From launching telemental health to a convalescent plasma program, these pros rose to meet the moment.
By: Ruben Castaneda
At hospitals nationwide, doctors, nurses and other health care professionals are staffing the front lines of the COVID-19 pandemic. Here, U.S. News brings you three voices from Children’s Hospital Colorado: a doctor who helped devise a way to quickly gather the blood of COVID-19 survivors to help adult patients; the provider who orchestrated a rapid transition to telemental health; and the nursing executive who earned the nickname “PPE Patty” for her efforts to prevent shortages of vital equipment.
Dr. Kyle Annen | 40 | Medical director of transfusion services and blood patient management
In March, as adult hospitals in Colorado were getting slammed with patients suffering from COVID-19, Dr. Kyle Annen, medical director of transfusion services and patient blood management at Children’s Hospital Colorado in Aurora, Colorado, got an unusual phone call from a physician at a nearby medical facility.
An adult patient at UCHealth University of Colorado Hospital was critically ill with COVID-19, the deadly disease caused by the novel coronavirus, the physician told Annen. The patient’s family desperately wanted their loved one to get a transfusion of convalescent plasma – a blood product from patients who have recovered from COVID-19. Plasma from such patients contains antibodies for COVID-19, which may help people infected with the disease fight off the virus.
Other nearby blood centers weren’t prepared to collect convalescent plasma, but Children’s Hospital Colorado could, in a hurry. “We don’t have a lot of bureaucracy; our small team can move quickly,” Annen says. Thankfully, the children’s hospital had not received many pediatric patients suffering from the disease – but it did have donation offers from adult survivors of COVID-19.
Annen and her team mobilized. Annen called the Food and Drug Administration to determine what she and her team would need to do to make the plasma donations FDA-compliant for a COVID-19 patient. A prospective donor, who had tested positive for COVID-19 and had experienced no symptoms for 14 days, agreed to donate. The donation staff volunteered to work late.
The collective effort paid off: Less than 48 hours after the phone call, the critically ill patient received the convalescent plasma.
The patient eventually recovered.
The workflow Annen and her team quickly created has helped the hospital maximize its collection of convalescent plasma.
“We’re not collecting (convalescent plasma) for our own patients,” Annen says. “We’re collecting this and sending this out (to other hospitals in) the community. It’s our way of supporting the community during this challenging time.”
News of the work Annen’s team was doing spread quickly in Colorado. They were deluged with calls from people who’d recovered from COVID-19 and wanted to donate blood plasma. The donation process takes about an hour.
“The phone lines were ringing so often, every time I talked to someone on my team there was constant ringing. It sounded like we were in the middle of a call center,” Annen says. To handle the volume of offers, Annen’s team set up a dedicated email address for people who want to donate.
“I think people who had COVID want to help,” Annen says. “They feel it’s a way they can make a direct impact to help someone who had it worse than they did.”
In the span of a few weeks, Annen’s unit has collected nearly 200 blood plasma donations from COVID-19 survivors.
Those donations have gone to 154 patients in 17 hospitals in the greater Denver area. Annen’s team has also sent convalescent plasma to hospitals in Utah and in the Chicago area.
The eagerness of people who have beat COVID-19 and want to help others has been inspiring, she says.
“Convalescent plasma donors are almost desperate to donate,” Annen says. “I’ve had people who have already donated blood plasma call me, asking when they can donate again. People really want to help.”
People can typically donate blood plasma every 28 days. Children’s Hospital has an exception and can take donations from a donor after seven days. The FDA has said that due to the need for convalescent plasma and the limited ability of donors, the medical director of a donor center can shorten the amount of time between donations at the center’s discretion.
Jessica Hawks | 36 | Clinical Director of Outpatient Services, Pediatric Mental Health Institute
When the COVID-19 pandemic hit the U.S. in a big way in March, the Pediatric Mental Health Institute at Children’s Hospital Colorado wasn’t offering telehealth appointments.
That had to change quickly, says Jessica Hawks, clinical director of outpatient services for the institute. She’s also a licensed child and adolescent psychologist. While the hospital has been offering telehealth services since 2012, the institute hadn’t yet made the leap.
To blunt the spread of the novel coronavirus and protect the health of patients and staffers, the hospital facility closed all its outpatient clinics, including Hawk’s Pediatric Mental Health Institute.
But she couldn’t leave her patients and families without access to behavioral health care. She and her team treat a raft of conditions, including anxiety, depression and attention deficit hyperactivity disorder. The institute also provides inpatient and emergency services.
One of the initiatives Hawks leads, the Partial Hospitalization Program, provides treatment to pediatric patients with eating disorders, and includes an autism unit for kids in crisis. Suicide is the No. 1 cause of death for Colorado kids ages 10 to 14.
“It was very clear that (telehealth services) was something we’d need to offer to our patients and their families during this stressful time,” Hawks says.
