Jason Little’s total interview with Dr. Jake Lancaster, chief medical information officer, is 15 minutes long. It includes many charts and graphs. Patient and employee trends are discussed at the beginning of the video (in case you do not have time to watch the entire segment). Also, a transcript is included below.
Jason: I would like to welcome my fellow team members to a new installment of COVID-19 videos. You will recall that I was taping these in the early days of the pandemic to keep you all informed. As the curve flattened on COVID-19 cases and viewership decreased, I discontinued them. However, we’ve had a significant uptick in volume that is stretching our system and our capacity. You all told me that you appreciated receiving updates in this format, so for the forseeable future I thought I would bring you the latest news that I can find from across our system every Tuesday and Thursday for the next several weeks. Today I want to start with sharing our recent data, so that you know our current status across our system and to do that I really want to introduce you to one of the key weapons that Baptist has in the fight against COVID-19 and that’s our own Chief Medical and Informatics Officer, Dr. Jake Lancaster. Dr. Lancaster went to medical school at the University of Mississippi. He did his residency in Internal Medicine at UAB and got a Masters in Health Administration there as well and then went on to Vanderbilt and got his Masters in Clinical Informatics. So this is a physician that knows everything there is to know about data and who better to bring you Baptist’s data than Dr. Lancaster.
Jake: Thank you. I’m glad to be here and happy to present some of this new data. We’ve had some interesting developments with what we have available to us over the past couple of months, so I am excited to share some of those insights.
Jason: That’s terrific and I appreciate you putting this together. I know our team is going to be excited to see what all you have. So, tell us…maybe start…. How are we doing as a system from a coronavirus admissions standpoint?
Jake: (Shared Screen –System Trends) So this is a slide that I look at on a daily basis that we present at multiple meetings across the system and this is showing our daily inpatient volumes. For COVID-19 patients that are admitted to the hospital, the blue bar are those that have been admitted to the med-surg beds, the orange being those patients that have been admitted to the ICU. As you can see, since June we have been on a steady uptick across the system. That doesn’t necessarily look the same if you look at each individual market and each individual facility across our system. If you drill down, you can see all sorts of inclines and declines, but at the moment across the system, we are seeing a steady uptick in cases, which as you know if you follow the news that is a pretty stable bar in our geographic area.
Jason: So, almost tripling really…it looks like since the end of June.
Jake: Right. We’ve been focused on our doubling rates since early on and if you will remember early on in New York and some of those other places that were having doubling rates every five days almost. Ours has never been that bad, but we are really doubling about every month, which is quicker than what we were back in March and April.
Jason: Yeah, got it..
Jake: (Next slide – Pt. Positive % by Result Date) One of the key metrics we follow is the percent positive rate of the patients that are being tested for COVID-19. Early on, March, April and May these numbers were less than 10%. They have gradually been going up as COVID-19 has become more prevalent in our community and so this is one thing we can watch and know when this number starts going down that we are starting to get a handle on it and it is becoming less prevalent in our communities. That is one of the things I definitely recommend showing and you need to focus on over the next few weeks.
Jason: Sounds good.
Jake: Our day to day lab turnaround times…or how quickly are we getting those COVID-19 labs back has been something of great importance to us as we have this influx of patients. As you can see, just a couple weeks ago we were taking a 176 hours to return that COVID-19 lab test. That is greatly improved over the last few days down to about 33 hours today. A lot of that delay was due to national shortage of reagents, which has improved over the last several days. That turnaround time is really key and something we need to keep watching on a daily basis.
Jason: Yeah, Dr. Lancaster, I want our team to understand that we’ve done so much testing and want to continue to do more, but we really take the specimen and send it off to commercial labs and like you said they’ve been beholden to these manufacturers who’ve not been sending the reagents and it has increased our turnaround time. I’m glad that it’s gotten down…back into something that we can live with in the 24-48-hour time frame. I heard some data yesterday that our drive-thru testing at Baptist Memphis for instance we processed almost 400 people yesterday through the drive-thru lane with an average wait time of 10 minutes. So that is much more improved over the folks who were waiting … in those drive-thru lines just a couple to three weeks ago.
Jake: That’s great!
Jason: Good work from our team!
Jake: One of the things we wanted to point out was… we talked earlier about the percent positive rates of those patients that are coming in and having a test for COVID-19. What percentage of those are testing positive? And so, I said it was around 18% at last check. But, that is also including patients that are coming in without symptoms and patients that are coming in with symptoms of COVID-19. So those that are coming in with symptoms of COVID-19 over our entire 6 months of treatment … 20% of those are testing positive for COVID-19. For those without symptoms at all that may be coming in for something else completely… a surgery or heart attack or something else… 7% of those are testing positive. One of the things that you get a lot of questions about is how do our employees do versus the general population. So one of the things I wanted to highlight was for our employees during that same time period, our asymptomatic positive rate was just .31% compared to that 7% of the general population.
Jason: Yeah, so what that really says is that our PPE and protocols are really working to keep folks safe.
