Lifespan began bracing for outbreak months ago

PROVIDENCE — Weeks before Rhode Island’s first case of coronavirus was confirmed, the staff at Hasbro Children’s Hospital and throughout the Lifespan system began planning for a potential spread, nurse Lindsay McKeever, Hasbro’s director of pediatric emergency services, told The Journal on Monday.

Those plans, being updated daily, include measures to ensure the safety of frontline workers at emergency departments and hospitals when possibly infected people arrive — while providing patients necessary care.

“The tip of the iceberg started late December, early January,” McKeever said. That’s when China began reporting mounting cases of the new coronavirus disease, COVID-19, but before it had gained a foothold in the U.S.

“We began dusting off some of our disaster plans,” McKeever said.

Sound medical and public-health policy, McKeever said, “is knowing that in emergency medicine, something like this could happen at any time.” This time, she said, was informed by the West African Ebola epidemic, which killed tens of thousands worldwide but resulted in one death and three non-fatal cases in the U.S.

“We really got good at this [planning] during the Ebola situation,” McKeever said. “So in 2014, we really built up a lot of our policies and procedures. This is different in the sense that this is not bodily fluids. We don't have to worry about some of the things we had to worry about with Ebola, but it was a great starting point in a refresher to staff to know to go over some of these policies and procedures.”

The ongoing effort, according to the pediatric emergency nurse, involves multiple departments and disciplines, including nurses, doctors, and non-medical staff such as housekeeping. Leaders of all meet in-person three times daily during the week, McKeever said, and by phone and other means on weekends.

Effective Monday, Lifespan established new and stricter visitation policies at its facilities.

As for staff morale, McKeever said, “I am very impressed by our nurses [and others] and their willingness to learn what the best thing to do is and how to care for these patients. They’ve really stepped up to the plate, so I'm very proud of them for that — but we all are nervous because there is not a ton of research to tell us about the coronavirus.”

Among the measures Hasbro Children’s Hospital Emergency Department has taken:

Dedication of four rooms forming a separate “pod” for treatment of potentially infected patients.

A Plexiglas barrier has been installed around the triage center, where people arriving check in. Previously, this center was open.

A “triage algorithm” to screen for risk has been updated.

“The first question all of our nurses or anyone who's greeting anyone is to ask: ‘Have you traveled recently outside of the country?’” McKeever said.

An affirmative answer would prompt more questions, including which country or countries were visited. Potentially infected patients (and parents) would then be handed a mask through an opening in the Plexiglas barrier, and would be escorted by a staff member wearing protective equipment to a dedicated area away from others waiting to be seen.

During that process, “we call our charge nurse and say ‘we have a patient under investigation who may possibly may have been exposed to the coronavirus,’” McKeever said. “And at that time, the greeter would get the okay to go to one of the negative pressure rooms.”

Protective equipment for staff includes N95 professional-grade masks, face shields that cover the masks, gloves that cover more of the arm than ordinary medical gloves, and full-length gowns.

McKeever said similar measures have been taken at other Lifespan hospitals.

“We are all planning for the next steps of this,” she said. gwmiller@ providencejournal.com

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