How do hospitals care for patients with the virus? How do they keep other patients and frontline staff safe? When is a procedure essential and when can it be delayed?
Those are the questions leaders at the UK Markey Cancer Center faced in March of 2020.
As other hospitals around the country made the difficult decision to delay some cancer treatments and procedures because of the pandemic, Markey weighed its options. To ensure Kentucky hospitals had enough space for COVID-19 patients, as well as those experiencing other emergencies, Gov. Andy Beshear recommended health care facilities pause any non-urgent and elective procedures.
The governor’s directive relied on hospitals to decide which treatments were elective. After careful consideration, University of Kentucky and UK HealthCare leadership came to a decision: Cancer treatments are essential, not elective.
This decision set in motion a host of responses to ensure patients still received vital cancer care in an environment that was safe for them, as well as for faculty and staff. The Markey team worked in tandem with UK HealthCare’s infection prevention and control team, following constantly evolving guidelines and information and making adjustments both big and small to help Markey adapt to this new climate.
“We had to rise to the occasion to make sure treatment would continue to be our primary focus,” said Dr. Mark Evers, UK Markey Cancer Center director. “At the same time, we needed to ensure the atmosphere was suitable for care.”
This meant procuring enough PPE (personal protective equipment) for staff and patients. It also meant visitors were prohibited, physical spaces had to be reconfigured to provide added safety, and physical distancing was implemented wherever practical. “We had to ensure that everyone was safe and that patients received the care they needed,” said Dr. Frederick R. Ueland, Markey’s director of oncology clinical operations. “The Markey response speaks to the passion and the commitment our team has to one another and our patients.”
Patients were screened for COVID-19 symptoms over the phone before their in-person appointments. These calls provided an opportunity for Markey staff to reassure patients of their safety and describe the latest precautions put in place to ensure a safe care environment. “These prescreening questions have since become a standard practice around the country, but we lived it in real time,” Ueland said.
Once patients arrived at Markey, they were welcomed by familiar, albeit masked, faces, who performed additional on-site symptom screenings. This helped patients feel more at ease in the new hospital environment.
Visitor restrictions were put in place across care settings, including the chemotherapy and infusion clinic. To help patients feel less alone and more connected with others during their chemotherapy treatment, Markey staff provided video conferencing access and other communication options.
And while the Markey care team nurtured relationships with existing patients, new patients also arrived. Patients from around the region in need of cancer surgery came to Markey when other hospitals delayed their procedures. Markey typically accounts for about 15 percent of all surgeries at UK HealthCare. In April 2020, Markey was responsible for 25 percent of surgical procedures. “We persisted with providing surgeries for patients when other areas could not,” Evers said.
Clinical research is an integral part of Markey’s mission, and that mission did not stop in the face of COVID-19.
Across the country, as COVID-19 cases surged, many academic medical centers had to pause cancer clinical trials. UK leadership made the decision to continue as much of Markey’s research as possible. “Research is woven into our clinical care model,” said Dr. Susanne M. Arnold, associate director of clinical translation at Markey. “University leadership allowed us to continue lifeprolonging research studies and our team found a way to get it done. I am so proud of them.”
Faculty and staff working on clinical trials adjusted to day-to-day upheaval wrought by COVID-19. Some researchers worked offsite and others rotated between working onsite and working at home, all the while keeping trials going. “It’s a testament to the team,” Evers said. “Our providers were committed to those patients.”
Not only did Markey continue offering trials specifically focused on treatment interventions, the number of patients who completed or were in the process of completing treatment trials actually increased. That number was 123 from March– August in 2019 and grew to 150 in the same period in 2020. “It really shows the commitment of our faculty and practicing oncologists who were talking to people about trials, and of the staff who were working so hard despite not being in their typical work environments,” Arnold said.
Markey’s well-established clinical trials infrastructure also helped the university quickly establish a COVID-19 clinical trial.
The trial is testing a number of treatments in patients with COVID-19 who are at a higher risk of severe illness. Markey researchers used their expertise to shepherd the trial through regulatory hurdles and swiftly get it up and running.
In addition to patient care and research pursuits, Markey continued to support its 20 Affiliate Network hospitals, which provide care options in local communities across Kentucky and connect patients to specialized treatment at Markey when needed.
Traditional in-person services to affiliates had to be put on hold, and Markey moved its affiliate retreats and annual affiliate network conference to virtual formats.
Despite not being able to connect in person, affiliate members connected virtually via a series of webinars on a wide range of topics. The webinars provided vital, reliable information on subjects including health disparities among racial and ethnic groups, methods and regulation for telehealth, and pharmacy-related strategies to help cancer patients cope and reduce their risk for COVID-19. These webinars were also opened to providers outside the Affiliate Network.
By mid-year, most elective procedures had resumed at UK HealthCare. And the Markey team continued to adjust throughout the year to carry out its mission to provide the best care for the people of Kentucky.
“All of us at Markey are lucky to work with such a tremendous group of professionals,” Evers said. “Everyone is very flexible and adapted to a situation that no one could have predicted. We’ve had some successes come out of this experience, and I’m so proud of that.”