COVID-19, Real-Time Research on Mask Effectiveness & Innovative PPE practices

An interview with Rachel Westervelt of Coxhealth

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Coxhealth is the only locally owned, not-for-profit health system based in Springfield, Missouri.

Rachel Westervelt, the Administrative Director of Nursing there, is proud of the difficult decisions they’ve made during the COVID-19 crisis, and those tough calls that have made a positive impact on their community.

Rachel talked about how their staff needed hours and to minimize exposure risk — and how Coxhealth came up with a solution to kill two birds with one stone.

She spoke in an interview with Health Carousel, which provides world-class healthcare staffing and workforce solutions designed to improve lives and make healthcare work better.


What I love about Coxhealth is multifaceted. But I can tell you that what I love is that we are not a we're not owned by people in other states, We are locally owned and managed — and our local board actually helps make decisions for our hospitals. So we are a complete community focus, everything that we do is for our community and not for anybody else. So, I feel like I'm very proud to work for coxhealth. Because we have made decisions this year, and last year and 2020 that weren't necessarily best for our business, but they were the best decisions for our community.

We've actually opened about 150 additional beds to take on COVID patients. That was an enormous expense. We opened a 51, that ICU in two weeks, from getting ventilators, monitors beds, completely constructing a unit and staffing it in two weeks. And all hands came on deck, literally all hands. So that was a decision that none of us really particularly wanted to do. But we made it happen. And it was ready when we needed it to. And then we've actually expanded that unit by 36 beds and built another 36 bed unit after that. So, we've just expanded and expanded and tried to be very innovative in our approach to meeting our community's needs. Creating all sorts of processes and units to really take care of COVID patients in the best way.


With CDC regulations changing every day and lay-offs across the industry, healthcare workers have been forced to remain vigilant about everything — especially PPE practices, to help minimize the risk of exposure to their staff.

But, the bright minds at Coxhealth may have found a brilliant solution that kills two birds with one stone.


Whenever surgeries closed, we had a lot of staff that were out of work. And they needed hours. And what Coxhealth did was they created jobs for those staff members, nobody went without pay, they didn't want to, they might have mowed the lawn over the summer, or helped with construction. But they came to work and we found a job for them to do.

So, one other really great job that we created is called a PPE observer. And what that does is they help the COVID staff, Don and doff their PPE, so that they aren't contaminating themselves, keeping the employees safe, and keeping the unit safe. And that has honestly saved us countless exposures, having that staff there. So every time you come in and out of the unit, they're like, wait, you just have that surface, hold on, or you forgot a layer, you forgot a step. I mean, these are complicated PPE steps anyway. So, these PPE coaches have helped us stay safe, and kept our employees healthy and working. And so, I’m really proud of that.


Coxhealth is a pillar of their own community, but recently made national news when the CDC published a report highlighting the success and efficacy of masks compiled by an infectious disease doctor at Coxhealth, Robin Trotman and the Springfield-Greene County Health Department.


I mean, we've essentially learned how to do real-time research in our clinical areas. A good example is some gamma infusions that we're doing right now, you know, looking at real time patients gathering clinical data, as we're using the infusions, watching for reactions, and then putting what we learn immediately back into practice. That's something that wouldn't have beenacceptable pre-COVID. We would have wanted to wait for a, you know, double blind study that's been peer reviewed and things like that.

But because we had to figure it out this year, we use our own studies. We actually have a big exposure in our community with one of our hairstyling salons that made national news. But it was a rea- time research study on the effectiveness of masking.

There was a huge exposure with a hairstylist that was positive for COVID, cut like 200 people's hair while they were infectious. And none of them contracted COVID. Because both parties were wearing a mask.

So, it's kind of like listening to the clinical research that's in front of us and learning from it real time and making decisions based on that. Those were gifts that we wouldn't have been able to access fast.

And, you know, in 2020, we also learned that every rule can be broken and can be rewritten anything that we didn't think was really possible, suddenly became possible.

I was actually talking to my kids about it. You know, they say that this generation of kids, that's really witnessed a lot of change, a lot of kind of devastating things in their short lives.. They have also seen that with the power of community and the right priorities, anything can happen.


Resilience seems to be a prerequisite amongst healthcare professionals across the country, especially over the past year — and the staff at Coxhealth is no exception.


One of our very first young patients, we posted about it on our Facebook page, I feel comfortable kind of sharing some of the details. So we had a pregnant mom, and she was COVID positive. Her husband was COVID positive. And she ended up intubated, very, very sick. We didn't think that she was going to make it. And ultimately, we ended up doing a C-section while she was intubated, because we had to deliver that baby to save both mom and baby.

And she ended up completely recovering. Baby was healthy. And that ended up you know, being able to come in eventually, when he was there with his COVID, you know, illness, and they went home as a happy family. But, we weren't sure how that sort of was going to end.

It took every single unit, you know, it took postpartum working with labor and delivery, with adult ICU and all these different teams that don't always work together, and then add in infectious disease on top of that, it just became very kind of, “okay, we've never done this before...none of us know how to do this.” But, let's get together and try to figure out how we can save this woman and her baby's life.


Healthcare workers in every aspect of the industry are experiencing burn out amidst a global pandemic. Staffing shortages, increased hours, personal risk of infection, heartbreaking events and frustration with the public’s adoption of recommended protocol — have left the staff of Coxhealth longing for reprieve.


What I hope is around the corner is just to be able to take a deep breath, I hope what's around the corner, our nurses that aren't burnt out, because there's been some relief here. We've had staff that have worked 5, 12-hour shifts for months. They're used to working 3, 12-hour shifts, but they have just really stepped up and done all that they can but they're tired. They're really exhausted and what really makes healthcare workers exhausted as when they go out into the community and people act like everything's normal.


With eyes on the future, innovative leaders like Rachel are always thinking about what’s to come. What’s in store for Coxhealth, and the healthcare industry at large, next year?


I think we will have financial challenges in 2021, we won't have the federal reimbursements that we had yet, we will still be paying for a lot of things, like we did in 2020. But not getting any sort of help with that from a federal level. We have a lot of people who didn't have surgery in 2020 that need it. And we've already seen those numbers increase, and the surgery demands come up, which should be a good thing for business overall. But it won't be a good thing for capacity.

We are seeing a lot of mental health crisis in 2021. A lot of people have been without their medication without their psychology appointments and normal kind of mental health things or just coping mechanisms in general. We have really, really high acuity from a psychiatric standpoint right now. And I think that'll continue. Because people have not been able to access the resources that they need to.

This episode of The Workforce Solution has been an interview with Rachel Westervelt from Coxhealth.

The Workforce Solution is a storytelling series brought to you by Health Carousel,  a world-class healthcare staffing and workforce solutions company designed to improve lives and make healthcare work better.