OAHHS Hospital Voice Fall/Winter 2021-22

ospital Voice H A magazine for and about Oregon Community Hospitals OCS Apprise implements new technology to help Oregon become a national leader in hospital capacity management. 28 Workforce Heroes As the surge stretched hospital staffs to the limit, it was all hands on deck as leaders showed their appreciation, often in creative ways. 6 COVID Survivor A loving family, a fighting spirit, and a dedicated care team helped Alejandro Castro spend the holidays at home after 299 days in the hospital. 19 Fall/Winter 2021-22 THE SURGE ISSUE

3 Fall/Winter 2021-22 ospital Voice H A magazine for and about Oregon Community Hospitals ACKNOWLEDGEMENTS Copyright © 2022 Hospital Voice, a publication for and about Oregon’s 62 community hospitals, is published two times a year by the Oregon Association of Hospitals and Health Systems (OAHHS), 4000 Kruse Way Place, Suite 2-100, Lake Oswego, Oregon 97035, 503-636-2204. Hospital Voice advertising rates may be obtained by contacting Grandt Mansfield at 503-445-2226 or grandt@llmpubs.com. Advertisements do not imply endorsement by OAHHS. No part of this publication may be reproduced in any form without written permission of the publisher. Opinions expressed in the publication do not necessarily reflect official policy or position of OAHHS. Chair, OAHHS Board of Trustees Scott Kelly, President & CEO, Asante Chair-elect Doug Boysen, President & CEO, Samaritan Health Services OAHHS Board of Trustees Steve Eldrige, Hospital Board Trustee John Hunter, CEO, OHSU Health Lisa Vance, Chief Executive - Oregon, Providence Health & Services Charlie Tveit, CEO, Lake District Hospital Ron Saxton, EVP & General Counsel, PeaceHealth Harold Geller, CEO, St. Anthony Hospital Dennis Knox, CEO, Mid-Columbia Medical Center Trent Green, Senior Vice President & COO, Legacy Health Joyce Newmyer, Chief Culture Officer, Adventist Health Joe Sluka, President & CEO, St. Charles Health System Wendy Watson, Hospital Board Trustee, COO, Kaiser Permanente Cheryl Wolfe, President & CEO, Salem Health Jenny Word, CNO, Wallowa Memorial Hospital President/Chief Executive Officer Becky Hultberg Executive Vice President Andy Van Pelt Chief Financial Officer Peggy Allen Editor Dave Northfield Design and Advertising LLM Publications ǀ www.llmpubs.com Jon Cannon ǀ Design & Layout Grandt Mansfield ǀ Advertising Sales About the Cover Grateful staff at PeaceHealth Sacred Heart Medical Center at Riverbend in Springfield greet Oregon National Guard soldiers arriving to serve as part of Operation Reassurance. Guard members provided badly needed support to hospitals across the state during the Delta surge. 4 Letter from the President & CEO 6 Bent, Not Broken 12 Oregon National Guard Deploys to Hospitals as COVID Cases Surge 19 Vital Survival 24 All Hands on Deck 28 Apprise Helps Oregon Lead the Way in Hospital Capacity Management 30 A Conversation with Dr. Dean Sidelinger 35 The Guest House Eases the Transition from the Hospital Workforce Heroes 6 As the surge stretched hospital staffs to the limit, it was all hands on deck as leaders showed their appreciation, often in creative ways. COVID Survivor 19 A loving family, a fighting spirit and a dedicated care team helped Alejandro Castro spend the holidays at home after 299 days in the hospital. OCS 28 Apprise implements new technology to help Oregon become a national leader in hospital capacity management.

4 » A magazine for and about Oregon Community Hospitals. i f r t r it s it ls. Becky Hultberg President & CEO Oregon Association of Hospitals & Health Systems To find out more about your community hospitals, please visit us online at www.oahhs.org. The 1918 pandemic had three distinct waves. The first was in the spring of 1918, the second in the fall of 1918, and the third beginning in late 1918 and stretching into the spring of 1919. An estimated one-third of the world’s population contracted the 1918 flu, resulting in at least 50 million deaths worldwide. The 1918 flu was the world’s last experience with a significant global pandemic. Much has changed in the last 100 years including dramatic improvements in medical care and globalization. Global outbreaks follow a predictable course, yet our lack of recent experience with pandemics meant we weren’t prepared for something like COVID-19. Experts in 2020 warned us that this pandemic wasn’t going to be over in a year and that there would be a high death toll, but in those early days it was hard to wrap our heads around an event of this duration and magnitude. I remember participating in a call in March of 2020 when an epidemiologist predicted 500,000 deaths in the United States. 500,000! That couldn’t be right. As of early January, 825,000 people have died in the U.S. We all desperately wanted this to be over in 2020 so 2021 could return to normal. While we’ve had glimpses of normalcy this year, Oregon also had its worst COVID-19 surge in the late summer and early fall of 2021—almost 18 months into the pandemic. For hospitals, 2021 was perhaps a more disruptive year than 2020. The year started with Oregon hospitals taking the lead role (unexpectedly) in vaccinating Oregonians, a massive logistical effort across the state. With vaccine programs in high gear, returning to previous activities seemed a possibility in the early months of summer, when case counts fell and masks came off. The Delta variant changed those plans, racing through the unvaccinated population like wildfire, sending hospitalizations to their highest level of the pandemic and pushing the health care system towards collapse. Hospitals weathered the storm, with assistance from the state, but there was a cost. Workforce shortages, always a problem for hospitals, became a national crisis as burned-out staff left their jobs by the thousands. At the end of 2021, COVID-19 hospitalizations remained persistently high. Once again, necessary care was delayed in many communities (as it was in 2020) as hospitals coped with the surge of acutely ill patients, and those seeking care often arrived sicker and in need of more intensive services. Labor and supply costs have risen dramatically, while revenue has fallen. Many hospitals are emerging from the pandemic with significant financial challenges. Our health system withstood a tremendous strain, but we have seen that the system is fragile. As anchors in their communities, hospitals are the safety net, the only open door, available 24/7 when other institutions fail. But their presence is not guaranteed. What does this mean for 2022? COVID-19 will continue to be a factor in our lives and in the health care system. We all want to know how this will end, and if history is a guide, COVID will leave us not with a bang but with a whimper. As COVID-19 becomes endemic, we’ll continue to develop new coping tools, including the ability to live with the disease as a continuous presence. Normalcy won’t be a moment, but a process. Hospitals will struggle in the short term, both operationally and financially, as they recover and rebuild. They will need your support. As we go into 2022, we should feel hope. Hope that we will ease into normalcy. Hope that our hospitals and other institutions that have helped us weather this storm are still standing. Let’s all hope we can identify and capture lessons from the COVID-19 pandemic that will help us prepare for the future.

