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Sutter Santa Rosa hospital prepares for surge of coronavirus patients

The doctors, nurses and medical assistants at Sutter Santa Rosa Regional Hospital have trained endless hours for a much-feared coronavirus surge that could flood the county's six hospitals with hundreds of COVID-19 patients.

They hope that day will never come, but if it does they're ready.

“This is only making me a better team member, a better nurse,” said Sutter Health nurse Joey Benton, standing outside an outpatient hospital room recently converted into an intensive-care room for coronavirus patients.

Benton said she gets “goosebumps” when she thinks about all the training and preparation she and her fellow nurses have received to handle a surge.

“We're health care workers. This is what we do,” she said. “As nurses we're ready to jump in and help.”

Benton a surgery nurse for more than 20 years, is among 700 to 800 direct caregivers on the hospital's 1,000-member staff who have spent thousands of hours training and planning for the COVID-19 pandemic.

Hospital administrators have been preparing for a surge in coronavirus patients since at least February. County public health officials have tried to buy them time, restricting most public activity since March 18 to slow the spread of virus as Sutter and other local hospitals scrambled to expand their capacity to treat patients.

They have been guided by computer modeling that attempts to answer two critical questions: When will the surge arrive and how big will it be?

The first projections, released April 2 by the county public health department, estimated about 1,500 county residents could require hospitalization when coronavirus infections peak between May 28 and June 2. The figure is more than twice the number of hospital beds typically available in the county.

Since then, Dr. Sundari Mase, the county's health officer, has said the actual number of people requiring hospital care will likely be less than that, given the success of a 4-week-old shelter-in-place order and other social distancing measures.

On Friday, Mase said more recent state modeling showed the number of hospitalizations during the peak of the outbreak could be much lower, between 600 and 1,000 virus patients in Sonoma County.

Mase said the second phase of modeling by Imperial College London would likely find a lower number of hospitalizations than first projected.

Only 21 people have been hospitalized in Sonoma County for coronavirus since the first case was detected in the county on March 2, and the first person infected via community transmission was announced by county health officials March 14.

Over the last seven weeks, testing has identified 181 cases in the county. Of those, 87 people have recovered and 92 were active Sunday. Two people have died.

“I think we're in pretty good shape,” said Mase during a press call Friday.

According to county emergency management staff, the county's six hospitals have the capacity to ramp up from an existing 689 inpatient beds to a little more than 1,000 beds by adding 345 beds, of which 90 would be ICU beds. The county's hospitals currently have 70 dedicated intensive care unit beds.

On Friday, Sutter Health officials allowed The Press Democrat to see some of the coronavirus surge preparations at its 84-bed hospital in northeast Santa Rosa.

The $284 million medical center - the county's newest hospital - opened its doors in 2014 and admits about 7,000 patients a year.

The entire 24-bed outpatient care unit on the first floor of the hospital can be converted for treating COVID-19 patients needing intensive care.

Normally, the unit would be used for pre- and post-surgery care when patients are undergoing elective medical procedures.

Conversion of the entire unit would triple the number of ICU beds in the hospital, from an existing 12 to 36, hospital CEO Dan Peterson said Friday.

Much of the outpatient unit, comprised of private rooms with sliding glass doors, is now empty following the cancellation of most non-urgent procedures and elective surgeries. Those activities were suspended both as a precaution and to allow the hospital to prepare for a potential surge.

A calm permeates the outpatient unit, as it has throughout the hospital. Patient visits during the coronavirus public health emergency have been severely restricted at the Sutter hospital, as they have at other local hospitals.

Several of the rooms have been outfitted with the necessary equipment to function as ICU rooms, said Dr. Bill Carroll, chief medical executive at Sutter Santa Rosa Regional hospital.

The modifications include adding equipment that can monitor patients' electrical rhythms, blood pressure and heart rate; iPad stations that allow staff to consult with Sutter Health intensive-care physicians in San Francisco and Sacramento; and bilevel positive airway pressure machines, or BiPAP machines, that can be converted into ventilators.

If needed in a surge, the hospital could deploy between 20 to 24 ventilators for patients.

Carroll said the hospital's engineers also have managed to reverse the air flows in the rooms so that air is “gently removed” from the room and sent through air filters, rather than freely flowing onto the unit floor where it could potentially affect staff or other patients.

The setup, known as a “neutral negative room,” is an alternative to negative pressure rooms, which are designed to prevent cross-contamination by venting air outside a building.

“It means that there isn't positive pressure pushing the air from the inside of the room out into the department, but it's not sucking air in either,” said Misi Nagle, a nurse who manages patient care in the hospital's ICU department.

Outside each converted ICU room is a small “clean table,” a three-tiered rolling utility cart with personal protective equipment - including disposable gowns, face masks, a face shield and gloves - that are donned before medical staff enter the room.

“The sickest patients are going to need to be in an intensive care unit,” said Carroll. “We're going to convert this to an intensive care unit if we need to do that.”

There were no COVID-19 patients at the Sutter hospital on Friday, but hospital staff have previously treated cases of coronavirus, as well as patients suspected of having the virus.

One key feature of Sutter's surge planning involves training of nurses and staff to care for coronavirus patients in both the ICU and medical-surgical setting, said Wendy Colgan, the hospital's chief nursing executive. Recently, 24 nurses who work in the outpatient surgery center in the medical office building next to the hospital were sent to “Sutter Health University,” Sutter's professional training center in Sacramento.

Melissa Brewer, an operating room nurse who's been with Sutter for a little more than three years, received training in med-surge procedures, which involves different skills than those she uses as a surgery nurse.

“In surgery, I'm taking care of one patient,” she said. “Med-surge skills are different, you're running IV pumps, providing medications, there's trach-care (for patients requiring a tracheotomy to open an airway to their windpipe), colostomy care, there's a lot of positioning. ... There are so many different areas in nursing.”

Brewer said the training allows her to be more “well-rounded” as a nurse, something that's really sought after.

“In one nurse's life you can't possibly do every specialty.”

The training also gives her comfort, she said, as the community waits for a potential surge, enduring what many describe as the calm before a storm.

“I'm trying to be optimistic, hoping that there is no storm,” she said.

“With these classes, we feel more confident in giving quality care if there is a surge.”

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