Dr. Mike Wilde is Chief Medical Officer with Sanford Health. He spoke with SDPB's Jackie Hendry about the system's ongoing COVID-19 response and addressed concerns about hospital capacity.
This interview was recorded on Monday 9/28/20.
Jackie Hendry:
When it comes to conversations about hospital capacity, most people never really think about it too often, but obviously these are unusual times. State leadership is telling us this is a key metric when we look at how we're dealing with COVID. So walk us through, when we're talking about hospital capacity, what all is included in that conversation?
Dr. Wilde:
Sure. So hospital capacity, there's really not one thing that defines our capacity to your question. It's really what it's defined by. And it's defined by of course, physical space, staff to properly and safely care for patients and then equipment as well. And so in general, those three areas are really what come together and what we watch closely to determine our capacity at the moment.
Jackie Hendry:
Can you explain, I've gotten questions about are NICU beds being counted in the state's overall ICU capacity? Is that something you can comment on?
Dr. Wilde:
I have no idea on that one. That would have to come from any states. I do not know how the state counts those beds.
Jackie Hendry:
Okay. Can you distinguish for us kind of the long-term care beds in Sanford versus ICU versus acute. People are asking me a lot of those kind of like detailed questions about how much availability we have in different sectors of care, if that makes sense?
Dr. Wilde:
Sure. So to me, we have the acute hospital, which includes adult care, pediatric care, labor and delivery, newborn infant. That's all part of the hospital. And in there, are intensive care unit beds, in addition to what we call general medical beds. And we really don't have long-term care, we have our rehab floor, but we don't have anything else from a long-term care standpoint in this facility.
Jackie Hendry:
Do we have an idea when it comes to COVID-19 patients so far, do we have an idea about an average length of stay for those patients between critical and non-critical COVID patients? Or is it too soon to tell some of that information?
Dr. Wilde:
Yeah, so there's obviously quite a difference. And so if you average them together it's an average. But if patients are in a general medical area with COVID, their length of stay can be one to two days and some of course can be a lot longer. A lot of those folks, they'll kind of, we've grown very, very familiar now working with this illness to really able to tell when patients may need more acute care or our intensive care unit care, versus being able to safely transition to home. And the intensive care unit, the early statistics back in the spring were around, if you're in the intensive care unit, it could be around on average, about an eight day stay. We're seeing more in the kind of five to six day for an intensive care unit stay.
Jackie Hendry:
I know a few months ago, the governor's back to normal plan. One of the recommendations there was for hospitals to reserve 30% of their beds for COVID patients as part of a preparation for a surge. Has Sanford met that?
Dr. Wilde:
As far as I know, we have complied with everything from city, state and federal regulation. Yes.
Jackie Hendry:
Some of the social media buzz I'm seeing, can you talk about whether or not it's true that adult patients are being sent to the children's hospital as part of accommodating the higher rates that we're seeing?
Dr. Wilde:
So, as I alluded to earlier, that's all part of Sanford Hospital and it's physically connected and that's part of our surge plan. While we are not caring for COVID patients at this time in the children's hospital, specifically adult COVID patients in the children's hospital, there will be times as that is part of Sanford Hospital, where we will care for adult patients in the children's hospital.
Jackie Hendry:
Obviously this is an unusual year, but I wonder if you can talk about just how unusual, I guess. How frequently do you find yourselves in a situation where you have to defer adult patients to the children's hospital or potentially from Sioux Falls to a smaller facility outside of Sioux falls?
Dr. Wilde:
So, two questions there really. We always have surge preparation, whether it's related to a pandemic or an event, or just times of high need. And we find that every year, starting about this time of year, there tends to be some higher need. Summer's over, people aren't vacationing and prior to the holidays, they'll maybe seek us for some care. And then it just, as things happen, unfortunately, people can kind of get ill this time of year as well. This year is obviously a little different because we're in the setting of a pandemic and everyone wants to focus on that. But that is actually really the vast minority of patients are seeking care from a pandemic standpoint. It's really those other care needs that we're seeing at this time. And we're working well within our surge plan, where most years at times, whether it's influenza or just general needs, we will have patients over in the children's area. And there's times when there's children in the adult area. I mean, it's all part of the hospital.