6 » A magazine for and about Oregon Community Hospitals. BENT, NOT BROKEN A summer COVID spike tested hospitals—and made them stronger in the end. By Jon Bell It was early July 2021 and Diana Erdman was feeling something a little like relief—that after more than a year of nonstop COVID-19 madness, things might actually be settling down a bit. As the administrative director of acute inpatient units at Adventist Health Portland, Erdman had been deep in the battle against the pandemic along with the rest of Adventist’s nearly 1,000 employees since it began in March of 2020.

7 Fall/Winter 2021-22 But at the beginning of July, COVID cases almost seemed like they were leveling off, if not downright declining. Vaccines were kicking in and turning the tide. According to the Oregon Health Authority, cases around the state were down to just a couple hundred a day in early July from an April daily high of more than 1,000. At one point that month, Adventist had no COVID patients in critical care and only single digits in its medical-surgical unit. Erdman could sense the difference. “I think we were feeling pretty good about where the direction of COVID cases was heading,” she said. “We were feeling like we were coming out of this and had actually started tackling a few non-COVID-related projects.” Then came the Delta variant—and out went that sense of relief. Cases in Oregon jumped throughout the second half of July: 777 on the 19th, 993 on the 26th, 1,076 on the 30th. August’s first day started off with more than 2,000. The COVID summer surge was on. “Toward the end of July, we, like many other health care organizations across Oregon and across the nation, saw the steady increase in COVID patients and then a full-blown surge by the end of August into September,” Erdman said. “It felt a little bit daunting, especially at a time that we thought we were turning the corner.” As a state, Oregon has fared pretty well with COVID, all things considered. But it was not spared the summer surge, which was driven by the Delta variant, infections among the unvaccinated, and, in some parts of the state, relaxed masking and social distancing measures. At the height of the surge, cases and hospitalizations were the highest they’d been during the entire pandemic. Nowhere were the impacts of the surge more tangible than in Oregon’s hospitals and health systems. At one point in early September, Oregon Public Broadcasting reported that 93% of Oregon’s hospital beds for adults were full and there were just 62 intensive care unit beds in the entire state. Hospitals struggled to care for a wave of new COVID patients, many of whom were unvaccinated. Many of those admitted patients were sicker, bodies unable to fight the ravages of the disease. Many of those patients stayed in the hospital longer, putting a further strain on bed availability. Resources wore thin, doctors, nurses, and staff burned out. But hospitals and the people who work in them also rallied and rose “When you see signs about heroes, the health care workers I’ve been around are absolutely who those are for. They are heroes.” Brian Sims, President & CEO, Good Shepherd Health Care System Hermiston to the challenge. They found ways to help people beat COVID and head home healthy. And they became stronger in ways that will help them do even better in the future when another surge rolls through. “When the chips were down, people really stepped up,” said Brian Sims, president and CEO at Good Shepherd Health Care System in Hermiston. “When you see signs about heroes, the health care workers I’ve been around are absolutely who those are for. They are heroes.” Heavy Load Even though hospitals and health systems in Oregon had had more than a year of COVID care under their belts by the time the summer surge hit, the onslaught of patients felt overwhelming. At Good Shepherd, there were times when all 25 of its beds—and six more in the ICU—were spoken for. “When the Delta variant hit us, it hit us hard,” Sims said. “We were beyond capacity in terms of bed space. Our ER was packed. And we couldn’t transfer people out because there were no beds to transfer them to. It was a true challenge.” continues 

