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Frontliners

SGIM is honoring our members at the front lines of COVID-19 with our new member highlight series, "Frontliners". Are you or anyone you know at the front lines of COVID-19? Contact us with the subject “Frontliners” to have your story told.

Simranjit Singh, MD, FACP (Assistant Professor, Division of Hospital Medicine, Department of Clinical Medicine, Indiana University School of Medicine

Q: You have worked as a hospitalist at the Indiana University Health Methodist Hospital since the start of the pandemic in early 2020. What are some innovative practices you and your institution have had to implement over this period?
A: We have implemented a number of strategies at the institutional level in order to combat the pandemic. We have adapted our Multidisciplinary rounds and system improvement processes in alignment with the pandemic challenges. The challenges of burnout and well-being for healthcare providers are actively addressed by arranging for locums and backup schedules to accommodate the increased census. We implemented a hospital-at-home program to triage patients according to their anticipated disposition, thereby reducing length of stay, facilitating early discharge planning, and removing discharge barriers in a timely manner. Initially, the hospital at home program was designed exclusively for COVID patients; however, due to the program's success, it was expanded to include patients with other medical illnesses like CHF, cellulitis, pneumonias, etc. We established a "Hospitalist care coordination process" in which patients are identified for post-discharge follow-up care. Care coordination requests are routed through the EMR to central scheduling in order to schedule post-discharge follow-up appointments with the appropriate specialties. Additionally, we utilized nursing team models. We have seen nursing shortages across the country during the current wave due to staff shortages and increased demand. This program aimed to improve the system by reducing the burden on nursing care. We used the "Conditional discharge orders program" to streamline discharges for medically stable patients, such as those awaiting placement in rehabilitation or pending outpatient dialysis arrangements, etc. Additionally, this program assists in facilitating timely discharge by reducing the turnaround time between the order and actual discharge through the active participation of nursing staff and the care coordination team as a whole.

Q: How have the last two years and several rounds of variants impacted the way your institution handles COVID cases?
A: The last two years have been a litmus test for healthcare across the country and around the world. The need of the hour is for healthcare systems to be resilient and prepared. Viruses mutate and new variants emerge. Similarly, new COVID-19 variants are emerging. Omicron is more contagious than its predecessors, including delta. Since we are still in the omicron wave, additional learning is required as each day brings a new wealth of information. Vaccines prevent serious illness, hospitalization, and death. Recent discovery of the omicron variant emphasizes the critical importance of vaccination and booster shots. Vaccines remain the most effective public health measure for protecting people against COVID-19, slowing transmission, and minimizing the risk of emerging new variants. We are still learning about the degree to which fully vaccinated individuals are protected against the omicron variant..

Q: How have you handled burnout during this time?
A: I've been spending more time with my loved ones recently. Regular visits to the gym, meditation, and yoga all contribute to overall health. In the early stages of the pandemic's lockdown period, things were challenging as social gatherings were forbidden. As we've become acclimated to dealing with the pandemic, social isolation, vaccination, and mask wearing, we've begun to be more comfortable going out again. We have not yet returned to pre-pandemic levels, but we have begun to learn and live with the essential safeguards for safety and well-being..

Q: Do you believe that shifting CDC guidelines combined with limited access to coronavirus testing impacts the transmission rates and therefore number of COVID patients that hospitalists see?
A: The current pandemic poses difficulties not just for individuals, but also for institutions and policymakers. To my mind, the CDC is doing an excellent job of tackling the difficult issue of responding to the current pandemic as new facts and learning emerges. Omicron is more infectious than delta. The omicron variant is estimated to account for 99.5 percent of cases in the United States on 1/15/2022, while the delta variant accounts for 0.5 percent. Omicron wave surpassed the number of hospitalizations during the previous delta wave. The Centers for Disease Control and Prevention (CDC) and healthcare institutions are actively addressing the need for COVID testing by expanding testing centers and reducing wait times, as well as by offering free home testing kits. To contain the pandemic, it will be necessary to employ all available tools. Combining vaccination with the CDC's recommendations for self- and community-protection provides the best protection against COVID-19.

Q: How has patient outlook changed with the Omicron variant? Has the mindset of your institution and/or patients changed in relation to this variant?
A: Patients are becoming aware that the COVID-19 pandemic is still far from over. It is more vital to act responsibly and to make use of available tools such as social distancing, wearing masks indoors when appropriate, and vaccination. Our hospitals are bursting at the seams with COVID patients. The Omicron wave topped the previous delta wave in terms of hospitalizations. Although the number of patients presenting to the ED and being admitted has begun to decline, total admission rates have not fallen yet, based on our institute's experience (largest hospital in the state of Indiana). All US states/territories remain in high-risk category, with a very high case numbers, with Indiana ranking 34th nationally. According to the most recent CDC data, 63% of the overall US population is fully vaccinated, and 38.7% of those who are fully vaccinated have gotten the booster dose. Whereas in Indiana, the rate of fully vaccinated adults 18 years and older is 55.2 %. The bottom line is that the pandemic is still ongoing. In general, I believe that healthcare institutions and policymakers are better equipped and prepared to combat this pandemic than the initial waves. Numerous innovative methods arose over the course of two years as we learnt to deal with the pandemic.

Q: At this point, full lockdowns seem unlikely to occur even as the number of cases skyrocket. How do you recommend our members continue to practice safety while still engaging in day-to-day activities?
A: Policymakers, corporations, and individuals have recognized the difficulties associated with lockdowns. Given the nature of the pandemic, a more amicable approach would be to employ available tools such as vaccination, social isolation, and the usage of masks where appropriate. Vaccination has been shown to be quite successful in preventing disease during the delta wave. When it comes to vaccination rates, there is still a significant gap and the potential for improvement during the present wave and in the unforeseeable future with the possibility of the emergence of future variants.

Cristina Gonzalez, MD, Academic Hospitalist at Montefiore Medical Center and Professor at the Albert Einstein College of Medicine

Chrysoula Liakou, MD, PhD, Attending Physician in Internal Medicine at Athens Medical Practice

Mitchell Feldman, MD, MPhil, Chief of Internal Medicine at University of California San Francisco

Tom Staiger, MD, Medical Director, University of Washington Medical Center, Professor of Medicine, University of Washington School of Medicine

Robert Fogerty, MD, MPH, Director of Bed Resources at Yale-New Haven Hospital

Sunil Sahai, MD, Division Chief of General Medicine at the University of Texas Medical Branch at Galveston

Kimberly Peairs, MD, Associate Vice Chair of Ambulatory Medicine at Johns Hopkins University

Eboni Price-Haywood, MD, MPH, FACP, Director at Center for Outcomes and Health Services Research, Ochsner Health

Simranjit Singh, MD, Assistant Professor of Clinical Medicine, Indiana University School of Medicine

Nicole Lurie, MD, MSPH, Strategic Advisor to the CEO, Coalition for Epidemic Preparedness Innovations (CEPI)

Noble Maleque, MD, Assistant Professor of Medicine at Emory University

Christopher O’Donnell, MD, Associate Professor of Medicine, Emory University School of Medicine

Karen DeSalvo, MD, MPH, MSc, SGIM Past President and Chief Health Officer at Google

 

Dan Hunt, MD, Director of the Emory Division of Hospital Medicine