In terms of our network facilities, we've had great support. All of our network facilities and our network facilities supporting us. We prioritize care and we try to make sure that the care is delivered as safely and best as close to home as possible. We're well connected with our network facilities, both from a video and telephone standpoint and can be in real time conversations as expertise as needed, as patient acuity necessitates. We will have patients come to Sioux Falls and that's part of our plan as well. So right now we're really prioritizing patients to the proper areas. And again, really focused on caring for patients as close to home as possible. We feel that's the best thing to do.
Jackie Hendry:
Seeing conversations on social media, people saying they work at all three of the major health systems throughout the state. The common theme seems to be concern about staffing capacity. I'm seeing people saying that we're already kind of at our limit when it comes to people being able to care for the folks that are here and being concerned about if numbers rise even more. Can you talk about staffing?
Dr. Wilde:
Yeah. Just speaking from Sanford's perspective regarding staffing, we have sincerely appreciated the hard work of all of our staff. Staff traditionally within Sanford have risen up in times of need and that's the case again. Staff, along with myself, along with all of us, we can get tired but at the same time, we're very dedicated to the patients that come to our facility. And we throughout all of COVID when there was certainly staffing issues that needed to be addressed, addressed those. And we are very proud and I'm very proud of our staff. And we did keep our staff intact in addition to supported them financially and we're going to continue to do that because our staff is what provides that great care for patients.
Jackie Hendry:
So would you say you have adequate staff right now to handle a potential surge?
Dr. Wilde:
We have adequate staff in this time of surge, and we're always working to increase that capacity because we feel the care is best delivered as close to home as possible.
Jackie Hendry:
Have you had to take advantage of any assistance from the National Guard as far as staffing or any other services or what might trigger requesting that assistance?
Dr. Wilde:
That would be close conversation that we have with our state and city resources, which we're in contact with. A lot of our staff, very proudly serves in the National Guard. And as an employer, we're very supportive of that, and worked very closely with the National Guard. We have not had conversations. We did obviously as part of our surge plan this spring, but we have not had conversations with National Guard and they've been great partners to work with in the past.
Jackie Hendry:
Does Sanford have any plans to release specific census or capacity numbers as it relates to the Sioux Falls facilities?
Dr. Wilde:
We do not. In compliance with federal regulation, I would have you work with our media team in regard to anything along those lines. But we typically do not release specific numbers. Frankly, it's numbers that change very rapidly on a daily basis. So frankly, anything that we would give you would be inaccurate by the time of publication or anything like that anyway.
Jackie Hendry:
For folks who are seeing how the Governor is pointing to a hospital capacity as a key indicator for this, Mayor TenHaken also doing that. Can you talk about maybe why that capacity, even if on a changeable day to day basis, wouldn't be useful information for the public?
Dr. Wilde:
I would look at it this way. We've had great relationships and work closely with our city and state resources on a daily basis, really monitoring that capacity because it helps to guide them if there's any sort of regulation changes, et cetera. We have said we're doing okay and continue to progress as we have. As we learned from earlier this year, there's the direct effects of COVID, but then there's really the indirect effects. If we are in a situation where people are having to delay care or not feeling comfortable seeking their care, we've seen episodes of delayed care, delayed diagnoses because people just would not seek care. And that can lead to very challenging personal situations for patients. We've also seen a rise in mental health concerns, which we feel is really indirectly related to this COVID illness. And so as we try to progress forward in the time of pandemic, we want to be very thoughtful of those who are really struggling indirectly from COVID at this time.
Jackie Hendry:
Can you tell us a little bit more about some other details of the surge capacity planning? Is that adding beds? What does that look like?