» A magazine for and about Oregon Community Hospitals. 8 In late August, the intensive care units in the three hospitals of the Asante Rogue Regional Medical Center in Ashland, Medford, and Grants Pass were all filled with COVID-19 patients. Adventist had a daily average of 30 or more COVID patients, a significant percentage of its overall daily average of 100 patients. And because most of those COVID patients were unvaccinated, they were in bad shape. “What we saw so much more this round than before was a really high critical care COVID census,” Erdman said. “At some point, our entire medical ICU was COVID patients, and the patients we were seeing were even sicker.” The extra COVID load was heavy on hospitals. Staffing levels, already stretched thin before the pandemic, became even more worrisome. Many hospitals saw early retirements or staff who simply burned out and left the field. Most have had to bring in contract nurses from outside of Oregon, known as travelers, to fill gaps that have only widened during COVID-19. And because demand for travelers is so high, costs are too. Sims said rates for traveler nurses have risen dramatically, and other hospitals report similar increases. Higher labor costs have put pressure on hospital finances at a time when revenues have stayed flat, according to data from Apprise Health Insights. “It’s just not sustainable using this type of expensive labor,” said Leslie Ogden, chief executive officer at Samaritan North Lincoln Hospital and Pacific Communities Hospital on the Oregon Coast. Those two hospitals were spared the brunt of the surge, something Ogden attributed to a high vaccination rate in the area and what continues 

9 Fall/Winter 2021-22

10 » A magazine for and about Oregon Community Hospitals. she called a “very proactive” public health system that has found all kinds of entities collaborating on the pandemic response. Even so, Ogden said the surge put a strain on North Lincoln and PCH because it takes a higher level of care to tend to COVID patients. “If we have COVID patients, it’s more taxing on staff in terms of assignments, the need for enhanced PPE and just that enhanced level of safety required,” she said. “But our staff rose to the challenge.” Getting It Done With the surge in full swing this summer, hospitals had no choice but to tackle it head on. At Adventist, leaders brought in skilled travel nurses from elsewhere in the Adventist Health system. They also developed a nonclinical support team comprised of existing employees who could be redeployed from their traditional roles to help with other tasks like answering phones and connecting patients and families via iPad. “It was pretty amazing the way they stepped up to support patient care,” Erdman said. She said daily 8:30 a.m. meetings helped ensure staff had the resources they needed for the day. Partnering with Oregon Health and Science University, whose Mission Control helps monitor hospital capacity in the metro region, was also key to creating capacity so hospitals from elsewhere in Oregon could transfer their higher-acuity patients to “It’s just not sustainable using this type of expensive labor.” Leslie Ogden, CEO, Samaritan North Lincoln Hospital & Pacific Communities Hospital

11 Fall/Winter 2021-22 “Our level of preparedness for infectious disease has reached a level we were not at before. This has made us a better organization.” Leslie Ogden, CEO, Samaritan North Lincoln Hospital & Pacific Communities Hospital OHSU. 15 members of the Oregon National Guard provided additional support, and many Adventist employees took on extra shifts. The hospital offered financial incentives to staff and made sure employees took their scheduled time off so they could rest and rejuvenate. “I am constantly in awe of their dedication to the patients,” Erdman said of staff, who have cared for 965 COVID patients in the hospital alone since the start of the pandemic. “It is amazing what they’ve been able to do.” Ogden said her hospitals have continued to work with other public health entities in the region, in part to vaccinate as many people as possible so that another surge doesn’t materialize. When vaccines first became available, the goal was to get 80% of eligible residents vaccinated. Partnering with Lincoln County Public Health, local fire departments and EMS teams, schools, and others—they hit that goal. Responding to the pandemic and the surge, which tapered off some later in October and November, has had lasting positive impacts for hospitals. Erdman said Adventist has held a number of town halls and forums to get input from the employees who are working on the front lines to help better design the health system’s approach to the pandemic. Lessons from this go-round will help inform the response if there is another surge—say, for example, from the new Omicron variant. Ogden said up until COVID-19, she and other public health leaders on the coast had been focused on what the response to the Cascadia earthquake—not an infectious disease pandemic— would look like. Rallying to beat back COVID and the summer surge have better prepared them for the future. “Our level of preparedness for infectious disease has reached a level we were not at before,” she said. “This has made us a better organization, and as far as partnerships and forging tighter bonds with our public health colleagues and just being forced to communicate more and become a tighter group of health care entities, that’s never a bad thing. It makes us better organizations to know each other so we can work together better in the future.”

» A magazine for and about Oregon Community Hospitals. OREGON NATIONAL GUARD DEPLOYS TO HOSPITALS AS COVID CASES SURGE Grateful staff say guard members have been a blessing. By Ben Hellwarth If you happened to walk through the main doors of an Oregon hospital recently, like Providence St. Vincent Medical Center in Portland, or the much smaller Mercy Medical Center in Roseburg, you might have been surprised to find a handful of Oregon National Guard soldiers staffing the front desk. Their desert-hued camouflage uniforms, a striking contrast to the river-blue scrubs and snow-white lab coats common to hospital attire, are more often associated with scenes of natural disasters, urban unrest, and foreign war zones. Yet the National Guard, whose military roots predate the founding of the Republic, can be called up to help contend with domestic crises of any kind—thus the Guard motto: “Always Ready, Always There.” So, when a summer surge in sickness related to COVID-19 infections put an 12

