In March, executives at Huntington Hospital in Pasadena, Calif., were faced with a challenge: They needed to conserve personal protective equipment.
Hospitals across the U.S. faced a shortage of masks, gowns and other PPE when the novel coronavirus outbreak began, and 619-bed not-for-profit Huntington Hospital—which in March signed a letter of intent to become part of not-for-profit Cedars-Sinai Health System in Los Angeles—was no different.
“Basically, everyone in the hospital was tasked with trying to preserve PPE,” said Chuck Sudvary, the hospital’s interim chief information officer and executive director of clinical systems.
A first step involved reducing emergency department physicians’ contact with patients who might have COVID-19. Sudvary worked with physicians caring for patients in the ED’s triage area to set up a barrier; basically a partition that physicians would stand behind to evaluate patients from a distance, so they wouldn’t have to switch out their PPE between patient exams.
But, when evaluating a possible COVID-19 patient, it’s key to assess their breathing—which requires a stethoscope. So, staff decided to “MacGyver” a new process, Sudvary said.
Now, a nurse or physician assistant is charged with taking a patient’s vitals, including placing a digital stethoscope on a patient’s chest in a way that lets a physician listen from afar.
Huntington Hospital purchased digital stethoscopes from Thinklabs, as well as Bluetooth transmitters and earbuds. When a nurse or physician assistant holds the stethoscope—with the transmitter plugged in—to a patient’s chest, the physician can hear their breathing via the Bluetooth earbuds.
The Thinklabs stethoscopes can also plug into headphones, though the Bluetooth system made it easier to keep distant from patients.
“The quality is better with the wire,” Sudvary acknowledged, but the Bluetooth system worked well enough for physicians to detect issues like wheezing.
Thinklabs charges $499 for the digital stethoscope.
Huntington Hospital also deployed the digital stethoscopes to the intensive-care unit, so physicians could listen to a patient using earbuds under the hood of their PPE.
As a new process, there were some unexpected challenges to troubleshoot. Sudvary said he was concerned a physician could pick up a set of earbuds paired with a different Bluetooth transmitter than they’re expecting, which would lead them to document breath sounds for the wrong patient.
To ensure that wouldn’t happen, Sudvary color-coded each set of linked stethoscopes, transmitters and earbuds so they wouldn’t get mixed up.
“What’s funny is we used my daughter’s nail polish,” he said.
Some hospitals were piloting Bluetooth stethoscopes prior to COVID-19, but they hadn’t been used regularly, said Dr. Julie Massey, a principal with the Chartis Group.
Before COVID-19, “there wasn’t the same kind of need and driver,” she said. She added that deploying devices to let physicians evaluate patients from a distance—even if the patient’s just a few feet away—is just one component of how hospitals have retooled workflow to conserve PPE and reduce contact with COVID-19 patients.
Hospitals have started conducting some aspects of daily patient rounds virtually, she said. Instead of a large care team visiting a patient, a smaller team will go into the patient room, with specialists tuning in remotely with telemedicine equipment.
The pandemic has shown that “you can still have great virtual collaboration while reducing exposure to others,” Massey said.
To examine hospitalized COVID-19 patients, Southern Illinois Healthcare is using digital stethoscopes from Eko, which cost $250 each. Nurses complete an exam at the bedside, while a physician watches via video on a tablet.
Audio from the stethoscope is shared with a computer workstation elsewhere in the building that the physician listens to using noise-canceling headphones. When rolling out the new process, it was particularly important to discuss reasons for the workflow change with nurses, since they would be the ones conducting the exam while physicians stayed outside of the patient room, said Dr. Craig Davis, system director of hospitalist medicine at Southern Illinois Healthcare.
Southern Illinois Healthcare’s leadership didn’t want nurses to feel as if only physicians were being protected.
By stressing the “very important, and real, concern of reducing PPE use” for all staff, the leadership team was able to address that concern, Davis said.