied on guidelines from the World Health Organization, the CDC, different professional societies and our own experts in infection prevention and infectious disease. We’ve done everything from putting in place proactive organizational engineering controls to minimize the likelihood of transmission in the hospital to adding safety rounds to make sure people are wearing PPE and washing their hands. So from a safety perspective, I’m very confident.

The bigger calculus relates to volumes. When will the COVID threat subside enough to begin opening up beds for inpatient care? As each week goes by, we get a little more data, but we don't know if or when we're going to have a second wave or what the contours of it will be. We have ideas, we have hypotheses, we have models, but we don't know for sure. So we have to keep a pulse on inpatient and ICU volumes in order to modulate some of our surgical volume.

So people should feel safe. We’re really tackled the safety issue. The issue is volume, and we'll keep a close eye on that as Washington reopens.

This period must have been an opportunity for us to also take a step back and reassess our safety practices in general. What changes are we making?

The speed at which some of the information and best practices change related to COVID really highlighted the importance of putting a lot of emphasis on communication. So that's the first thing. The second is a renewed emphasis on safety rounds. We’ve done them in the past, but having members of the patient safety team proactively going through all care environments and talking to frontline caregivers about ways we can improve has been a very powerful tool for demonstrating the importance of safety and learning about things we should focus on. We put a lot of effort and energy into making Swedish as safe as possible and take pride in the results.

For updates on services available to you at Swedish as we continue to navigate the COVID-19 pandemic, visit our hub for coronavirus resources.

PHOTO GALLERY: Take a virtual tour of our hospitals to see how our caregivers are responding to COVID-19 and working to reduce its spread.