13 Fall/Winter 2021-22 unprecedented strain on hospital staffs, Gov. Kate Brown ultimately made more than 1,500 of the state’s roughly 8,000 Guard members a frequent sight in and around some 50 Oregon hospitals with an urgent need for extra hands. “In my 20 years-plus in health care, never in my life did I imagine that I would be soliciting the National Guard’s help,” said Elva Sipin, vice president of operations at PeaceHealth Sacred Heart Medical Center at Riverbend, in Springfield, the main destination for COVID patients in Lane County. “I’m just extremely grateful that they were able to help with our operational needs, at such a critical time, to help make sure that we were there for our community.” In the spring, Guard members could already be seen on the frontlines of the fight against COVID, mainly helping to staff Oregon’s mass vaccination sites— in spaces like fairgrounds, community centers, parking lots and gyms—to get the newly-approved immunization shots into thousands of waiting arms. That mission, known as Assurance, was largely winding down by the Fourth of July. Then came the summer’s surge in COVID infections from the highly contagious Delta variant—and the beginnings of the mobilization that put soldiers and airmen to work inside hospitals, a mission the Guard dubbed Reassurance. At a 347-bed facility like PeaceHealth Riverbend, COVID hospitalizations in July had dwindled to as few as about 20 per day, Sipin said. continues  “I’m just extremely grateful that they were able to help with our operational needs, at such a critical time, to help make sure that we were there for our community.” Elva Sipin, VP of Operations, PeaceHealth Sacred Heart at Riverbend

14 » A magazine for and about Oregon Community Hospitals. Then in August and September, the daily number of COVID patients hovered at more than 100. An hour’s drive to the north, at Salem Hospital, with its 494 licensed beds, the COVID caseload peaked on Labor Day, with 112 patients hospitalized, of which 22 were in the Intensive Care Unit and 14 on ventilators; 90 of those patients were unvaccinated. Hospitalization tallies were only slightly lower in the days just before and after Labor Day at Salem Health, the single hospital serving the state’s capital city, a metropolitan area with a population of more than 400,000 and surrounding rural areas in the mid-Willamette Valley. By early November, at least 1,440 Oregonians with COVID-19 had died over the previous three months, more than the 1,435 fatalities last winter, from November 2020 through January 2021, prior to vaccines being available, according to Oregon Health Authority figures. By the end of the Thanksgiving holiday, Oregon had another 27 COVIDrelated deaths, bringing the state total to 5,142. The number of hospitalized patients with COVID-19 stood at nearly 400, with 91 of those patients in ICU beds. Statewide, there were just 68 available adult ICU beds out of 679 total, a 10% availability, and 368 available adult non-ICU beds out of 4,092, a 9% availability, according to the OHA. At Salem Health, the summer strain on staff was compounded by what President and CEO Cheryl Nester Wolfe called “a perfect storm of accumulation,” brought on by so many people having delayed their care because of fears of catching COVID. By last summer, Nester Wolfe said, as vaccines became available and the virus’s threat seemed to be waning, those patients finally started to seek appointments. But by then, many were even more sick, and required more urgent medical attention—at the same time as the new Delta-propelled wave of COVID patients was filling beds. “This kind of steamrolls after a while,” Nester Wolfe said. “You start to get the number of individuals who are so sick that they’re coming in because we absolutely have to do their surgery right away, or they haven’t taken care of their high blood pressure, or their diabetes—so now they’re just sicker, they have to stay with us longer, and they require more resources.” One of the most critical resources, at Salem Health and hospitals across the state: staff. “Staff were getting exhausted,” said Elaine La Rochelle, director of facilities at Grande Ronde Hospital in La Grande, who has been in charge of the 25-bed hospital’s COVID response. Their exhaustion was not just a product of working long shifts. “Beyond the physical toll there was the mental toll of feeling like they weren’t getting people better,” La Rochelle said. “They were used to treating people and caring for them, and they went home happy, and everything was good.” But as the surge

15 Fall/Winter 2021-22 hit, “we were seeing deaths on a weekly basis which we just don’t see,” La Rochelle said. “Our staff is not used to that. We’re not a terminal-care facility. We’re a make-you-get-better-and-gohome facility.” In addition, the staff at Grande Ronde, midway between Portland and Boise, became more shorthanded as the spread of COVID in the surrounding community of 25,000 forced workers to stay home to quarantine, La Rochelle said. “So, we were pushing on staffing anyway, and now you add, all of a sudden, 20% of your staff is out because they’ve had a contact exposure somewhere out in the community”—there was only one known case of patient-to-staff infection—“and now those that are left have even more work, and more patients.” Having up to ten Guard members, while one of the smaller hospital mission contingents, made a huge difference at Grande Ronde, La Rochelle said. Prior to the surge, her hospital was seeing between eight and 20 people a day with COVID-related symptoms. Then those numbers more than doubled, to between 30 and 60, putting the rural hospital on the brink of having to care for COVID patients only—and possibly postpone surgeries and other non-COVID-related treatments. continues  “When I talk to my team about what’s the biggest impact—aside from, of course, the help with logistics and stuff like that—what’s been the biggest impact of the National Guard, I can tell you, it’s just that morale boost. The way they just came in and were willing to do anything to help out with a smile on their face.” Elva Sipin, VP of Operations, PeaceHealth Sacred Heart at Riverbend