Dr. Wilde:
Yeah, so our surge capacity, as I looked at those three areas, it's space. We have space and we did prioritize more space early on in the times of COVID. So we invested in more patient rooms and those are about to come online. We also invested in more staff as they are available. And of course, that's not an infinite supply, but we have great people who are graduating from great programs. And we've been able to retain a lot of those folks in this area, and they're coming online as well. And we're really making investments in not only our people, but our facilities to try to meet that surge plan irregardless of what is causing the surge on a daily, monthly, annual basis. And we're doing that again.
Jackie Hendry:
If folks are concerned by what they're hearing on social media, things like this, what would you tell audiences listening to this about the situation as far as Sanford is concerned?
Dr. Wilde:
Yeah. As I alluded to earlier, we're in a time where there's a lot of people seeking high needs. There's a lot of people seeking care at this time, mostly not related to COVID, although there are some indirectly related to COVID. Have a conversation with your care team, with your physician. And in times like this, people do tend to maybe reach out to social media and make some comments and that's fine. You need your release and that's okay. But we would like to hopefully have people realize and be comfortable with the fact that there's a lot of folks working really hard to meet patient's needs as close to home as possible. We're going to continue to do that. We're accustomed to working in times of high patient needs and we're in one of those times right now. And we're going to continue working hard for the people of this area.
Jackie Hendry:
And finally, I wonder how much you can tell me about transferring folks out of state. What goes into that decision. And when people hear the Secretary of Health saying, "We have plenty of capacity in state," they get a little confused by hearing their neighbors talking about a relative having to be sent out of state. What would you have to tell people about that?
Dr. Wilde:
Well in the setting of COVID, we're really trying to keep people in state, again, as close to home as possible and that's what we've done. There are times where there's large healthcare facilities, well-resourced offering additional services that we may not offer at Sanford. And that occurs in times of pandemic and not in times of pandemic. So if patients come to us with certain needs and we feel that their care would be better served elsewhere, we work closely with facilities in larger cities around this area and we will transfer patients. We'll receive patients from some of those facilities as well, and have worked closely with Omaha and Mayo and Minneapolis and Denver and Michigan. And so if patients are being transferred out of state, it's because caregivers are having a conversation with those people saying that we need some expertise that's available at one of those outlines facilities, and we're going to transfer. And so, as people maybe hear those conversations, they may not have the entire context of the conversation, and that's everyone's right to privacy, to hold those issues within their family. That's perfectly fine.
Jackie Hendry:
So has Sanford had to divert COVID patients out of state?
Dr. Wilde:
Not that I'm aware of. We would prioritize getting those folks taken care of as close to home as possible.
Jackie Hendry:
And finally, I saw late last week, some health facilities in Iowa talking about, they would typically send patients up to Sioux Falls and Sioux Falls, not being able to accept them at this time. Is that something you can comment on? Has that changed since Friday?
Dr. Wilde:
So my conversation around that would really be about the prioritization of care and the need that they sought at that local facility. And there may have been an ask to just wait a little bit and they're comfortable providing that care. And then if it makes sense, that patient needing higher acuity in Sioux Falls, we would have them come to Sioux Falls. And so situations like that may develop where we have a conversation with a referring facility in that moment to take care of that patient where it most makes sense. If there's a little bit of delay, it's not in the setting of patient safety, but it's rather just, hey, we need a little time to get some rooms ready and things like that, and make it as comfortable for people that are coming to Sioux Falls as possible.
Jackie Hendry:
Dr. Wilde, you've been super generous with your time, and this has been really informational. Is there anything else you want to close with, want to make sure that you add or emphasize?
Dr. Wilde:
Well, just really emphasizing that people should feel comfortable seeking care at this time. There's a lot of needs out there. We see a lot of those indirect effects like I alluded to from COVID. Not necessarily people with the illness, but effects because this pandemic is upon us and they should feel comfortable seeking care during this time. We are really prioritizing our staff safety and facility safety and would welcome those that feel the need to seek care at this time.
Jackie Hendry:
Dr. Wilde, thanks so much. That's all I've got for you right now.
Dr. Wilde:
Have a great day. Thank you.
Jackie Hendry:
Thank you, you too.