At the regular Ketchikan City Council meeting on Dec. 16, PeaceHealth Ketchikan Medical Center Chief Administrative Officer Dori Stevens gave a quarterly update on the hospital’s operations.
Topics addressed by Stevens were: Patient experience, quality metrics, Long-Term Care, growth, physician and caregiver recruitment, survey updates, a COVID-19 update and information about the KMC medical detoxification program.
The patient experience topic addressed people’s rating of the care they received in the hospital’s emergency department, using percentile rankings comparing ratings to other hospitals across the country, Stevens said.
PeaceHealth KMC was in the 83rd percentile in "patient experience: emergency department" metric, Stevens reported.
“That’s extremely high,” she told council members.
All of the percentile results addressing Ketchikan’s emergency room care are in the “high 80s to the low 90s” she said.
“People are recommending the emergency department, they’re receiving care within 30 minutes,” she cited as an example of the emergency room’s quality service.
In the slide that Stevens displayed as part of her presentation, there were categories listed that patients had responded to, from which the percentile rankings regarding emergency room carwere created. There were 95 or 96 survey responses for each category.
The two highest-ranked categories were “doctors listen carefully to you,” earning a 98th percentile ranking, and “nurses treat with courtesy/respect,” which earned a 94th percentile ranking.
Her slide referring to “quality” addressed the lack of infections related to central lines or catheters, pressure ulcers or falls related to patient care. All of them were listed as having zero incidences in a time period ranging from 108 days for falls to 2,740 days for central line blood infections.
Referring to the Long-Term Care facility in the hospital, Stevens reported that new flooring has been installed and new windows and roofing installations are scheduled to be completed in March, 2022.
The flooring design was chosen with dementia patients in mind, Stevens said.
“Sometimes when they see cracks or something on the ground, they don’t like to step over it or around it, so there’s actually a particular design that helps people that have Alzheimer’s dementia walk more comfortably,” she explained.
As of Oct. 2, all new Long-Term Care residents have been required to be fully vaccinated. One Long-Term Care patient who was infected with COVID-19 was placed in quarantine in November, Stevens said.
As part of her presentation concerning growth of the KMC offerings, Stevens said that the hospital’s orthopedics knee and hip replacement program has been accepted into the Blue Cross Blue Shield “Blue Distinction of Excellence” program.
The orthodpedics program has seen an increase in volume of 3% over the past year, and an increase in joint replacements of 48%, which Stevens said was “pretty impressive for a COVID year” that caused many disruptions.
Stevens also outlined recent growth in the hospital’s diagnostic imaging program as well.
“Our chief medical officer has been working with community providers to see what it is that they need from us to help them take care of their patients better, and one of the things that they had mentioned was, you know ‘we see patients in urgent care on weekends, and we don’t have a place where we can send them to get CT and X-rays.’”
In response, Stevens said the imaging department now offers weekend hours for urgent needs.
She additionally mentioned that there is a new telehealth program to support critical care medicine.
Stevens also introduced a doctor who is new to KMC. John Huffer, a urologist who is based in Juneau and now is scheduled to visit KMC twice monthly. His first two-day visit was in November.
Also under the topic of caregiver recruitment, Stevens cited a total turnover rate for KMC staff of 15.9% and of 17.1% for nursing staff.
Stevens noted that the general staff turnover rate was “a little bit high,” and had been, pre-pandemic, about 10%.
“I don’t know what’s normal anymore,” she said, and added that those rates will be watched carefully in the coming year.
There were 70 caregivers hired in the year between November 2020 and October 2021, Stevens said, with registered nurses comprising 16 of those.
Stevens said that four new local registered nursing graduates were hired in the Long Term Care facility and two were hired to work in the medical/surgical department.
A new graduate residency program, based out of the PeaceHealth facility in Bellingham, is expected to start in 2022, Stevens said.
Stevens next displayed a graph showing that contracted labor hiring had increased in the past year.
In June 2021, the hospital began to hire more contract personnel in preparation for expected vaccine mandates, “and people leaving us because of that,” she said.
The vaccine mandate was in place by September, she said, and the hiring of contracted personnel eased up starting in October.
PeaceHealth KMC saw a loss of 1.1% of its total caregivers — a total of five individuals — due to the vaccine mandate. They were placed on unpaid leave.
After Stevens’ presentation was done, Council Member Gass asked why Stevens had cited the loss of 13 staff members, rather than five, as having been lost to the mandate in her previous presentation to the council.
Five staff were placed on unpaid leave, Stevens explained, and the remainder “left prior to that on their own free will.”
Gass also asked if a recent court decision concerning vaccine mandates would affect the KMC policy regarding vaccine requirements for staff.
“We feel that (vaccinated medical staff) is what patients want, and deserve, to keep them safe,” Stevens replied.
Gass also asked about the changing advice about COVID-19 vaccinations — that at first, people were told that the vaccines would prevent infection by the virus, then it changed to a message that the vaccine would only prevent extreme illness.
“It just seems to me, that it comes back to that personal choice, and if me getting the vaccine isn’t really going to stop me from spreading it …” Gass offered.