16 “Every four hours we were assessing: do we have enough beds to do the next round of surgeries? OK— we’re good,” La Rochelle explained. “The next four hours: do we have enough beds and people to do the next set of surgeries? People were still getting sick with other things.” Enter the National Guard, which Gov. Brown initially called up for hospital duty in mid-August. What began as a mission to combat the summer’s Delta surge has recently been extended, for several hundred Guard members, to the end of 2021. From the start, the Guard’s orders have essentially been to do just about whatever non-clinical jobs needed to be done. Maj. Gen. Michael Stencel, the Oregon National Guard Adjutant General, speaking to hospital mission members of the 41st Infantry Brigade Combat Team on September 2, at Camp Withycombe in Clackamas, said the soldiers should simply tell any hospital staffers they met, “I’m with the National Guard, and I’m here to help. You tell me what you need me to do, whether it’s sweeping the floor, folding sheets—we need to do everything we can to free them up to do the technical aspects of their job.” This meant picking up the kind of slack that healthcare professionals, often nurses, were having to do, which cut into their time to do the most important parts of their jobs, namely, caring for patients— a persistent pandemic frustration. “Doctors and nurses want to do the very best we can for our patients,” said Salem’s Nester Wolfe, who is herself a longtime registered nurse. “It just feels really bad when you can’t do things that you would normally do for a sick patient and being able to have those extra hands just made a huge difference.” Those National Guard hands could be found doing a variety of jobs, and the fact that they were being done in so many hospitals, in so many departments, made this Reassurance mission something » A magazine for and about Oregon Community Hospitals.

17 Fall/Winter 2021-22 of a first in the long history of the Guard—and, at the very least, adds a new layer of meaning to “Always Ready, Always There.” “The National Guard here, they typically will be delivering supplies, restocking things for the nurses to have them on hand, and just basically be on stand-by for nurses if they need a little assistance here or there,” said Pfc. Emilia Gomez, 19, standing in the ICU at Kaiser Permanente Sunnyside Medical Center in September, when up to 45 Guard members were working at the 233-bed hospital in Clackamas. Gomez, of Hillsboro, and others in her support battalion, a subunit of the 41st Infantry Brigade Combat Team, were able to “help take out soiled linens, trash, and they also help with running down to get blood, and running down for a lab, just the many little things that actually make a difference in medical.” That difference was measurable, said Josh Franke, chief project officer at Salem Hospital, where up to about 160 Guard members— about half from the Army National Guard and half from the Air National Guard—were integrated into the Salem Health Hospitals and Clinics systemwide staff of more than 5,000, of which 1,806 are registered nurses, 304 certified nursing assistants, and 64 nurse practitioners, most of them working at the main Salem Hospital. “They came right at the height of our COVID surge, and they were with us through the peak,” Franke said. “So, we had really good baseline data prior that we were able to compare the benefit of their being here with.” A few examples: • With more manpower to clean vacated rooms, a common Guard task at many hospitals, Salem was able to make rooms available more quickly for new patients as daily discharges from the hospital averaged between 50 and 70 per day in recent months. This also freed up nursing staff who may have had to help with cleaning prior to the Guard’s arrival. • In Nutrition Services, the time it took to deliver meals to patients throughout the hospital was cut by an average of 22 minutes per order. “You’ve got 400 people in the hospital, so 22 minutes per order is pretty significant,” Franke said. • Helping to move patients around the hospital, especially on the busy route from the Emergency Department to Imaging, the Guard made possible a 19% improvement in the time it was taking to get from placing an imaging order in the ED to transporting a patient to the imaging location. During the baseline period in August, that process had taken an average of 10.8 minutes; by mid-September, after Guard members had arrived and been trained, the average time had been cut to 8.7 minutes. Those saved minutes add up in the busiest Emergency Department on the West Coast from San Francisco to the Canadian border, which had more than 91,000 visits in 2020 and by early December 2021 had already logged 88,000, while averaging nearly 300 visits per day. • At Salem’s drive-through COVID testing site, where about 300 cars per day were lining up in September, the aggregate patient wait time was reduced by about six hours once Guard members were on the scene to assist—with such tasks as queuing cars, moving supplies from the tent to the building, and getting paperwork started. “Beyond the boost that they’ve provided to the morale of the staff,” Franke said, “they’ve had some very tangible impacts on our operations.” But the impact of the Guard’s morale boost was itself tangible, continues  In Nutrition Services, the time it took to deliver meals to patients throughout the hospital was cut by an average of 22 minutes per order.

