May 13 Town Hall Q&A: Part One

If you missed the Wednesday, May 13 PHC All-Staff Town Hall, here’s Part One of the Q&A, which includes answers to the questions that were addressed during the session.

Didn’t get your question answered? Watch for Part Two of the Q&A coming soon which will provide answers to questions we didn’t have time to cover.

The number next to each question indicates the approximate time the question was addressed in the webcast playback.

Personal Protective Equipment / Supplies

What are the plans for staff protection at outpatient registration desks? Will sneeze guards be provided as in all retail operations? If not, then what are the barriers to implementing this measure? Are not physical barriers better than worn PPE? (23.02)
We've had requests from many areas for Plexiglas and we’ve gone out and looked at the workflows for the people who are working in those areas. We determined that even if we put Plexiglas up, only a portion of those people’s days would actually allow them to avail of that protection. They still have to get up from their desk, they're moving around, and in those circumstances they need to have the right PPE on. Because we're going to extended use of PPE, we're asking them to wear a mask and to wear eye protection, and those will carry with them. They move about the organization as the individual moves. That's far more effective than a stable piece of Plexiglass. From a principle perspective, we think that is the best way to protect the people working here. There may be other circumstances where it is the right thing to do (in long-term care, they would really like residents to be face-to-face at meal time and so that might be a better use of Plexiglas), but from all of the circumstances we've seen, we think that PPE is the best way to keep our people safe.
Are non-clinical staff able to get masks and gloves when asked to return to work? (29:27)
For non-clinical staff, if PPE is required, it will be provided.
Have all the PPE donations been used? Gloves in particular. Are more needed? (52:48)

All PPE, whether donated or purchased from alternative vendors, must be put through a comprehensive testing protocol to ensure we don't use anything that is below standard. The donated PPE has been moved to a central PHSA warehouse where it can be held and used according to those guidelines. The donated PPE has not all been used yet. It is being assessed, categorized and stored and could be something that's accessed in the future.

We have sufficient PPE for the moment. We're really grateful for everything, but if people have small amounts of PPE they wish to donate, there are other industries, other businesses and small  non-profits that could likely benefit from supports and offers like that.

What about using face masks in indoor public spaces? (37:53)

In indoor spaces where you're unable to maintain a physical distance, the personal protective equipment that we recommend for clinical staff is what you should be using. For example, in clinical areas where patient care is being provided. we have the prolonged PPE use policy which addresses this idea of inability to maintain physical distancing during the course of a work day. This should also be followed in areas such as lunchrooms and break rooms. Of course, while you're eating you can't have a face mask on so we have general guidance for these areas to stagger the number of staff.

For public spaces and indoor spaces, the Public Health Agency of Canada is recommending everyone use non-medical face coverings when they are unable to follow physical distancing recommendations. 

Is Providence purchasing more isolation gowns? These are often running out lately. And what about PPE supplies in general? (45:46) 

We do not have a shortage of isolation gowns at Providence currently, but individual units may need to increase their on-hand supply. If you are not able to get one on your unit, please let your manager know.

We have been working hard on several fronts to increase supplies of disposable gowns. There are large quantities of those items being purchased, and we are also working with local companies to bring in more reusable/washable gowns. Those are currently being manufactured for us right now. In addition, we have an order for gowns on their way over to us right now.

With regards to overall PPE, we have a lot of product now moving. We have large quantities in hand, plus a lot more in the pipeline.

The one exception is a certain model of 3M mask that has been affected by US restrictions. But even with that item, we have about 50-60 days’ supply provincially.

We are in a good place with our supplies of PPE. This has been achieved by applying several techniques, including fit testing for other masks, using reusable masks, and also being very clear about the proper use of PPE.

