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Healing Together

July 08, 2020
by Jenny Blair

Cancer doesn’t pause during a pandemic, and neither have the providers and staff at Smilow Cancer Hospital. During the COVID-19 outbreak in Connecticut, the top priorities for leadership at Smilow Cancer Hospital have been to care for patients and their families and to support providers and staff. To meet those goals, major changes were implemented, but teamwork and quality cancer care remained at the forefront.

“I am continually proud of our community, who rose to every challenge together to put our patients and their needs fi rst. We have kept patients and our own community safe and continued patient treatment and care in innovative ways,” said Charles S. Fuchs, MD, MPH, Director of Yale Cancer Center and Physician-in-Chief of Smilow Cancer Hospital. “We didn’t miss a beat.”

“Together, we’ve been able to safely care for cancer patients during the pandemic,” said Kim Slusser, MSN, RN, Vice President for Patient Services. “As we start to have patients return to our main hospital, I want to reassure them that we’re doing everything to keep them and our staff safe.”

When Smilow Cancer Hospital was designed, its architects planned for the top three floors to have negative-pressure ventilation, which is important for patient safety in the event of an infectious respiratory disease. The Yale New Haven Health System (YNHHS) activated the ventilation system when the COVID-19 pandemic hit early this spring, using the negative pressure to keep air fl ow restricted and protect the remainder of the hospital and patients from COVID-19. Th at meant patients already based on those floors needed to be relocated to make space for patients with COVID-19, and over the course of a single day, all were safely transferred via ambulance to the Yale New Haven Hospital (YNHH) Saint Raphael Campus just a few blocks away.

Of that move, Maggie Zampano, RN, an oncology nurse with 16 years of experience at Yale New Haven, said, “It was poetry in motion. It was thought out. It was calm. Th e unit is beautiful where we are and we very quickly became a tight-knit group.” Infection prevention begins before the care encounter. Though some oncology surgeries were postponed for safety, those that could not be were scheduled at the Saint Raphael Campus. Stringent COVID-control protocols continue, including complete physical separation from other patients. Prior to surgery, bone marrow transplant, or hospital admission, patients are tested for COVID-19. Those who are scheduled for an outpatient visit or for radiotherapy or chemotherapy receive a phone call the day before from a nurse who screens the patients and assesses for COVID-19 symptoms. “It’s also a great opportunity for our nurses to answer patients’ questions around safety,” Ms. Slusser said. In a second layer of safety, patients arriving at all Smilow Cancer Hospital facilities undergo another screening, including a temperature check. Those who do not have their own masks are provided with one before entering. During the actual check-in process, patients are screened for a third time. As for staff members and providers, all of them are masked, and all self-monitor for COVID-19 signs and symptoms twice a day and all wear personal protective equipment while at work.

“The additional level of safety has really helped not only our patients feel safe, but also our staff feel safe. We know our community is well protected,” Ms. Slusser noted. To make physical distancing easier, ambulatory care centers have expanded treatment hours. Other safety measures include sixfoot markers and plexiglass screens in waiting rooms. Exam rooms are extensively cleaned between patients and deep-cleaned daily.

Not all patients need to see their physician in person for followup care and regular check-ins, and safe, time-saving Telehealth alternatives have blossomed. Between March 15 and April 19, the number of video and phone visits with Smilow Cancer Hospital providers more than tripled, with thousands of visits occurring each week. Support groups, complementary therapies, and question-and-answer forums are available virtually as well. “In many cases patients are very pleased and prefer it,” said Kevin Billingsley, MD, MBA, Chief Medical Officer for Smilow Cancer Hospital.

“To not have to travel, to not have to park, or, if you are working, to not have to take as much time off from work— all of those are positives.” Dr. Billingsley added that for people who are uncertain how to navigate the technology, a team of employee volunteers offering tech support are available to help.

Patients with cancer who are grappling with COVID-19 at home are not overlooked, Ms. Slusser added. “We started daily wellness calls for our patients who were either waiting for a COVID test result or were COVID positive,” she said. Nursing staff call daily to check in, asking about symptoms and answering questions.

These patients sometimes develop symptoms that resemble those of COVID-19, such as fever or shortness of breath. Instead of risking a visit to the emergency department, they can now get immediate testing at the newly developed Smilow Rapid Evaluation Clinic. Ms. Zampano, who is among those staffing the new clinic said, “We needed a safe place for our oncology population to come and get their [testing and treatment], but also be able to keep others safe. So they come here.” Patients with mild or no COVID symptoms can also continue to obtain COVID testing through one of the YNHHS’s ambulatory test sites.

As Connecticut’s outbreak subsides, many aspects of care at Smilow are reverting to the pre-pandemic normal, while maintaining an array of COVID-related safety practices to protect patients and staff . Ambulatory care is moving back to Smilow, surgeries are resuming, and many clinical trials are once again welcoming new enrollments. But many changes, including COVID symptom screening and physical distancing in waiting rooms, will remain in place for now. So will masks: “We haven’t even begun to discuss not wearing masks,” Ms. Slusser said. “Until we’re at a difficult erent place nationally with COVID, I don’t see these measures going away any time soon.”

Th\e pandemic’s first wave is waning, and hospital leaders are proud of the collective response of the Smilow community. Together they have healed patients, supported one another, and built an even stronger foundation for cancer care under unprecedented circumstances. “Our interprofessional teams have done amazing things over the past eight weeks,” said Dr. Billingsley. “One of the takeaways for us is we can do more for our patients over a shorter period of time than we ever imagined.” But with future outbreaks possible, Smilow Cancer Hospital and other healthcare systems across the nation are working to establish a new normal. Many of the changes will continue, leaders say—Telehealth, for one.

“The use of telemedicine to communicate with patients, to evaluate patients, to check on patients, is something we want to continue and make part of the practice in Smilow,” Dr. Fuchs said. Of course, in-person care is not going away. Many patients need to be seen in person and safety for those patients is paramount. “We have infusion and exam-room space in the building that is safe and protected,” Dr. Billingsley said. “We are assuring patients that it is safe to come to their main treatment home for their ongoing therapy.” It’s crucial that routine medical care, including cancer screenings, continue as well. “Routine appointments like colonoscopies, mammographies, OB/GYN exams, people going to the doctor because they’re tired and they find that they’re anemic, all that care where things get discovered—that has not gone on in the last few months,” Dr. Billingsley said.

“Now, we’re really trying to get people reengaged. Our goal is to meet patients where they are.” He added that although the pandemic requires extra caution, human touch is an important part of the healing process. “We never want to get too far from those roots.”

Submitted by Emily Montemerlo on July 08, 2020