18 » A magazine for and about Oregon Community Hospitals. said Sipin of PeaceHealth, where up to 70 Guard members joined the staff. “When I talk to my team about what’s the biggest impact—aside from, of course, the help with logistics and stuff like that— what’s been the biggest impact of the National Guard, I can tell you, it’s just that morale boost. The way they just came in and were willing to do anything to help out with a smile on their face.” Guard members could feel the smiles in return. “The reception from the nursing staff here at the hospital has been fantastic,” said Sgt. 1st Class Peter Powers, part of a Brigade Engineer Battalion, another sub-unit of the 41st Infantry Brigade Combat Team, and the non-commissioned officer-in-charge of Kaiser Permanente Sunnyside Medical Center, where up to 45 Guard members have been serving. “They’re happy to have us,” said Powers, 53, of Vernonia. “They’re happy to have the help. The patients we’ve dealt with are also happy to see us— though we’re harder to identify without the uniforms on,” he added, smiling, in recognition of how, in some settings, Guard members traded their camo for scrubs, but wore ID cards showing their Guard affiliation. But there was no mistaking a 23-year-old Guard member like Spc. Dominic Deitrick, in uniform, also of the 41st IBCT, as he washed pots, pans, and dishes amid the stainless-steel fixtures in Nutrition Services at Providence Medford Medical Center—a very long distance, and a very different duty, from his previous station with a scout and sniper section of the headquarters unit of the 1-186 Infantry Battalion that had recently returned from Djibouti, in East Africa. Now, he was just down the road from his home in Eagle Point and said, “It is an honor to serve my community.” “The staff here at Providence has been more than welcome to all of us soldiers, and we thank them for their help,” said Deitrick, one of the 65 Guard members working at Providence Medford at the surge’s peak. That help often came in the form of what might be called crash courses in non-clinical hospital operations—how to clean rooms, how to move patients, how to check patients in, how to keep track of supplies in stock rooms, how to pick up and deliver medications from pharmacies, and how to deliver meals. “We were very strategic in terms of where we wanted to deploy the National Guard. It really had to be plug and play,” said PeaceHealth’s Sipin, because there was scant time for training. But procedures for jobs like room cleaning could be taught quickly, and staff— especially nurses—who had been picking up a variety of essential, if sometimes unglamorous, slack, could then get back to focusing on their jobs. One unanticipated consequence of the Guard’s hospital deployment has been the opportunity for some Guard members—whose average age is about 28, and whose civilian jobs are many and varied—to do work that opened their eyes to career paths they might like to follow, said Maj. Chris Clyne, an Oregon National Guard public affairs officer whose focus has been the hospital mission. “I’ve heard quite a few stories of a lot of people deciding to go into health care professions after this experience,” Clyne said. “A lot of them got to work with people who had been doing the job for a while, and got to see the work conditions, and the hours, and they were very agreeable to them.” Specialist Dominic Deitrick washed dishes at Providence Medford Medical Center, a very different duty from his previous station with a scout and sniper section in East Africa. Now, he was just down the road from his home in Eagle Point and said, “It is an honor to serve my community.”

Fall/Winter 2021-22 VITAL SURVIVAL After nearly ten months in the hospital, a COVID patient is back home thanks to a fighting spirit, a loving family, and his care team. By Claire Sykes Alejandro Castro loves to swim, hike, and cook. But throughout his 299 days at Providence Portland Medical Center (PPMC) as a COVID-19 patient, he couldn’t even breathe on his own, and many times was at the brink of death. Thanks to the hospital ’s critical care and respiratory/cardiology department teams—and its cutting-edge extracorporeal membrane oxygenation (ECMO) machine—the 44-year-old many call Alex, a husband and father of four, is back home in Sandy, Oregon. The vaccines weren’t available when Castro and his kids became infected with COVID-19 in early December of 2020. His wife, Amanda Chase, was the only one in the family who was spared, and she took care of them. Their four children had mild cases and soon got better. But after Castro began struggling to breathe, she rushed him in the middle of the night to the nearest medical facility, Adventist Health Urgent Care in Sandy. A few days later, he was whisked into the critical care unit (CCU) at PPMC and immediately hooked up to an ECMO machine. This invasive, aggressive treatment, around since the 1970’s, is the last resort for patients with severe respiratory distress. ECMO machines do the work of the lungs and heart, hopefully giving the patient’s lungs the chance to heal. Luckily, one of the hospital’s three units, in constant use during the pandemic, was free. Without the treatment, Castro’s care team is convinced he would have died. 19 continues 

20 » A magazine for and about Oregon Community Hospitals. The ECMO machine’s tubes, or cannulas, were threaded into the large veins and arteries in Castro’s neck and groin. Through them, the machine continuously pumped blood out of his body, adding oxygen and removing carbon dioxide before returning the blood via the cannula. He was on ECMO in the CCU for 108 days, the longest ever at PPMC. Along with his lungs, heart, and liver, Castro’s kidneys also failed, so he was also put on dialysis. “Every day on ECMO, the risk of dying goes up,” says Tara Tuepker, RN and ECMO specialist, one of a large team of CCU staff who took care of Castro. 50 of the 130 PPMC critical care nurses are trained on the complex ECMO technology that kept Castro alive. To avoid muscle atrophy and brain trauma, Alex was not sedated. Javiera Pobanz, a nurse and ECMO specialist, described the routine. “Since before COVID, we’ve been doing what we call ‘awake-mo,’ so the patient can stay alert,” she said. “That helps them keep track of time and process what’s going on, and not get delirious. But it’s risky because the cannulas could move.” The tubing also means a liquid diet, Castro preferring orange sherbet and milk with protein powder. ECMO patients are susceptible to the occasional infection, and Castro was no exception. The infections were further setbacks to his recovery, but Alex fought them off each time. Since early 2018, PPMC also had been walking their ECMO patients, a relatively unusual practice in American hospitals. “Those in Europe have been doing it for years and have standards for it, so we thought we should do it, too,” said Pobanz. “Walking helps patients sleep, sticking to a routine night-day cycle. At first it was scary, though, because the cannulas can get pushed in further or