Jake: I think so and a few more studies have come out saying that you are more likely as a health care worker to get COVID-19 from somebody that you live with or from the community than getting it from work, so I think that is encouraging. One of the other things I wanted to point out was our asymptomatic positive rate and symptomatic positive rate for a special age group that 0-30-year-old age group… this is only looking at the past week…the asymptomatic rate across the system has gone up to 17% so double what it is from the general population. And, if you look specifically at the Memphis Metro area 27% so 1 in 4 of 0-30 year olds that you meet without symptoms of COVID-19 that we are testing are coming back as positive. … staggering
Jason: Yeah, that really is….and with school starting back here in the next week or so and colleges …it will be interesting to see and watch that number.
Jake: One of the new features that we were able to add recently was getting more of this demographic information out of EPIC and being able to track those disparities across time. One of those things that you have heard about in the news is that our Black and African American community have been affected much more than the rest of the community as far as COVID-19 goes and we have that listed in our data. The blue bar is for our white patients that starts the week of March 15 and goes all the way by week to this last week. You can see over time how that has changed. That gray bar in the middle being our Hispanic population, if you will remember we had quite a bump in June and saw a lot more Hispanic COVID-19 patients that increased…and that has improved somewhat. Then one of the big things you also read about in the news is that COVID-19 is affecting the older population much more than the younger population. So if you look at all of our patients that have COVID-19 and break it down by age bracket …on the right you will see your ages at 61+ and breaks it down to 51 – 60 years old, etc. You can see as a whole we really did have an increase over the last several weeks in that 0 – 30 age group that are testing positive…early on it was less than 20% testing positive and now it is up to 30% positive for COVID-19. If you look at those that are admitted to the hospital….
Jake: And then if you look at just those admitted to the hospital…you see that orange and blue bar just almost disappearing and that green bar of our 61+ population really taking over… the majority of the patients admitted to the hospital are in that category …we have seen an uptick in that 22-30 age group for the last couple weeks, but it’s still not nearing …it’s running about 5%.
Jason: It’s interesting.
Jake: So some of the questions we’ve had is what are these patients coming in with….early on everybody was thinking that they were coming in with shortness of breath, fever…cough, but there were all these other symptoms that were being added to the CDC’s list of symptoms we need to watch out for …and so, what percentage of our patients with COVID-19 had each of those symptom categories? As you can see from this chart those that are ….the majority of these are coming in with shortness of breath, fever and cough. Though light in number — are coming in with generalized weakness, abdominal pain and nausea. And, altered mental status…7% of those COVID admissions have got altered mental status.
Jake: There’s a good article out recently from the American Journal of Geriatrics that talks about altered mental status as a presenting sign for COVID-19 in the elderly….Then…once they come in …How long do they stay? The COVID-19 patient generally does have a longer length of stay than our typical patient population. The majority are falling in that 2-5-day category with another large percentage falling in the 5-10-day and about 7% of these patients are staying 20 days or more. I thought this was very interesting and all of this data is available in SlicerDicer…so anybody with access to that can explore, so I just had some time the past couple days to play around a little bit, but one of the things that I thought was very interesting was that 65% of COVID-19 patients have a prior diagnosis of hypertension and the top 3 diagnoses are hypertension, diabetes and hyperlipidemia. So, definitely those risk factors put you at a high risk for COVID-19. And similarly, to compliment that slide…on the left is the BMI range for our COVID-19 patients. You see that 60% of those are in the obese range. Compare that to our non-COVID-19 admitted patients…only 41% of those have a BMI in that range. So, definitely some risk factors for obesity.
One of the things that we are often asked is what is the mortality rate looking like for our COVID-19 patients? So, again breaking that down by those age categories that I showed earlier …that 22-30 and 61+… you can see that the majority of the patients that are dying of the COVID-19 illness are in that 61+ category…with only one patient in that 22-30 category….zero in that 0-21 category
Jake: One of the things that is hopeful is this next slide, which actually shows our mortality rate by these different age brackets. So that prior slide it looks like deaths are definitely increasing, but if you take a look at the rate of death for the different age brackets, it actually is improving as we get better at treating this disease….So back in early May…18% of those age 61 and over were dying of COVID-19…that has dropped dramatically over the last several weeks…as we get more and more therapeutics that actually work. Down to close to 6% and most recently 4%….that is a huge improvement for the last several weeks and that is something to celebrate. Our overall mortality rate got as high as 6% and that has gone down for each age bracket which is a good thing.
Jason: Anything else for us today, Jake?
Jake: One of the things I’ll just mention is that a lot of this data is available within EPIC. One of the things that we didn’t go over is the capacity data. So our ICU capacity and non-ICU capacity is available for everybody with the Pulse COVID-19 dashboard in EPIC and then that other demographic data that I was showing is available in these SlicerDicer application in EPIC. So, I will be happy to answer any questions that anybody may have on how to get access to that and use it if there is interest.
Jason: So there is data out there for you to access it yourself and then…also, I look forward on Tuesdays and Thursdays to bringing you updates on these data as we move forward. So, that’s all for now. We’ll see you next Tuesday. Thanks, Dr. Lancaster. We appreciate you being with us today.
Jake: Thanks for having me.
Jason: Alright. Bye-bye