Message From Linda Raftery

Thank you for the amazing work you have been doing over the last six weeks.  We could not be more proud of what you have done to take care of our patients, our learners, and each other.  You have each stepped up to help in countless ways.

Here is an abbreviated list of some of the specific achievements:

• Relocated internal medicine schedulers from the trailers to make space for the RDC
• Led opening of the RDC
• Relocated the Infectious Diseases clinic off campus to Meadowmont
• Re-organized inpatient teams to create COVID floor teams, COVID ICU team, and COVID consult teams
• Held 39 morning huddles, which have become essential to medical center processes.
• Designed a plan to care for 438 SARS-CoV-2 + floor patients and 243 ICU patients, using volunteer faculty and residents, teams of two who would care for 10-12 patients.
• GI and Rheumatology have formed an inpatient care team
• Completed 9,059 virtual visits: 7,055 phone and 1,506 video despite many challenges
• Developed a consultation service to our affiliates
• Rescheduled thousands of patients
• Scheduled and held thousands of WebEx meetings (“can you hear me?”)
• Developed a clinical research process for patients with Covid-19
• Cared for 82 COVID+ patients
• Put yourselves on the front lines and led the organizational response
• Extended our palliative care reach
• Continued to deliver factor to hemophilia patients across the state
• Advised local agency
• Led the infection control response
• Been there, by the bedside, when family could not be

We have collaborated quickly to make decisions and remove barriers in partnership with leaders in other departments and the hospital. All of this was to prepare for a massive surge of COVID patients to our medical center and our system.  Our world was changing quickly and we took quick and decisive actions to conserve PPE, protect our patients and our healthcare workers, and ensure that all needed resources were available and prepared.

Over the last two weeks, we have seen a very different reality.  There are many contributing factors to this including that we have no mass transit, a lower population density, and have been adhering to social distancing recommendations and stay at home orders. As a result the curve is flattening. Significantly flattening.

Today, we have 34 COVID+  patients, 17 of which are in the ICU. You can see from the graph that we have not seen a significant influx. A forecasting model has been developed at UNC and is being adjusted weekly. The model currently suggests a much lower peak in mid-July. Several nursing homes, businesses and prisons in the area are experiencing outbreaks. For the foreseeable future, we need to be prepared to care for COVID-19 patients as well as people who are have new and chronic medical conditions unrelated to COVID. Our patients need our care, and we will continue to deliver that care in a manner that is safe for them and our health care workers and that reflects our deep compassion and understanding.

Initial projections of a steep demand curve for intense inpatient COVID care have been revised by weekly modeling to suggest a gradual increase and a prolonged period during which we will provide care to both individuals who may be COVID+, and patients who are presumed negative.  We have developed a backlog of needed services, including in-person clinic visits and procedures, and have patients with new health concerns who need care. We are working on a plan to safely phase in needed surgeries, procedures and clinic visits in a manner that is consistent with the Governor’s orders and optimally safe for our patients, providers and staff.

Clinics:

Initially, appointments were rescheduled 90 days out.  Now, visits can be accommodated virtually. Many thanks to Spencer Dorn, Larry Klein, Bill Wood and all of our medical and administrative directors for their leadership.  Urgent transition to virtual care involved a huge effort on everyone’s part. Thank you.

• When medically necessary, patients are to be seen in clinic with our standard screening and testing referral workflow.
• Schedule all non in-person appropriate visits as video visits. Our clinical staff are doing the pre-visit planning with med reconciliation and appropriate questionnaires.  The flexibility of using Doximity will make this much easier. We expect video visits to remain an integral part of our care model.
• If a video visit is not an option, and it is not necessary that the patient is seen face to face, the visit can be scheduled as a phone visit – this is last resort.
• COVID positive patients at home are being monitored with telehealth. Those who require ambulatory, in-person evaluation, may be scheduled for the RDC Care and Treat area.

Procedural areas:

Rowell Daniels, interim COO, UNC Hospitals and for the DOM, Rick Stouffer, are leading operational changes to ensure that we can safely accommodate appropriate procedural visits. Workflows are being developed, from scheduling to discharge, to ensure repetitive screening, availability of PPE and appropriate patient testing.

• Procedure prioritization:  Each procedure area is revisiting its prioritization algorithm, and assigning / re-assigning a priority to new and pending cases.  As patient condition changes over time, there needs to be an on-going process to reassess.
• PPE:  Appropriate PPE use during performance of procedures is protective for SARS-CoV-2 infection. Leadership will continue to monitor both current and forecasted PPE, and provide an advance feedback loop for surgical and procedural scheduling.
• Pre-procedure testing: The lab has made great strides in increasing capacity for testing. Procedures are grouped by aerosolization and hospitalization risk, which coupled with physician input and screening results will determine which procedures require testing.
• Pre-procedure screening: patients will generally receive pre-procedure symptom screening three times: at time of scheduling, the day prior, and the day of.  Screening should be performed by clinical staff.

On Monday, May 4, from 6:30-7:30 pm local first responders from city and county emergency services, fire departments and police will be coming to UNC Hospitals to thank all of the wonderful workers who are caring for our communities.

 

Thank you,

Linda Raftery
Vice Chair for Administration
UNC Department of Medicine