GIG HARBOR — If a surge of COVID-19 patients arrives at the CHI Franciscan hospital system in Western Washington, the staffers inside mission control, a large NASA-style command center, as they call it, will be among the first to know.

And if all goes as planned, the artificial intelligence-aided system at St. Anthony Hospital will have predicted that influx to help workers prepare.

A dozen TV screens line the room’s front as if it were a sports bar. Color-coded graphics tell viewers in real time how many ICU beds are available in each of the system’s eight hospitals, how many patients are waiting for rooms, and how long individual patients have been waiting.

Doctors and nurses at CHI Franciscan describe the challenges they face as they prepare for an influx of COVID-19 patients. Care is coordinated via their Mission Control Center. (Ramon Dompor & Corinne Chin / The Seattle Times)

The data “tiles” give a birds-eye view of the hospital system and help visualize some of its vital signs as health care workers face a pandemic sweeping through Washington state, and now the rest of the nation.

Facing the tiles, staffers in charge of hospital beds, transferring patients, expediting patients, emergency dispatching and managing the hospitals’ work forces hammer away at their keyboards. A doctor helps oversee the flow and prioritization of resources.

Behind the scenes, an algorithm churns, providing forecasts for patient needs so administrators understand how many hospital beds, health care workers and medical supplies each hospital could soon require.

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The tiles of data inside the nerve center that powers CHI Franciscan offer a rare look at the decision-making process of a hospital system during crisis and how health care administrators are managing stress on their medical systems amid COVID-19 and its cruel mathematical march.

Vital signs

So far, the vital signs tracked at mission control and elsewhere within the CHI Franciscan system remain relatively stable.

As of Saturday morning, the system has 122 total intensive care beds and reported them at 90% capacity. About  eight days’ supply of personal protective equipment were available for use. Conservation measures for that gear are in place.

The hospital system was treating 28 confirmed and 91 suspected COVID-19 patients across its facilities, according to a spokesperson. Two ventilators were in use for COVID-19 patients.

Mary Ragsdale, chief operating officer at St. Anthony and board chair of mission control, said Friday the CHI Franciscan hospitals had more ventilators than needed so far.

“Is it more full this year than last year? It’s not,” Ragsdale said of the hospital system’s capacity on Friday. “People who don’t need to be in the hospital are staying away.”

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The hospital system, which serves Pierce, Kitsap and South King counties, postponed all elective procedures early last week. It made virtual sessions with health care providers free with a special code, and has performed more than 1,400 COVID-19 screenings virtually. Visits to the hospital are allowed only for special circumstances.

“We’ve restricted all our movement,” Ragsdale said in a quiet hospital hallway. “Everyone has a purpose and a reason for being there.”

Ragsdale said the hospital system was seeing “increased pressure” on its negative airflow rooms, which are designed to prevent viral pathogens from escaping into the broader environment.

As of Saturday morning, facilities managers had expanded the number of negative airflow rooms from 40 before the outbreak was identified to about 100.

The outbreak’s discovery and its initial pattern of confirmed cases were documented north and east of most CHI Franciscan hospitals.

In King and Snohomish counties, confirmed cases are counted by the many hundreds. Pierce and Kitsap counties still count cases by the dozen.

Ragsdale said the system’s King County locations — Highline Medical Center, in Burien, and St. Francis Hospital, in Federal Way — had seen more impacts than other parts of the system.

But hospital administrators are preparing for significant impacts throughout.

“What we are preparing ourselves for is the experience they had in China,” Ragsdale said, where hospitals saw a sudden, overwhelming spike in visits. “We’re preparing for a peak in volume and potentially with sicker patients.”

Meantime, the Mission Control Center’s artificial intelligence system, one of only five in the country and the only one of its kind in Washington, is forecasting metrics that help administrators to work proactively to manage system strain.

The AI system, implemented last August, relies on World Health Organization infection growth rates, the percentage of patients requiring ventilation and COVID-19 mortality rates to predict future demands of care, said Dr. Jessica Schlicher, medical director of the mission control system.

“We can program what we will need to do locally,” Schlicher said, using county-level data from the Washington State Department of Health to inform projections.

The hospital system has taken measures to prepare. Triage tents are available, if needed, and there are backup tents if overflow exceeds capacity, Ragsdale said. If workforce becomes an issue, the hospital system is ready to redeploy staff across its eight sites.

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“The models, the data we’re seeing, there is potential for over-capacity to hit,” Ragsdale said. “We need to get ready for that.”

Widespread testing

Widespread testing should help hospital systems better understand and react to COVID-19’s spread.

Three floors below the mission control center, and attached to St. Anthony’s hospital, is Franciscan Prompt Care — Gig Harbor, one of 11 clinics where the hospital system has established public screening and testing for COVID-19.

A masked nurse greets patients, giving those with moderate COVID-19 symptoms a mask of their own to wear. The patients are encouraged to distance themselves in a large waiting room, which on Friday morning remained sparsely populated.

“It’s stressful. Everybody wants to be tested,” said Christine Hawkins, a licensed practical nurse. To some, who are asymptomatic or have mild symptoms, “You have to say no.”

Four nurses and two providers Friday were operating the triage testing clinic at Franciscan Prompt Care. CHI Franciscan, which is part of CommonSpirit Health, has suspended billing for COVID-19 testing and treatment.

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The Gig Harbor prompt care clinic sees an average 40 patients a day and volume has remained similar to normal times, said Kris Andrews, who supervises the team’s nurses.

These days, about 60% of patients come with respiratory symptoms, Andrews said.

Between 10 and 20 patients are tested for COVID-19 each day, said Hawkins, who has taken extra shifts for testing triage.

The screening and testing sites have been critical to keeping COVID-19 patients from overwhelming busy emergency departments, said Dr. Francis Mercado, an ambulatory associate chief medical officer for CHI Franciscan.

“We needed to protect emergency rooms. We knew they were going to get inundated,” Mercado said.

Mercado said having enough personal protective equipment, particularly masks and gowns, was the “limiting factor” for the system’s testing program.

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Testing procedures illustrate why these critical supplies are needed to protect against respiratory droplets.

“Testing is a swab as far back as you can get in the nostril,” Mercado said. “At the back of the palate, you turn the swab. It’s not very comfortable. The patient may sneeze or cough.”

Once swabbed, the sample is placed in a vial, placed on ice and sent to a LabCorp facility in North Carolina, where it takes about three to four days to return results, Mercado said.

At its 11 sites, the hospital system has screened more than 15,000 patients for COVID-19 and tested about 1,200 people, according to Cary Evans, vice president for communications and government affairs.

About 4.8% of tests have been positive, but many results are pending.

To speed crucial health workers’ return to work, CHI Franciscan employees’ samples are sent to a University of Washington lab for rapid processing, Mercado said.

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One of the system’s 12,000 employees had tested positive for COVID-19 and was recovering at home, according to a spokesperson.

As volumes build, Mercado said CHI Franciscan plans to expand testing sites outdoors or as drive-thrus to reduce exposure and conserve protective gear.

“I’m hoping early measures in this state help the community have less exposure,” Mercado said. “We are preparing for the worst, though.”