Morehead hospital says covid-19 surge came from patients who delayed treatment for other conditions; telehealth is here to stay

St. Claire Regional Hospital (Youtube photo, from The Daily Yonder)

At the end of 2019, St. Claire Regional Healthcare System restructured its finances after finishing the fiscal year about $9 million in the red. In March, the novel coronavirus hit and basically brought the hospital to a standstill and forced it to make even more changes, Liz Carey reports for The Daily Yonder.

Headquartered in Morehead, St. Claire provides services to eight Eastern Kentucky counties. in addition to its hospital, it hascclinics in Frenchburg, Olive Hill, Owingsville and Sandy Hook. It also provides mental and behavioral health services, palliative care, aesthetics care, dental care, and pharmaceuticals. 

Donald H. Lloyd, II, the hospital system's president and CEO, told Carey that the restructuring had resulted in a positive cash flow by February, but then the pandemic hit Kentucky and Gov. Andy Beshear banned elective surgeries, which account for 90 percent of those at the hospital. This forced them to make more personnel changes, including furloughs.

The first case of covid-19 showed up in Rowan County in March. By then the hospital had been converted into two separate areas, a hot zone for patients suspected of covid-19, and a cool zone for all the rest, Carey reports.  

“You would walk down a corridor and you would see this huge barrier that you had to don and doff protective equipment and then zip through a series of barrier walls in order to enter where the actual patients were,” Lloyd told Carey. “It was just so surreal. It was like from a science-fiction movie.”

Lloyd and his staff found that patients with heart attacks weren't coming into the hospital's emergency room, Carey writes.

“On the video calls with my colleagues, not only here in the commonwealth but across the United States, we were all asking ourselves ‘Where are the heart attacks, where are the strokes?’ We all thought the coroners must be extremely busy,” he said. “My chief medical officer and myself had numerous conversations with our coroners and a realization came that if we did begin to see a spike in deaths in the general population that our coroners would actually be the first to observe them.” 

This realization set the hospital into action to find high-risk patients and a way to care for them. “We aggressively worked to contact these patients, especially those that we knew have chronic conditions, and reminded them that it was imperative that you know they needed their conditions to be monitored and managed,” Lloyd said, estimating that they reached out to more than 25,000 of their 200,000 patients. 

It turned out that the surge caused by covid-19 was indirect: untreated chronic conditions caused by fear of infection. When those patients finally sought medical attention, they had "acute exacerbations," Lloyd said.

This also led to a move toward telehealth, and that led to the realization that many patients did not have access to high-speed internet. So, Carey reports, the hospital set up an area in its empty parking lot where patients could park, use the hospitals' tablet computers, access its wi-fi and visit their health-care provider through telehealth. 

“Our patients have really embraced that, and we perceived that people that, you know, that maybe live at the margins, or that maybe have a lower education level, would be intimidated by the use of that technology. On the contrary, they have embraced it,” Lloyd told Carey. “Many of our patients (in outlying counties) can’t afford to travel to Morehead or they have very limited transportation ability. It is amazing to me how effective this technology and the use of telemedicine has been for us to connect with them now.” 

Since mid-May, Lloyd said, the hospital has started to come back to normal, but telehealth is here to stay. He said, “I think [telehealth] is part of the new reality going forward in the way we deliver care and that there is going to be, for Saint Claire Healthcare and our enterprise, at least 25 percent of our future patient encounters will be virtual."