Milwaukee VA Medical Center

Registered nurse Shannon Ribbich puts on a CAPR helmet as she prepares to work in the COVID ward at the Milwaukee VA Medical Center.

While a surge of COVID-19 cases is flooding hospitals now, the Milwaukee VA Medical Center is staying atop the wave, thanks to preparation and lessons learned in the spring.

“We’re handling it the best we can,” said Dr. Ankur Patel, one of the commanders for the hospital’s Incident Command response team.

“We certainly took a lot of steps to be proactive after the initial surge (in the spring). A lot of those systems we built then have been integrated into our response to this latest surge.”

Still, the hospital has been hit hard by the surge; as of Monday, Nov. 16, there were 38 inpatients and 105 employees infected with the virus, with those numbers climbing over the past several weeks.

And while those numbers are higher than what the hospital saw in the spring, the facility is better equipped now to manage it.

 “We learned a lot in the spring on how to treat patients,” Patel said. “There is no magic pill, but medical management has been better, and the many preparations we made in the spring have really paid off.”

Medical advances

Dr. Michael Erdmann, Chief of Staff for the hospital, agreed, noting that doctors have made great strides in the past eight months in treating patients.

“We have more effective treatment and timely diagnoses, which are preventing some Veterans from having to be hospitalized,” he said.

While COVID-19 is still a serious and deadly virus, Erdmann said new medications and different forms of treatment have helped curtail both the death rate and the hospitalization rates.

“In general, we have fewer people going to the ICU, their stays are shorter, and we can initiate treatment more quickly.” Chief of Staff Dr. Michael Erdmann

In the spring, many COVID patients had to be intubated and ended up on ventilators. There’s much less of that now, and doctors have instituted new, less traumatic procedures to address the respiratory problems brought on by the virus.

“In general, we have fewer people going to the ICU, their stays are shorter, and we can initiate treatment more quickly,” Erdmann said.

“We’re better, but we wish could do even more,” he said. “It’s not like the anti-virals we have for influenza. We do not have a truly effective anti-viral treatment agent for COVID. If we had that, it would be another thing.”

Dr. Annette Severson, Associate Director for Patient Care Services, agreed.

“We’re in a better place than we were. If we had seen this volume of patients in March or April, it would have been really difficult.”

Keeping Veterans safe

As the latest COVID surge sweeps through the population, the elderly and those with underlying conditions are most at risk.

And while Veterans are disproportionately represented in those groups, Patel said many are taking the necessary precautions.

“Our patient population is among the most vulnerable, but they also tend to be out less at social gatherings,” he said. “And we’re taking extra measures to keep veterans in a very safe environment.”

Those include:

• Continuing to focus on emergent and urgent medical procedures and limiting elective care.
• Curtailing gathering areas and creating safe spaces and practices for employees and Veterans.
• Moving as many appointments as possible to virtual visits via VA Video Connect, all while maintaining quality of care.
• Creating the ZIHP clinic, which allows Veterans to get routine lab work done without entering the hospital.

Infrastructure, equipment

In the spring, the world learned a new acronym – PPE – because so many hospitals and health-care providers were in desperate need of personal protective equipment.

That’s not as critical of a problem now, as hospital officials said the Milwaukee VA is well-equipped with the necessary PPE, while still taking steps to conserve it.

There have been a number of physical modifications to patient rooms, wards and hospital wings to better protect staff and patients.

Screening procedures at the East and South Entrances also have been streamlined and improved.

“I think we really did a good job in the summer months in preparing for the infrastructure issues,” Patel said. “Had we not done that, we probably would be seeing some consequences of inaction now.”

Bed management, nursing

Patel praised the bed management and nursing plans that were formulated to address the expected surge.

While a COVID ward was created on the sixth flood in the spring, also created was a plan for when COVID would overflow that space – which has happened now.

The plan involves gradually moving overflow COVID patients into other spaces in the hospital while moving those displaced patients to other areas. The plan has allowed the hospital to maximize its beds and minimize disruption.

Meanwhile, the hospital’s 1,000-plus nurses were surveyed to assess their individual skills. In turn, a database was created so nurses could be directed to the areas where their skills are most needed.

“As we have a need, we can pull nurses from other places to work where they are needed,” said Kristy Fritz, nurse manager. “Everybody is stepping up to get the job done.”

Nearly 40 nurses have been deployed through the plan, according Severson.

“That makes the learning curve not as step,” she said. “We know how to augment our care for Veterans who are ill.

“But the biggest thing for nurses is that we better understand the trajectory of the illness. … Nurses are much more comfortable in their ability to predict and do appropriate assessments.

“We’ve seen the science evolve, and now a vaccine is on the horizon.”

Keep wearing your mask

And while hospital officials said they are cautiously optimistic about recent news of vaccines’ effectiveness, they know it will be many months before a vaccine is available.

“The vaccine will come, and we already have a team working on how to distribute that,” Patel said.

Until then, the messaging is the same, Patel said – wear a mask and eye protection, social distance, don’t gather in large groups, wash your hands often and get a flu shot.

“It’s unfortunate that we still have people doing things in the community that are really ignorant,” he said, saying that Wisconsin’s recent COVID numbers are “completely unhinged.”

“People are sick. People are dying, and people are still saying it’s not real. It is real.

“Internally, we’re focusing on masking and getting flu shots. That’s important every year, but especially this year. We hope that with masking and flu shots, we can get through the winter safely as VA employees and for our Veteran population.”