As the Palo Alto Medical Foundation and all of the affiliates across Sutter Health morphed care procedures to handle COVID-19 cases while keeping patients and staff safe, the respiratory care clinic (RCC) was created. First in parking lots, eventually carving out space at several PAMF clinics, the RCC model has served as a focal point for our COVID-19 diagnostic and care process. Our focus on COVID-19 protocols, procedures and treatments has been finely honed, but of course there is more to healthcare than coronavirus. This is where the RCCs and other coordinated efforts including My Health Online, nurse lines, call centers and video visits become even more critical for everyday care.
Two nurse practitioners from PAMF Santa Cruz made some important medical catches within weeks of each other while taking their shifts in the RCC or staffing virtual care resources. Stephanie Dowden, family nurse practitioner at PAMF Santa Cruz Urgent Care, has been taking regular shifts in the RCC tents. She triages patients with a detailed list of diagnostic screening questions that have become familiar to many of us during the pandemic – fever, shortness of breath, cough etc. But instead of only looking for COVID, Stephanie and all her colleagues know keep an eye out for problems beyond COVID-19.
“I had an older female patient complaining of shortness of breath and leg swelling,” Stephanie recalls. “Her heart rate was low and I ordered an EKG.”
Complete heart block — that is what the EKG showed. A medical emergency that was fixed when the patient received a pace maker. Within a week, Stephanie saw another patient with shortness of breath and chest pain. This young man seemed fine through Stephanie’s examination and once COVID-19 had been ruled out, she ordered a chest X-ray.
“I saw a pneumothorax – air in the chest – in the X-ray, which can be life threatening if it is big enough,” Stephanie says. “I consulted with a pulmonologist who agreed to see the patient right away.” We did determine it would be safe for the patient to go home, but he returned for a follow-up X-ray to insure the pneumothorax was not getting any bigger.
In the same timeframe, family nurse practitioner and advanced practice clinician, Jinah Byram — hired as the first desktop nurse practitioner at PAMF — was going through her caseload as part of a multidisciplinary team answering patient questions that come in through My Health Online (MHO)or that are referred to her from call centers. She spends 75% of her time answering questions virtually when one curious inquiry came in through MHO.
A younger male patient diagnosed with pneumonia at a PAMF Urgent Care facility was given antibiotics. After a few days, the patient was experiencing joint pain and posed a question through MHO to see if this could be a side effect from the medication.
“I knew right away this wasn’t a side effect of antibiotics and called the patient when I learned that the pain was in all his joints and getting worse,” Jinah explains. “My fear was that this patient had valley fever and if he didn’t get the right medicine, that pain could spread to his spine.”
Jinah called ahead to Urgent Care and ordered a valley fever test. The cases can be tricky to catch, especially in this case because the patient had no other underlying conditions. We put this patient in the care of an infectious disease specialist and within a couple of days he was on the mend.
“People were impressed that I could catch valley fever from an online message,” Jinah says. “But the credit goes to the patient who thought to use MHO and ask about his pain, that is what got my attention, and I hope other patients understand that a simple message through MHO can make a big impact.”
With poor air quality and flu season coming up, some of the telltale signs of COVID-19 could mask other conditions. But the collaborative efforts starting in the RCCs and virtual care and extending to any specialist that is needed, is proving to be a critical tool to providing exceptional healthcare during these overlapping medical emergency scenarios.
“I jumped at the chance to work in the RCC – maybe it is my military background which keeps service to others top of mind, but being a part of the RCC has really been my way to help the community, not only with coronavirus, but any other medical conditions,” Stephanie says.
Both Stephanie and Jinah are grateful for the rapid roll-out of video visit capabilities. That has been a mainstay for their work, connecting with patients who couldn’t come in person, but still maintaining a high level of care. They also acknowledge the tremendous community support that has provided not only money for iPads to conduct the video visits, but for PPE and food throughout this pandemic.
“We are extremely grateful,” Stephanie and Jinah concur.