Hawks and her team collaborated with the hospital’s information technology unit to launch telehealth services for patients. Hawks’ staff also helped families set up whatever technology they needed and walked them through the process. In the span of about two weeks, the hospital’s 40 or so mental heath providers had shifted from in-person appointments to telehealth.
The transition called for some creative problem-solving. For example, the software the hospital was using didn’t have the capacity to include multiple participants in a digital video meeting – needed for remote group therapy sessions.
Hawks also had to make sure that whatever program they used adhered to the Health Insurance Portability and Accountability Act (HIPAA). The law protects the privacy of patients. Hospital staff identified software that allows multiple people to participate in group therapy sessions remotely while safeguarding their personal details. The remote group therapy sessions are similar to any other Zoom-like meeting with multiple participants. The names on the screen are put in by each family, meaning family members are in control of what names others see. Contact information is not accessible to the other families, and the remote meetings are password protected to prevent “Zoom bombing.”
As a result of the pandemic, telehealth has exploded throughout the Children’s Colorado system. The number of daily telehealth appointments has increased from roughly 100 to 1,000 a day.
Meanwhile, the institute went from doing virtually no telehealth appointments to about 100 a day.
The response by Hawk’s patients and their parents to the shift to telehealth has been overwhelmingly positive, she says.
Telemental health video appointments have also provided an unexpected benefit to providers like Hawks. Conducting virtual sessions offers counselors, psychologists and psychiatrists the opportunity to see patients in their home environment, affording insights they would not get with a typical office session.
For example, Hawks had a video appointment with a patient who sometimes has difficulty regulating her emotions and behaviors at home, but is typically fine at the clinic. During the session, Hawks observed the patient become aggressive toward her mother.
“Most of my conversations with parents are abstract,” Hawks says. “They can’t always apply the strategies I tell them about when the need arises. In this instance, I was able to talk to the mom about strategies she could use, in the moment, to help her daughter re-regulate her behavior.”
With telehealth, “We can better understand the dynamics of the family to tailor the treatment we provide,” Hawks says.
Pat Givens | Chief Nursing Executive, Children’s Hospital Colorado
In December 2019, before the novel coronavirus upended life around the world, the epidemiology and infectious diseases team at Children’s Hospital Colorado was monitoring the early, devastating effects of the virus overseas.
The squad’s surveillance of such outbreaks helps Children’s Colorado prepare for whatever risk is coming, says Pat Givens, chief nursing executive at the hospital. She’s also senior vice president for patient care services.
Because the hospital treats patients who suffer from seasonal respiratory illnesses, like the flu, it’s important for the infectious disease team to keep track of what’s happening throughout the world. That includes reading medical journals and reports from reputable news sources; it entails connecting with peers to stay on top of worldwide health events and taking notes on how other communities are managing outbreaks of disease. “It gives us a picture of what might happen here, ideas for mitigating, reducing the impact,” she says.
Based on the surveillance, Givens and other hospital officials created a system to ensure that Children’s Colorado would have a sufficient supply of the personal protective equipment – such as N95 masks and gowns – needed to safely treat people with COVID-19.
A significant amount of the hospital’s supply chain for PPE comes from China and Europe – areas impacted significantly and early on by the novel coronavirus. Amidst a global shortage of PPE, Givens and her colleagues ensured the hospital received the protective equipment it needed, while also conserving equipment, like N95 masks, that could be reused. All conservation measures, including decontaminating supplies, were done only when appropriate and using scientifically verified methods approved by the Centers for Disease Control and Prevention, she says.
For example, hospital workers used UV light and vaporized hydrogen peroxide to decontaminate N95 masks, and cleaned face shields with diluted bleach solution. “We decontaminate and reuse masks for a limited time,” she says. “Team member safety is the most important thing.”
It wasn’t long before her colleagues started calling Givens “PPE Patty.” The effort paid off. “We started watching and tracking our PPE supply very carefully in January,” she says. “Because of our early tracking and conservation measures, we never ran out. We’ve been able to sustain our PPE throughout the pandemic.”
Some hospital workers, such as nurses and administrative staff, were redeployed to the effort of monitoring and conserving PPE.
The hospital also received support from community members who wanted to contribute to the battle against COVID-19. Some people used printers to create 3D face shields, which they donated to Children’s Colorado.
“It’s amazing how people have stepped up and supported and helped,” Givens says.
Ruben Castaneda, Staff Writer
Ruben Castaneda has worked at U.S. News since September 2016. Mr. Castaneda has written … Read more
Kylen Annen, DO
Annen is medical director of transfusion services and patient blood management at Colorado Children’s Hospital.
Pat Givens, DHA, EdM, BN
Givens is chief nursing executive of Children’s Hospital Colorado.
Jessica Hawks, PhD
Hawks is clinical director of outpatient services, Pediatric Mental Health Institute, Children’s Hospital in Aurora, Colorado.