Can you clarify if eye protection/safety goggles/glasses need to be worn over they eyes on the clinical unit when not providing direct patient care? For example, while in a nursing station where everyone is wearing surgical masks? (48:32)

If you’re, say, a unit clerk and do not have any direct patient care, you do want to have your mask on. But if everyone around you also has their mask on, then you don’t need eye protection because you are not at risk of being in the line of their droplets. The reason why nursing staff continue to wear eye protection at the station is because we're asking them to keep it on for extended use and not take it on and off between patients. They need it when they're at the bedside, they don’t necessarily need it when they're at the nursing station, but because they contaminate their hands every time they touch it, we're asking them to leave it on. In short, you don't need to wear eye protection in your clinical area if you're not having direct patient contact and everyone around you has a mask on.

The other piece is around transmission and acquisition. We don't know how significant the transmission risk is through the lacrimal duct down to the sinus tract and into the upper respiratory tract. There have been concerns the virus may cause different presentations involving the eye including conjunctivitis, but we don't have enough evidence. In terms of bare levels of protection, protecting the respiratory tract is the primary one. The eye protection is also dependent on the type of protection that's available. Ultimately it comes down to a balance between comfort and the risk of acquisition, depending on the context in which you're providing care.

Human Resources /Occupational Health & Safety

I have heard people suggest that as we move into phase 2, those that can work from home should continue to do so. This may help keep ridership down on transit, for example, to make sure it is available for people who really must use it to get to work. What are your thoughts on this for PHC staff? (25:35)

The short answer is absolutely. We're following the provincial government’s advice, and that is that you should absolutely continue to work at home, if you can work at home. That's what we have been doing, and some teams have made pragmatic decisions about needing to be at work some days but not on other days. There's no big change on Tuesday around this.

Essentially, there are no changes. People have been at work that needed to be at work; if you're able to work from home, you continue to work from home. If your leader or you want to have a conversation about coming into work, then we're asking the leaders to contact Occupational Health & Safety to talk about plans to have people return.

How will work spaces be assessed to ensure they meet new guidelines. What about consolidated departments? i.e. HIM, health records/registration in sites across other health authorities? (27:09)

With people working at home, there have been some real changes because most of us don't have offices set up at home that meet the same needs as at work. Occupational Health & Safety can do virtual assessments if it’s required. If you have concerns around your workstation, then give OH&S a call and they will take care of that assessment.

One of the most common things we hear from people working at home is that they forget to get up. They are sitting down for too long. We will send out reminders about making sure you get up and stretch, setting the expectations for the day.

When people are coming back into the workplace, they need to give OH&S a call and we will look at what spacing is required. We do want to maintain that physical distance that's required to ensure we're not spreading any viruses. We'll look at each set of circumstances to ensure we have that and that we have hand sanitizing stations. If there's not an ability to maintain that physical distance, we will provide masks to be worn for those circumstances.

Is the organization going to be providing ergonomics for those of us working from home, like a mini desk and computer screens? (28:10)
We have not gone to that level of actually providing equipment to work at home. It would depend on the particular circumstances. Each circumstance would need a conversation.

Parking / Transit

What are the plans for staff parking now that more patients and visitors are expected to come? Parking at Century Plaza Hotel gets filled up very quickly. If more staff have to resort back to transit, how would this affect their risk of potentially getting COVID? (32:03)
We are waiting for some guidance from the province. The province is looking at the situation; it declared that parking be made free. The province is aware it needs to make some changes to allow patients to come back. We're working closely with the province and our counterparts to make sure we have a consistent approach. We are also working with the local hotels to ensure we get the maximum amount of hotel parking available for our staff. There is also street parking still available. The city is continuing to try to support us on that. 
What about parking? Parking for staff is a challenge. Before 8am this morning, both the SPH and Century Plaza parkades were full. (43:40)

This week we have started to take back some of the parking for staff to designate for patients. You will start to notice more areas roped off for patients and our parking ambassadors actively helping patients find spaces.

Next week, we will be allocating more spaces to patients. Also, we are starting to see the free parking in the neighbourhood returning to normal. The free City of Vancouver parking spaces for health care workers, with very strict criteria for eligibility, will be available until May 31. After that, regular pay parking will resume. Hotels in the area are starting to see a return of their own clientele, so they will be returning to paid parking.

