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During pandemic, some care could not wait

While some Ascension Via Christi hospital and outpatient services paused in response to the COVID-19 pandemic are gearing back up, others never skipped a beat.
"We put non-urgent services on hold to free up beds and preserve supplies and equipment should they be needed for an anticipated patient surge, which was mild given the community social distancing interventions undertaken," says Sam Antonios, MD, chief medical officer for Via Christi's Wichita hospitals. "Even our emergency rooms were less busy, but we continued to care for patients."
Some patients coming through the ER may have compounded their illness by delaying care over concern about COVID-19, Antonios says. Others, like Kent Koehler, recognized the need for immediate medical intervention.
Kent, who four years earlier had experienced a transient ischemic attack, asked his wife to call 9-1-1 the moment he began exhibiting signs of a stroke. He was transported by Sedgwick County EMS to the Comprehensive Stroke Center at Ascension Via Christi St. Francis, where the stroke team met him at the door. Within 23 minutes, he was administered a clot-busting drug known as tPA. 
"Hours later, all of my symptoms were gone," says Kent, who was discharged home approximately 24 hours after his admission. Subsequent testing found no trace of any damage to his brain, so it is unclear whether Kent suffered a stroke or second TIA, which is sometimes referred to as a mini-stroke. Either way, he says, "I am one of the lucky ones. I walked out on my own with no deficits whatsoever."
The Comprehensive Stroke Center at St. Francis is just one of the areas that have remained busy during the pandemic.
Although most transcather aortic valve replacement, or TAVR, procedures performed by the Structural Heart Program team at St. Francis are pre-scheduled, it would have been difficult to determine which were emergent cases and which were not, says Bassem Chehab, MD, the program's medical director.
"If a patient has severe aortic valve stenosis, their risk of death or additional complications is quite high," says Dr. Chehab. So while some patients elected to postpone their procedure, most opted to proceed as scheduled once they learned about all the steps being taken to ensure their safety. 
To further reduce TAVR patients' risk for infection, 30-day and one-year follow-up visits are now being done virtually and new patient visits are being scheduled outside the hospital environment, Dr. Chehab says.
If anything, Ascension Via Christi's Wound Center has been as busy, or even more so, than usual, says Marilee McBoyle, the clinic's medical director. 
"We see a lot of patients with diabetic foot ulcers who need to be seen every week," says Dr. McBoyle. "They have a much greater mortality risk from complications resulting from their diabetic foot ulcer than that of the COVID-19 patient."
Patients with venous ulcers typically have compression wraps covering their wounds and those need to be seen and changed weekly as well to prevent further infection and complications. Patients with pressure ulcers also need regular visits and wound treatment. While some patients can be seen virtually, most require hands-on care or an in-person visit for services such as hyperbaric oxygen therapy.
"Given that we are treating wounds, we already had strict protocols and environmental precautions in place to prevent the spread of infection," says McBoyle. "So the only change has been that we are screening patients for COVID-19 symptoms before they even enter our clinic and we are not allowing patients to bring anyone with them to their visits except when it is essential.
"So while some services were paused, our team continued to provide much-needed care to patients and I could not be any more proud of them."
Another area that saw increased activity is the Ascension Via Christi CyberKnife Center.
"Cancer care doesn't stop because of a pandemic, but it can mean changes in the way it is delivered," says radiation oncologist David Bryant, MD. Treatment with CyberKnife typically requires five or fewer treatments, while traditional radiation therapy can mean dozens of visits. "Each time a patient with cancer doesn't have to leave home reduces the risk for infection," says Dr. Bryant, who, along with other members of the Ascension Via Christi Cancer Center team, has been doing virtual consults when possible, further reducing patients' risk.
Another area that has incorporated virtual visits is Ascension Medical Group Via Christi. That's been particularly beneficial in the area of Behavioral Health, says psychiatrist Moneeshindra Mittal, MD, who leads Behavioral Health services at Via Christi.
"Ascension Via Christi has been at the forefront of innovation and bringing care to the people before it reaches the crisis level," says Dr. Mittal. "Virtual care, at a time of high stress for everyone, helps ensure our ability to do that."
Likewise, the childbirth education team at the NewLife Center at Ascension Via Christi St. Joseph has also gone virtual.
"We quickly got set up to offer virtually the same childbirth and new parent classes we were already offering at no cost to participants," says Toni Howard, RN, who coordinates the class offerings and serves as a nurse navigator for expectant parents. "While we expect to return to offering in-person tours, classes and breastfeeding support groups some day, we likely will offer them both ways going forward."
The Wound Care Clinic team at Ascension Via Christi St. Francis.
Kent Koehler, four years after his life-saving stroke procedure at Ascension Via Christi St. Francis' Comprehensive Stroke Center. 
About Roz Hutchinson

Roz Hutchinson is a Wichita wife, mother and chief spoiler of six grandkids and three Chihuahuas, a die-hard women's basketball fan, and director of Communications and Public Relations for Ascension Via Christi.