MTMC Blog

As of May 6, 2020, there have been close to 1.2 million confirmed cases of COVID-19 in the United States, resulting in some 70,000 deaths, according to the Centers for Disease Control and Prevention. The scope of the pandemic is ever-evolving, but to date more than 1 million individuals who have contracted the novel coronavirus worldwide have recovered, including an estimated 170,000 Americans. Mike McCabe, MTMC’s Area Vice President for the western region, is one of those people. With the full support of the MTMC family, Mike has decided to share his COVID-19 experience publicly, in the hopes of putting an honest, human face on a dangerous infectious disease that can be difficult to comprehend. For the latest information, statistics, and directives, visit cdc.gov/coronavirus.

Mike McCabe describes March 5 as a day like any other in his town of Coto de Caza, about an hour south of Los Angeles. It was partly sunny and gently breezy, with highs in the mid-70s, and he was looking forward to grabbing lunch with an old high school friend he hadn’t seen in about six months.

The previous day, Gavin Newsom had declared a State of Emergency to mitigate the potential spread of COVID-19, but it’d be two more weeks until the Governor issued an official stay-at-home order for all of California, America’s most populous state. As such, the restaurant the pair settled on was packed. “In the moment, it was just life as usual,” says Mike.

Though he noticed his friend seemed to be fighting a cold, Mike didn’t think much of it, beyond hoping he felt better. On Monday, March 9, however, he “started to feel something coming on.” At first, it was mild — aches and pains, low fever, general malaise. But over the next few days, his status took “a complete cliff dive.” In addition to a persistent fever and more severe aches, Mike began experiencing a dry cough, dizziness, loss of appetite, and increased fatigue. He gave himself two at-home flu tests, thinking the common malady may be the culprit. “They both came back negative,” he says. “That’s when I began thinking, ‘This isn’t good.’”

In addition to his duties at MTMC, Mike, who has been with Med Tech Associates since 1991 and became part of its ownership team in 2003, works as an NCAA football official, his second career for the past 25 years. He officiates Pac-12 Conference games, and most recently refereed the 2020 Gator Bowl in Jacksonville, Florida. In other words, the 51-year-old married father of three is in excellent cardiovascular health, and leads an active lifestyle off the field. None of that prevented Mike from contracting COVID-19 (his friend would later test positive). And none of it prepared him for the subsequent two weeks, a scary stretch where uncertainty weighed on him as heavily as the debilitating virus itself. “It was unlike anything I’ve ever gone through,” he says.

About a week after exposure, Mike contacted his primary care physician remotely; he was prescribed Tamiflu to start, but it had no positive effect. All the while, Mike’s health worsened. The dry cough became more violent, body pain increased, and his fever reached levels as high at 103 degrees Fahrenheit. New symptoms began emerging, too: dizziness, chills, shakes, chronic shortness of breath, loss of taste and smell. “You hear about all the symptoms you have with COVID,” he says. “Lucky me — I checked off pretty much every single one of them.”

At the behest of his physician, Mike decided to get tested for COVID-19 on Monday, March 16. That morning, his wife brought him to a new drive-thru testing facility that had just been established close to their Orange County home. With Mike still in the passenger’s seat of their vehicle, the workers at the parking lot site, fully outfitted in personal protective equipment (PPE), began by asking a series of questions to rule out other explanations for his symptoms. “They didn’t want to waste a COVID test on somebody who might have the sniffles,” he says.

After determining he was a candidate, they administered a nasal swab via the rolled-down window of Mike’s vehicle. While quick, “it’s uncomfortable — it’s like you get punched in the nose for a second. Your eyes water up,” Mike says of the experience. The results would, indeed, come back positive — but not until nine days after the test was administered, a period that proved to be the most trying portion of Mike’s ordeal.

By this time, Mike, at home with his wife and two of his three children, had restricted his movements between a spare bedroom and his office, living on Delsym to combat his cough, Tylenol and Advil to fight fever spikes, and vitamins and fluids he hoped would bolster his immune system. “Nothing was changing, and everything, especially the shortness of breath, was starting to get worse,” he says. After consulting his physician once more, he decided to admit himself to the emergency room of Mission Hospital in nearby Mission Viejo.

“For me to throw in the towel took a lot,” says Mike, whose wife brought him to the ER early on the morning of Friday, March 20. “But I’ve never been this sick in my entire adult life. I didn’t know where this was going to go.” He wrote letters to each of his kids, hoping for the best but planning for the absolute worst.