Regarding the Century Plaza, they generously offered us 80 parking spaces. We have actually been using 135 of their spaces as no one else has been using those stalls. But starting Tuesday, May 19, this will be changing.

We know transportation is going to continue to be a challenge for our staff. We are trying to acquire more dedicated parking spaces, but these will likely be paid spots. Updates will be provided in the staff COVID bulletin so please check that for the latest information.

Screening, Testing and Tracing 

What type of screening will be done at the door for outpatients coming into the hospital and how can we ensure it is consistent between greeters? (30:53)
We are following the regional guidelines and the provincial guidelines around screening and testing. All of our ambulatory surgical patients are being pre-screened before they come in. In some cases physicians are ordering testing. When patients do come into the hospital, they're going to be rescreened. We’re not rescreening at the door. What we're asking our greeters to do is to ensure there's good hand hygiene when patients come in and that they know where they're going. Then they'll be rescreened in the area they're getting treatment. We do have a script for your greeters and will make sure it is consistent between individuals.
Routine pre-op COVID testing of patients is being eliminated. But testing has identified asymptomatic patients who were planned for surgery at SPH in the past few weeks and these would have been missed with the new protocol. Why is this being changed when we know there is capacity? (33:33)

Routine pre-op COVID testing is not being eliminated; it's being altered to be consistent with the provincial surgical algorithm, which has a standard set of questions. This is applied for all patients undergoing surgery. The recommended decision point is evaluated by the surgical team to come to some decision prior to the surgery as to what needs to be done.

The testing that has occurred through the surgical program at PHC has only identified one patient. We have not verified if that patient was truly asymptomatic.

This protocol is being changed because of the downstream consequences we've seen from minimizing the number of surgeries that are going through. When the initial announcement came, all elective surgeries were canceled, and only emergency and urgent surgeries were committed up to certain time points. As we learned more about how we could manage patients going through surgery, there were some local changes, and now there needs to be a provincial approach to ensure that patients across the province are getting equal access to surgeries that are needed, balancing the risk for health care workers as well as the patients in hospital.

This protocol is being changed with those considerations in mind, and will be monitored to see if it’s effective.

Physical Distancing

I have been visiting my parents through the window the last few weeks. Is it now safe to see my parents, who are seniors who have health conditions, in person while maintaining the 6-ft rule? I’m still leery since the virus is still active. But then again the numbers of infections/deaths have decreased. (55:00)
Public Health has some general parameters around visiting and increasing the number of people you socialize and interact with. Of course, some of those factors will depend on the risk of who you're interacting with. We know that, at minimum, patients might be infectious at least 48 hours prior to manifesting symptoms and that's why the contact tracing minimum goes back to 48 hours prior to symptom manifestation. So that risk will still be there. We know that the virus is still circulating and so you're never going to be in a situation where there's zero risk. We still need to avoid having large gatherings, where multiple people then have to assess individual risks. But if it’s a one-on-one interaction, depending on the situation, you can make that risk assessment based on your symptoms at the time, knowing that there is still potential to transmit while asymptomatic.
Why rush to return to in-person outpatient visits when virtual visits seem to be working well for most patients? (39:55)

Clinics do not have to bring patients back on site. If virtual visits are working well, please continue with that. For example, the Diabetes Center will continue to do most of their appointments virtually. On the other hand, patients in Geriatrics still don’t have a lot of access to technology and have communications issues. For those patients, we are slowly bringing them back in and seeing them as needed.

We have also heard from many patients from around the province who are finding it much better to be able to access their appointments virtually.

We should continue with this approach, bringing in patients face to face when necessary, for example in cases where a hands-on assessment is warranted, or there are issues with technology. But the default should be to continue with virtual visits whenever possible.

What about non-essential hospital visits for research participants? (42:05)

UBC is starting to phase in research activities. We are expecting an update next week for the gradual return of research activity. We will be following these guidelines at Providence as well.