Stevens replied that, “the people that are sick in the hospital are unvaccinated.”
In a telephonic interview Wednesday, PeaceHealth KMC Manager of Marketing and Communications Kate Govaars confirmed that Stevens' comment was "largely accurate," but also that case counts are complex due to the methods by which COVID-19 patients are officially tallied.
Stevens was not directly available for comment by the Daily News' presstime on Wednesday, but had discussed the issue with Govaars earlier this week, Govaars said.
Stevens, in her presentation at the City Council meeting, added that when the hospital had had surges in patients who are sick with COVID-19, “it's from unvaccinated patients.”
Govaars confirmed the latter statement to be accurate.
Stevens told the council, “So, if we want to protect our hospital and our resources, vaccine is the answer."
Govaars echoed Stevens words, saying that medical personnel "know (that) the way to prevent severe illness" and to protect against the omicron variant is to get vaccinated.
Stevens also gave an update on the hospital’s work with patients who were ill with COVID-19.
From Nov. 7 through Nov. 18, she said there were 11 patients treated for the virus. In one 36-hour period during that time, eight patients infected with the virus were admitted.
“It was a little stressful, and the team rallied and we reallocated resources and we did what we needed to do to take care of these patients,” she said.
She also said that the recent surge of patients was unexpected, as in the time prior to the availability of vaccinations, patients infected with COVID-19 were more rarely seen at the hospital.
“All of a sudden, in the fall and late summer, we’ve been averaging about four patients a day, pretty steady. We haven’t been down to zero in quite some time,” she said, adding, “that is a little alarming.”
She said that all of those patients were treated without disrupting routine care, but staff gathers to discuss the strategy for balancing the needs of their patients every time an uptick in patients with COVID-19 is seen.
Other concerns related to COVID-19 were touched on by Stevens as well.
Staff has a 30-day supply of PPE on hand, which is plenty, she said. The hospital also has ordered moveable walls to separate patients when needed. The supply of monoclonal antibodies is sufficient as well, and is administered in the emergency department.
The hospital had, at the time of the meeting, four available rooms for COVID-19 patients in the Intensive Care Unit, eight in the Medical/Surgery department and one in the Labor and Delivery department.
Stevens also advocated for community members to get their COVID-19 vaccinations to keep those rooms available and the infection numbers down.
The hospital’s “surge plan” is fully complete and reviewed by a team at least monthly, Stevens said. A review of elective procedures is made daily when the COVID-19 numbers in the facility reach eight or more, she explained.
To be ready to treat patients ill with COVID-19, Stevens said they doubled respiratory therapists more than a year ago, and those numbers are maintained. She said that KMC also began to use a “crisis staffing agency” to help with hiring the needed medical personnel more quickly.
The hospital’s new medical detoxification program saw two patients treated in November, Stevens said. A memorandum of understanding currently is in progress with two local facilities that would identify patients needing elective treatment.
Council Member Abby Bradberry asked Stevens how long it would be until the hospital could admit more patients into the medical detox program. Stevens said that the program is ready to accept new patients now.
Bradberry asked how many patients the hospital expected to be able to treat simultaneously within the detox program.
“Again, that’s very fluid,” Stevens said, noting that it depends on some factors such as how full the hospital is with patients infected with COVID-19.
She estimated one or two patients at a time is what would generally be taken in for the program, however.
“These patients are very complex,” she said, of people being treated for addictions. “They do take a lot of resources,” she added, explaining that they need much attention and observation from nursing staff.
Answering another question from Bradberry, Stevens said that the usual length of time needed for medical detox is about three days, but that each person has individual challenges.
Council Member Lallette Kistler asked Stevens how the detox program was started.
Stevens said that when she first took the position with KMC about a year and a half ago, one of her first tasks was to meet with various medical providers in the community.
When she met with representatives from Ketchikan Indian Community, she said she was told that one of their biggest needs was support and help with medical detox. At the time, patients identified as needing such a program were sent up to Anchorage for help.
That was right at the onset of the pandemic, Stevens said, so she had to put the implementation of a medical detox program on hold. Over the past year, however, KMC staff was able to build the program and get it running.
Council Member Jai Mahtani asked about the administration of monoclonal antibodies in the emergency department.
“I understand, from my research, that it takes a nurse three to five hours to administer this medication,” Mahtani said. “Why has there not been a room set up … so there can be one nurse assigned permanently to administer the same medication which is helping to three or four patients at the same time rather than wasting time of an ER nurse who could be helping other ER patients?”
“Lots of reasons,” Stevens said.
She listed limited resources as one reason — if one nurse is dedicated only to the one or two patients infected with COVID-19, then a second nurse would be needed to take care of other patients, rather than one nurse being able to take care of the entire patient group.
Overviews about KMC operations are presented to the council quarterly. A list of proposed topics is presented to the council by KMC staff prior to the planned presentation date. Council members review and revise the topic list during a meeting and vote to approve the finalized topic list.
The slides presented to the council at the Dec. 16 meeting can be found attached to the council’s Dec. 16 meeting agenda at the city’s website online at www.ktn-ak.us/current-agendas-and-minutes.