Jason Chang: The president of Queen’s Medical Center deals with a crisis as COVID-19 patients stretch capacity to a breaking point

What is the status of the relief workers for Queen’s? What other solutions to the hospital caseload are being tried?

The first group of nurses arrived the week of Aug. 23. There were 64 in total working on the COVID units at all of our hospitals. The timing couldn’t have been better, as many of our nurses have been working extra shifts and going long stretches without a day off. Not only will the relief nurses give our staff a break, but they allow us to open additional beds.

The first group of relief workers was followed by another 60 nurses and respiratory therapists. Since this surge has become critical, we’ve been treating patients in nontraditional spaces like the OR (operating room) Recovery Unit and other procedure areas. Anywhere we can safely care for the influx of patients is being used.

Can you give some examples of the types of elective procedures that have had to be canceled due to COVID?

All surgeries that are nonemergent and require a hospital stay post-surgery have been postponed. This includes many of the orthopedic, cardiac, neurosurgery, urological and general cases.

Our surgeons have been amazing, and we work closely with them to determine when a case becomes urgent or emergent. Our highest priority is patient care and safety, so we’re working with our surgeons every day to assess the condition of each patient who needs surgery.

As conditions worsen, we want to make sure our patients have access to the OR and get the care they need. I sympathize with everyone who needs surgery to alleviate pain or repair an injury, but has to wait because we simply cannot provide a bed for recovery.

Do you think the surge in hospitalizations has changed minds about the vaccinations?

Unfortunately, I don’t think so. Our hospitals remain very full despite pleas from our nurses, physicians and civic leaders to be safe, practice social distancing and get vaccinated.

The Queen’s Medical Center- Punchbowl, The Queen’s Medical Center-West Oahu, and even Queen’s North Hawaii Community Hospital are starting each day with nearly zero available beds. This isn’t just a COVID problem because these beds are needed to treat people who get into car accidents, suffer heart attacks, need hemodialysis, or for the surgeries that have been postponed.

Vaccination is the backstop that will prevent unnecessary hospitalizations. Being vaccinated doesn’t mean you cannot catch COVID, but it allows your body to fight the virus more effectively. Moreover, the more people who are vaccinated, the smaller the chance for the virus to circulate in our community.

Can you project how COVID treatment costs may affect the cost of health care overall for your patients?

We know that treatment costs for COVID, both outpatient and inpatient care, are high. Patients typically spend anywhere between nine to 60 days in the hospital receiving intense treatment. The luckier ones need assistance with breathing and medication, but it’s difficult to tell who will be OK and who will end up in the ICU (intensive care unit) on a ventilator.

The overall cost to Medicare, Medicaid and the greater health care industry is significant. Other added costs range from PPE (personal protective equipment) and new medications, to additional staff and equipment needed to care for the advanced respiratory issues that COVID causes.

Another big concern is the recovery after COVID. Many patients have lingering effects that can be described as a mental fog. There are also unknown effects to our organs that may have a lifelong impact. The one thing I know for sure is that the cost to treat COVID is definitely higher than the cost of a vaccination.

Have there been any lessons learned that may lead to operational changes, post-pandemic?

We’ve learned so much over the past 18 months. We immediately learned that our caregivers needed space better designed for infectious disease.

With COVID, visitation is difficult and the use of video has become so critical. We use video for monitoring as well as communication with family. We saw a 1,500% increase in telemedicine from pre-COVID. For years, many of our providers were slow to adopt telemedicine, but COVID forced us to change our business model and I think it’s here to stay.

We also learned about the need for space. Segregation typically comes with a negative connotation, but in this case it’s safer to have space designed to separate infectious patients from others.

COVID patients accounted for approximately 15% of our total patient encounters in 2020, which means 85% needed care for some other reason, typically an emergent reason.

Living with COVID among us will have to be part of our daily lives for a while. We can help protect ourselves by getting vaccinated and being cautious about the environments we’re in.

THE BIO FILE

>> Title: President of The Queen’s Medical Center; executive vice president and chief operating officer of The Queen’s Health Systems.

>> Professional experience: Chief executive officer of the McAllen Heart Hospital and South Texas Health System; interim CEO, McAllen Medical Center.

>> Community: Chairman, Oahu Workforce Development Board; Blood Bank of Hawaii Board; St. Francis Healthcare System of Hawaii Board; American Hospital Association Regional Policy Board 9; Vizient West Coast Board.

>> Personal: From Fresno, Calif., and lived in McAllen, Texas, prior to moving to Hawaii six years ago.