Currently, there are 35 research projects active at Providence exempted from the shutdown. Many of these projects are related to COVID or to ensure essential laboratory assets are maintained. There are also some clinical trials that are starting to come back online. These do not require direct patient contact. 

Although we at PHC encourage family involvement in patient care, can we ask those patients coming for an outpatient appointment to not bring family members/other companions unless necessary (e.g. need support to walk, translate)? (50:54)

As our patients come back, if they need families to help them, then obviously we need to support that. That was the original policy at the very beginning of the pandemic, so really it's around what the patient needs as far as who comes in. We are still trying to limit the number of people in the organization, but if a patient does need a family member to help them, then we should have that family member come with them for the appointment.

We are continuing to try to limit access to the hospital to people who really need to come in. In terms of the visitors to both acute and long-term care, there will be provincial guidance on this. It’s a tricky balance of keeping everyone safe and minimizing traffic, but also ensuring that people who genuinely need support get support. For our acute patients, this is an extremely stressful time in their lives and many of our acute patients are in hospital for extended periods of time. For long-term care residents, this is increasingly distressing. It's our role not just to keep them safe, but also to bring joy to their lives. We are engaged in that provincial debate and hopefully we'll get to a reasonable answer on that.

Reopening Plan

Can you please summarize the surgical reopening plan at PHC over the next few months? (57:40)

The surgical team has been working on a very detailed plan, which actually started at the beginning of the pandemic and has continued throughout to ensure urgent and emergent patients received the proper care. Now we will be addressing the waitlist. There is a very purposeful plan around which patients will be seen next, between those on the waitlist and those who have become more acute during this time.

We are phoning the patients whom the surgical team have deemed will be next. They are pre-screened to ensure they are not symptomatic. If there are any concerns, patients will be tested before coming in. Then they will be screened again right before the surgery actually takes place.

The surgical team will also have a safety huddle before every surgical procedure to determine appropriate PPE and to ensure that everyone is aware of any potential risks. We will be limiting the number of surgeries the first week because we do want to ensure we have all of our plans in place, given the new guidelines around physical distancing. From there, we will ramp up our patients’ numbers each week.

These plans are specific to St. Paul's and MSJ because each site is unique. All the teams have had to come up with creative ways of ensuring safety and how to bring patients back in. It will be relatively slow to start, but we will consistently increase volumes to try and reduce the waitlist in a timely fashion.

We will be looking at resource utilization very carefully. As we increase surgical procedures, we will be monitoring the usage of PPE and adjust as necessary. For ICU bed utilizations, we do not have large ICUs so we will be ensuring beds are used properly, moving people as appropriate. We continue to have many non-surgical, non-COVID patients to care for so this may take some work if one site gets full.

The surgical program is also looking at ways to expand hours to evenings and weekends, while still maintaining distance between surgeries so cleaning protocols can be followed properly. Some physicians and staff have already told us they are not planning to take vacations and are willing to work extra shifts.

Other

What is happening with the CST project? (29:53)
We're very committed to continuing with the CST project. It obviously took a pause during the pandemic. Grant McCullough and his team have gone out to all the programs to ascertain what still needs to be done to sustain what we went live with last year, and what still needs to be implemented. We have a very comprehensive list of what's left to do and what's still needed from a sustainment perspective.
Will lessons learned from this event be incorporated into the design of the NSP? (36:04)

Yes, absolutely. Currently, the design of the new St. Paul’s is being re-looked at with COVID in mind. The good news is that it was already designed thinking about pandemics and many of the obvious things we struggle with (lack of single rooms, lack of negative pressure, more space) are automatically in there.

That applies not just to the new St. Paul’s, but also our initial views around MSJ and also long-term care and ensuring that our long-term care residents each have their own room and bathroom.

The designs are reasonably far advanced for the new St. Paul’s; however, there will be an opportunity to review them. We will reflect on what we've learned and we can feed those learnings into all of our physical designs.

This page last updated May 13, 2020 4:32pm PDT