Hospital staff performed another COVID-19 screening on Mike, which came back positive on-site. He was moved to an isolated area designated for COVID-19 patients, after which point doctors ran him through a battery of tests, including chest X-rays, an EKG, and extensive blood work. At first, Mike was told he’d need to be admitted, and they began preparing an isolation room and possibly a ventilator for him.

Late that same night, though, the plan pivoted. Though X-rays confirmed that his lungs were stricken with pneumonia, “My white blood cell count was good, so they told me they wanted to save the beds for critical patients they were going to put on ventilators,” he says. There was nothing further doctors could prescribe, beyond the regimen of over-the-counter medicines he was already taking.

In the moment, Mike found himself wavering between two states of mind. While thankful to be back at home, he remained frustrated and confused about his prospects. “There were lots of moments of prayer and tears — just thinking, ‘Is this thing going to end?’” he recalls.

On March 22, nearly two weeks after he began displaying symptoms, “I woke up and felt something different,” says Mike. He had a little more energy, and was able to stay up and alert for longer during the daytime hours that previously saw him incapacitated. That night, he woke up in a pool of sweat — his fever, a constant throughout the previous two weeks, had finally broken. It’d take another month for Mike to fully feel like himself again, and lingering effects like fatigue and trouble breathing still linger, but as of now, he’s happy to report that he’s at “99 percent” of where he was before.

From exposure to recovery, Mike’s COVID-19 experience lasted roughly eight weeks. In addition to his own improved health, he’s thankful that his family was not stricken by the virus the same way he was, though he theorizes they might have been asymptomatic carriers. Back on his feet, Mike has donated his plasma to the American Red Cross in the hopes of aiding recovery efforts. Now, he’s focused on getting back to his normal routine as a member of the MTMC family — and hopefully, football in the fall.

“As much as most of the population might see this virus as not affecting them, I would issue some caution,” he advises. “Do you best to avoid being in a position to acquire it. It is a dreadful experience to have to go through.”

Value-Based Purchasing (VBP) is an external motivator for providers to lead the re-engineering of healthcare delivery. Key measurements that comprise an effective VBP strategy are: improvements in patient care and safety, timeliness, and streamlining processes which make care more patient centered and equitable. Providers are looking for tools to incorporate into their standard operating procedures which help to improve these metrics.

Venipuncture is one of the most common and frequent invasive procedures within an acute care facility and is often cited as painful when repeated sticks are necessary. The HCAPHS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is interested in gauging patient pain and contains a survey question about pain management. Vein visualization technology is becoming a crucial tool to help mitigate negative pain metrics.

Failed venipuncture attempts aren’t just a pain for patients, they can hurt facilities too, causing increased costs per procedure, (e.g., needles, catheters, gauze, etc.) It’s estimated that every attempt to insert a peripheral catheter can cost a facility about $32. Decreased staff productivity can occur because a missed vein requires the procedure to be repeated; productivity can be further impacted should the caregiver have to escalate the procedure to specialized staff. Delays in treatment and diagnosis can occur because lab work is held up. Higher costs may be incurred when more invasive procedures are required to gain venous access.

AccuVein’s vein illumination technology based on independent clinical studies have shown to improve first stick success rates by 98%, reduce escalation calls by 45%, improve ability to cannulate by 81%, reduce pain by 59%. In addition, 93% of patients surveyed would give hospitals a higher satisfaction score if they used AccuVein. Due to these improved metrics, many AccuVein customers are incorporating vein visualization into their standard of care.

A few thoughts I would like to share with you from my experience working with Southern California health systems is that the key in process improvement is to implement an adequate standardization of AccuVein devices to see the full benefit. We have a few facilities that identified a lean six sigma project around 'delayed therapy secondary to inability to gain venous access' that implemented AccuVein house wide, and the projects all showed process improvements with the implementation of AccuVein.

The key was and is standardization and utilization to gain the full value of AccuVein. The AccuVein device, when placed in a facility with adequate numbers and in proper locations, will yield untold value across many areas, from meeting the goals hospital systems have set forth with respect to skills, to decreasing treatment delays , to increasing patient satisfaction scores. We have been successful with this manufacturer due to the ease of substantiating to value analysis committees the need to implement adequate numbers of devices and which actual geographical locations will yield the best utilization. Also, discussing adding AccuVein to the IV policy, and that successful pull through of utilization comes with the implementation of best nursing practice council meetings to facilitate the ongoing process.

Hospitals are facing many challenges and vein visualization can help meet these challenges. Patient satisfaction is core to today’s healthcare providers as it impacts reimbursement. Controlling costs isn’t optional. It’s part of everything providers do. Excellent patient care is why providers go to work every day.