Podcast #199 - Roundtable Discussion on Tips and Tricks with COVID-19 Management

We had an excellent opportunity that we had to turn into a video podcast.  The roundtable discussion is with Weill Cornell Medicine in New York City staff: a physician (Dr. McCarty), a PA (Matt), and a RN (Christina).  They cover their ED's response and how each of them took on new roles to better manage patients in this challenging time.  Their tips and tricks are worth listening to, especially if you have not yet seen a surge of patients.

As always, it is worth listening to the entire podcast, but here are just some quick highlights:

• Take off-service staff and train them with how to manage lower acuity patients.
  • Use training videos and protocols.
  • Still have someone who is ED staff and is can support/look over the off-service staff.
  • When patients present with a specific complaint (head injury, eye pain, etc), try to use off-service staff that it is in their specialty.
  • Have a vetting process to make sure anyone off-service or volunteering can adequately fulfill the roles needed.
• Telemedicine can be extremely helpful with patient volume and addressing certain complaints.
  • Can work with 911 dispatch, to help in the triage process of patients calling for EMS.
    • ED staff can help determine when talking with the patient if they require EMS, can get themselves to the ED, or may not even need emergency services.
    • This can done from the ED or at home.
  • Being able to work from home via telemedicine has helped for those staff currently infected but still able to work.
• A good triage system is necessary to get patients the care they need quickly.
  • Vital signs are a must and should be obtained very early in the visit.
    • Vital signs should include an ambulatory oxygen saturation when possible.
    • This is very important for borderline patients.
  • Decrease exposure by keeping patients separated, especially those with the greatest concern for having COVID-19.
  • Every patient (and visitor if applicable) should be receiving a surgical mask as soon as they enter the hospital.
• Use the same level of personal protective equipment (PPE) throughout the system.
  • Assume that everyone has COVID-19 and keep appropriate PPE on for all patients.
  • The recommendation was N95 and other appropriate PPE to stay on the entire shift with the exception of breaks.
• Breaks are important for productivity, morale, and more.
  • Make sure people are taking their breaks.
  • Have extra staff (not on-call) and then release them based on actual volume.
  • Track staff exposures to help ensure safety and wellness.
• Test staff early if symptoms develop.
  • Check on them frequently if positive or symptomatic.
  • When they start improving and are up to the task, they can start working again.
• Support environmental staff (housekeeping) to help speed up cleaning process.
  • Increase the number of negative pressure rooms.
  • Remove curtains as these often take a long time to clean.
• Increase your usable spaces to hold patients.
  • Can use some areas that are being used less frequently given current volumes (for example pediatric or surgical areas).
  • Use other areas not currently used seating area of cafeteria, chapel, lobby, etc.
  • Maximize ED and ICU rooms as much as possible.
• "Silent hypoxia" is a very real concern.
  • Another key reason to check vital signs early.
  • Provide pulse oximeters whenever possible to patients.
  • This is especially helpful for those people you send home that maybe you normally would not.
  • Also try to get oxygen concentrators that can be used a home for patients.
  • Have a strong follow-up program to help with those being sent home.
• Prepare for daily changes in protocols and systems.
  • Ensure that everyone is getting updates such as via email and pre-shift reports.
  • Help promote the mindset and preparedness for change.
• Limit the number of times and which staff go into rooms.
  • This helps limit contact with staff and their exposure.
  • The physician, PA, or NP should try to get in the room first to assess the patient and determine what is needed (IV, labs, etc) to avoid nursing having to go in and out of the rooms which could increase exposure and PPE use.
  • Using patient phones (something that used to be more common) can allow people to call in and ask questions such as billing staff, specialists, or if additional questions need to be asked.
  • Call lights can also be used and should help with some discussions to avoid going in and out of rooms.
• Create intubation teams for airway management.
  • Limit the amount of staff physically present in the room.
  • Have spotters to help with donning and doffing of PPE.

Let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook.  Remember to look us up on Libsyn and on iTunes.  If you have any questions you can also comment below, email at thetotalem@gmail.com, or send a message from the page.  We hope to talk to everyone again soon.  Until then, continue to provide total care everywhere.