21 Fall/Winter 2021-22 pull out. But we researched ways we could ambulate these patients, and we developed a strategy.” Two to three times a week, Castro gave his all in slow, small steps down the hall, still connected to the ECMO machine. Each walk involved a team of several nurses, a respiratory therapist, a physical therapist, and an occupational therapist. “Oxygenating blood is exhausting, and there were days he felt fatigued being on ECMO for so long, and he didn’t want to walk or even sit in a chair because, also, he was so depressed,” said Pobanz. In the beginning of Castro’s stay, visitors weren’t permitted. Staff rallied around him, though, giving him extra support and encouragement, so he wouldn’t feel so alone, isolated in the CCU. “We were his only social connection then,” said Pobanz, who spoke Spanish with the Mexicoborn Castro. “I just concentrated on the positive, joking with him about our countries’ soccer teams (Pobanz was born in Chile) to lighten the mood. We all engaged with him, to take his mind off what was going on. And we’d move his bed or turn his chair toward the window, to give him some connection to the outside world.” Sometimes Castro let down his guard and the tears would come. “I felt privileged in those moments when he was very open and vulnerable, while wanting to be strong for his family,” said Tuepker. Then, finally, Castro could have one visitor. That was his wife Amanda, who made the journey from Sandy to the hospital in northeast Portland every day. Soon, Castro’s 20-year-old son, AJ, was allowed to visit. AJ would often help with his father’s ECMO walks, urging him to go just a bit further each time. Several times over his long stay at PPMC, Castro’s nursing team bundled him up for a wheelchair ride outside to feel the sun and see his other children, Marielena, 22; Luis, 17; and Yasmin, 14. “There were multiple times I thought I was losing him,” Amanda said in the video PPMC made of her and Castro the day he left the hospital for home. Doctor Jason Wells, an ECMO specialist in pulmonology critical care at Providence and Castro’s physician, said, “There were lots of ups and lots of significant downs where you know you couldn’t see a path forward for him where he’d make it through.” That was hard for CCU staff, but they bonded through adversity as they have throughout the pandemic. Pobanz, among the 20 CCU nurses on day shifts and another ten who work at night, said, “I rely on my fellow nurses a lot. We started meeting monthly so we could air out our issues and feelings as a group.” Tuepker adds, “Our team is so tight. And the doctors are right there with us.” Tuepker says she draws strength from her faith, prayer, and her family. Long walks outside also help with her stress. Pobanz took up running after watching Castro fight so hard to build strength. “If Alex can walk while on ECMO, I can do a 5K, so I started training,” she said. “I realized I needed to take care of myself, my body, and mind to remain healthy and take care of patients.” By March 2021, Castro made enough progress that he was ready for the respiratory/cardiology department on floor 2R. Nurse Erin Robertson-Otis became part of this care team. She said, “When he arrived, he was incredibly anxious. Patients here still have intense respiratory- treatment needs, and they’ve been through so much more than you can imagine. He was quite fearful to leave [the CCU], understandably, even though that means good things.” The respiratory/cardiology department’s goal is to wean the patient off the ventilator, remove the tracheostomy tube, get them strong enough to move around and, eventually, eat safely. Right across “Watching him leave, I cried like a baby. When Amanda gave me a hug, that’s when I lost it the most.” Tara Tuepker, RN & ECMO Specialist continues 

22 » A magazine for and about Oregon Community Hospitals. from Castro’s room, a bank of monitors in the nurses’ station constantly tracked his heart rate and oxygen saturation, sending Robertson-Otis into his room several times an hour to increase his oxygen. Two to three times, he had to go back to the CCU, once after only 12 hours on 2R. “We’ve had so many respiratory patients, but we’ve never seen the massive fluctuations like we did with Alex,” she said. “I’ve never been tried to this degree. I don’t think most of our staff have been taxed in this way before. Their skills are impressive, they save people’s lives, but that’s not the part that’s hard. It’s the emotional part. I felt for a while that I was carrying the emotional weight of the global pandemic, then I realized we can only care for the people here. And that was freeing for me.” Meanwhile, Castro felt imprisoned by fear when the pandemic compelled the hospital to again bar visitors. “He missed his family so much. It was terrifying for him because he was utterly losing hope from not seeing them at all,” Robertson- Otis said. “He was on Facetime with them, but if he couldn’t have anyone visit, we didn’t know if he was going to make it. So, we asked for special permission to have just his wife come.” Castro started to improve. By August, about a month before he was discharged from PPMC, he walked the hall twice a day on 25 liters of oxygen, a significant increase from what he could handle when he first arrived on 2R. “Then he had a respiratory event that made him a little bit worse,” said Robertson-Otis. “We were so afraid, after all this time, that he wasn’t going to make it. I told him, ‘You’ve given so much, and we realize you may have little motivation for yourself, but we can’t handle you not making it home.’” Castro was finally able to, after more than six months in respiratory/cardiology and nearly four months more in the CCU. In the PPMC video, when asked about this next, huge step in his healing, he says, “I feel happy to see all my family. A little scary, but I’m happy to go home,” he says. He had missed his wife’s and four children’s birthdays, Christmas, New Year’s, his youngest daughter’s eighth-grade graduation and the funeral of a friend who died of cancer. But he would be home with his wife in time for their 22nd wedding anniversary. And what about COVID? “I don’t believe it before, the COVID, but now I believe. I tell everybody be careful, this is scary. I’m scared, very scared,” says Castro. By then, everyone in his family had been fully vaccinated. The day Castro left PPMC, about 50 nurses, doctors, physical and occupational therapists, the chaplain, and almost everyone else who was a part of his life at the hospital lined the hallways. They shouted, applauded, and cheered. A patient transporter slowly rolled him in a wheelchair past them and out the door, a black-andwhite-plaid fleece blanket on his lap topped with two red roses, as he fought back the tears. Behind him, his wife carried a dozen colorful mylar balloons. “I can’t express my gratitude, my appreciation, for everybody here,” Chase says in the PPMC video. “The nurses have become friends, or you know, family. They’re closer to us than a lot of people. It’s beyond words how much I appreciate the hospital staff and the doctors who’ve taken such good care of him.” Castro says he doesn’t remember half of what happened to him at PPMC. But he’ll probably never forget how he felt the day he left. Neither will his care team. “Watching him leave, I cried like a baby,” says Tuepker. “When Amanda gave me a hug, that’s when I lost it the most. Then I walked by Alex, and he reached out and gave me a hug. No words were needed. He was so grateful.” Pobanz took up running after watching Castro fight so hard to build strength. “If Alex can walk while on ECMO, I can do a 5K, so I started training.”

