Stanford Children’s Health Resumes Care Delayed by COVID-19

Lucile Packard Children’s Hospital Stanford is anticipating an increase in patient volumes after safely reintroducing deferred and delayed clinical services last week. Services that resumed include surgeries, diagnostic tests and imaging procedures. Operating room volume has reportedly returned to nearly 70 percent of pre-COVID-19 levels this week as patients return to receive needed treatment and care that had been put off since the March 19th state-mandated suspension of non-emergent medical procedures.

“At Packard Children’s Hospital, there is actually very little that we do that can truly be considered ‘elective,'” said Dennis Lund, MD, chief medical officer at Stanford Children’s Health. “We had to carefully evaluate scheduled procedures to determine whether they could be safely delayed for 30-plus days, since that was the definition of ‘elective’ included in the mandate.”

The steps to scale back services resulted in a reduction of patient census (inpatient occupancy) inside the hospital as well as cancellations of approximately 65 percent of clinical visits across the more than 65 Stanford Children’s Health clinics.

Ready for the surge

Packard Children’s Hospital played an important role in preparing for a potential surge of COVID-19 patients, according to Yvonne Maldonado, MD, chief of pediatric infectious diseases. “We were prepared to provide care for pediatric patients from regional hospitals and for adult patients from Stanford Health Care.”

Furthermore, specially designated “landing zones” were established to accommodate patients with suspected or confirmed COVID-19, to minimize the risk of spread to other patients, their families, and health care workers. All of these precautionary measures contributed to the decline in capacity and reduction of services.

“Now we’re on the other side of the surge preparation, and we are focused on restoring operations back to normal, in the safest way possible,” said Maldonado, who is also professor of pediatrics, infectious diseases, and epidemiology at the Stanford University School of Medicine.

“We are tremendously proud of our staff and providers, who are ensuring that throughout this crisis, our patients and families continue to receive the highest-quality care,” said Paul King, president and CEO of Stanford Children’s Health. “Now, as we focus on resuming the patient care that had been put on hold, I am especially grateful for our teams’ commitment to ensuring a smooth transition to serving our full patient population once again.”

Safely resuming procedures

Stanford Children’s Health leaders identified three essential criteria necessary to safely resume services in the hospital and clinics. First, the availability of sufficient supplies of personal protective equipment (PPE) remains at the forefront of the defense against spreading the virus, according to Maldonado. “We continue to follow government health agency PPE use recommendations to safeguard our patients, families, health care workers and staff.” 

Second is the capability to broadly test patients and health care providers; Stanford Children’s Health has made COVID-19 PCR (polymerase chain reaction) and antibody (serology) testing available to all providers, staff, and patients, consistent with procedures implemented across all of Stanford Medicine.

Routine PCR testing is currently being performed for all hospitalized patients; patients who are receiving certain procedures or diagnostic tests that need general anesthesia; symptomatic outpatients; and patients who may have significant exposure to COVID-19. Providers may also order antibody testing for any patient seen at Stanford Children’s Health.

Based on their experiences, clinicians plan to study how to optimally use serologic testing to inform future recommendations for prevention and care.

“We are in a fortunate position to have access to the Stanford Medicine-developed test that was among the first FDA-approved COVID-19 tests in the nation,” said King. “It allowed us to scale up testing quickly for our patients and health care workers, thus creating a safer environment to provide care.”

“For health care workers and patients alike, testing will continue to be central in reducing community spread,” said Maldonado. To date, nearly 12,000 employees across Stanford Medicine, including Stanford Children’s Health, have been tested, and of that total, 99.7 percent of tests have been negative. “The data demonstrates that the measures we’ve taken to slow the spread, including appropriate supply and use of PPE, health care worker screenings, and masking, have been effective.”

The third criteria is to uphold physical distancing whenever possible, which is being successfully supported through the increased use of telehealth. “During the pandemic, we’ve made tremendous progress in familiarizing many families with the virtual visit process, many of whom had not tried it before,” said Natalie Pageler, MD, who serves as the chief medical information officer at Stanford Children’s Health and also works in the pediatric intensive care unit. “While we know that telehealth isn’t necessarily appropriate for every appointment, it can reduce the need for families to go to the doctor for in-person visits. “Children and families will continue to benefit from the convenience of this form of health care even after the crisis.” Telehealth has also been used inside the hospital for inpatients; some physicians can provide their consultations without needing to be physically present in the patient’s room through the use of video monitors.

A protected place for care

“We’ve seen through this crisis that there are families who are frightened to come to the hospital, even for emergent care, or to go to their pediatrician for routine care, like immunizations,” said Lund. “From very early on we implemented protocols to ensure that we are a safe place to come for those who need to be here.”

And moving forward will be no exception. COVID-19 health screenings will continue at the entrances of the hospital and its clinics, and masks will continue to be required for everyone. Existing visitor restrictions will also remain in place to protect our patients and staff.

In Stanford Children’s Health’s primary care offices, “healthy” patient visits are being separated from “sick” patient visits. “If your child is sick and they need to see their doctor, we are here,” said Pamela Kum, MD, a Stanford Children’s Health pediatrician with Bayside Medical Group in Livermore, and the Livermore Pleasanton San Ramon Pediatrics Group. “We also want to make sure that patients keep up with their immunization schedules. This provides them with important protection from other dangerous viruses and bacteria. We are taking extra precautions when seeing all patients, to ensure the safety of patients, their families, and our medical staff.”

According to King, safety has been the organization’s guiding principle throughout the crisis. “Our health care workers, patients, and families have all had to make drastic and swift changes to adapt. But everyone has risen to meet the challenge, and together we’re moving forward.”