Fall/Winter 2021-22 “That he had gotten better made all the work we did worth it,” says Pobanz. “It can be draining to put in so much effort and time and nothing to show for it. But to see that he got to go home was so rewarding.” Robertson-Otis feels the same way. She said, “We’ve seen so many people die, and the fact that he made it gave all of us not only hope that we can work hard enough to save people, but also that he is an inspiration for our team about how many times you can want to give up, but you don’t. Real human interaction is one of the things that matters most, and if you can’t be there for people, what else is there? When they need you and you can give to them, it’s a wonderful honor. It changes you to know someone and have something major happen together with them. As a nurse, I’m a part of something major in someone’s life. And I want to be as present with them as I can, and have an open heart, helping them get to the next stage.” The man who once proudly held three jobs now turns to his wife and eldest daughter, Marielena, for the family’s income, while AJ takes on the role as his main caretaker. Castro tires easily and still struggles to breathe. He will need oxygen constantly and he may eventually need a lung transplant. He faces a long, difficult road to recovery ahead, but physical and occupational therapy are already helping to bring noticeable improvements every day. “He’s doing so well right now,” said Tuepker, who has stayed in touch with Castro and his wife. “It’s very unusual for me that a friendship has come out of this. Amanda tells me, ‘I’m still scared.’ And I say, ‘Yeah, you’re probably going to continue to be.’” Today Tuepker pictures Castro at home, which reminds her “to continue to have hope and pass that on to others. There’s a fine line sometimes between hope and reality and sometimes you need hope to push through reality.” “He is an inspiration for our team about how many times you can want to give up, but you don’t.” Erin Robertson-Otis, RN 23

24 » A magazine for and about Oregon Community Hospitals. ALL HANDS ON DECK Hospitals show gratitude to staff, use creativity to survive worker shortage. By Dave Northfield For everyone working in a hospital during the darkest days of the Delta surge, one thing was clear. The capacity crisis was about staff, not stuff. While access to care during the first COVID surge was affected by the supply shortage, especially PPE, access issues during the summer heading into the fall were driven by the workforce shortage. “Our system was at the breaking point,” said Becky Hultberg, OAHHS President and CEO. Fortunately for Oregonians, the system did not break, thanks to incredibly hardworking employees and leadership at the facility and HR level. “We have gotten pretty creative, I have to say,” said Ginny Williams, CEO of Curry General Hospital in Gold Beach. “We have not stood on the corner and said woe is us, the sky is falling, and we’re never going to make it out, but we have really focused on recognition, retention, and recruitment.” As November began, Curry General, a critical access hospital in

Fall/Winter 2021-22 rural Oregon, had 90 openings. Not all of them were clinical, but one-third of them were: nursing, diagnostic imaging, respiratory therapists, laboratory, and more. “We are struggling like everyone else to maintain safe nursing standards,” Williams said. Williams said appreciation bonuses of $1,000 were helpful, but she also said her team went further. “We needed to bring some normalcy to our staff, so we started an employee recognition drawing. Every day we do a drawing of two $50 gift cards. It’s really a gift of gratitude, thank you for being part of our team.” When it comes to showing gratitude and getting creative, it’s hard to top the special gesture from Curry General’s management team during Hospital Week. They washed staff members’ cars. “We are working toward creating a culture of gratitude and appreciation. And it is through our staff that we will be able to recruit people that want to be here.” At Good Shepherd Medical Center in Hermiston, staff support has also been a top priority to address the exhaustion the surge brought. “It’s the burnout from their day to day lives at home, the expectations at work, and everything that comes from society,” said Sara Camden, Director of Critical Care. “The first wave of COVID was ‘I’m a superhero, I can do anything.’ The second wave it felt like I don’t really matter this time, I’m not really that important. They didn’t really feel that valued.” Good Shepherd has brought in outside resources for support and counseling in addition to the many daily efforts from the team. “There have been plenty of one-onone discussions in your office, and just shut the door and let people have a moment,” said Janeen Reding, Vice President of Human Resources. “Some of what I ammost proud of is to see the emergence of empathy in the staff,” Reding said. “They could have become disgruntled, but there is a resilience instead. I’m really proud of the staff for that, they have chosen to be even more supportive to each other, given each other some extra grace.” Of course, the staffing crisis was not confined to rural hospitals. Urban hospitals were affected as well. Legacy Health’s chief nursing officer said they took an “all hands on deck approach” to surviving the surge and maintaining high standards of care. “My job is to make sure we have the right amount of resources to “There have been plenty of one-on-one discussions in your office, and just shut the door and let people have a moment.” Janeen Reding, VP of Human Services, Good Shepherd continues  25