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Frontliners

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

Q: How are you involved in the COVID response?
A: I am a frontline provider as a hospitalist at a tertiary care center providing care to COVID patients, and the Accountable Care Team Lead for the orthopedics-trauma-neurosurgery unit. As a lead physician, I offer clinical services pertaining to perioperative inpatient medicine care and leadership/administrative role of supervising and coordinating various disciplines including but not limited to nursing staff, social workers, case managers, physical/occupational therapists, and clinical managers, towards keeping daily patient care and unit operations effective. Therefore, along with providing care to the general COVID patient population, I am also involved in providing care to COVID patients in a perioperative setting. Currently, with the cancellation of the majority of elective surgeries, most of the care is channeled towards emergent surgeries. Emergent surgeries in the setting of COVID invariably pose a greater challenge from the standpoint of inpatient care, complications, disposition, etc.

Q: What novel methods have you had to implement in caring for patients during this time?
A: MDRs [Multidisciplinary rounds] are a vital tool in modern-day inpatient/hospitalist medicine practice. As an accountable care team lead, I am involved in supervising multidisciplinary rounds involving various disciplines like nursing staff, physical/occupational therapists, social workers, case managers, etc. Due to current COVID pandemic situation, in-house absence of many vital staff members (case managers, social workers, clinical managers) has posed a major challenge towards the efficient functioning of MDRs.

To bridge the gap and to keep MDRs effective, as a team, we have implemented utilization of WebEx call conference software to bring together clinical staff and providers. We have also utilized audio/video calling approach to connect patients and patient families to non-in-house clinical staff like social workers and case managers. Additionally, we provided personal room phones to patients under isolation. The list of patient’s room phones is made available to providers in a PDF format. Patients under isolation are provided updates over the phone [unless in-person presence of provider is deemed necessary] by primary and specialist services. This does not include the daily rounding visit by the primary team, which is provided as usual including thorough in-person evaluation. This strategy has effectively decreased the requirement of PPE and exposure to the coronavirus.

In coordination with case managers and social workers, we have implemented in-house models to triage patients early on based on anticipated disposition, to effectively minimize the length of stay, early discharge planning, and isolating discharge barriers in a timely fashion. These in-house models for triaging are designed specifically to COVID patient population.

Q: How has COVID effected your working relationships? How has communication and collaboration for patient care been affected?
A: Most surgeries and inpatient procedures are requiring COVID rule out, thus, increasing the waiting period with a possible impact on outcomes and associated complications. Most of the consultant services are not seeing COVID positive patients in person. They are offering services virtually/phone interviews and a chart review. This has further increased the burden of clinical responsibilities on primary [hospitalist] teams.

Due to visitor policies in place, no visitors are allowed. This requires more phone calls to patient's families regarding updates, therefore, it has further increased the daily work burden. It is even more challenging to engage family members over the phone in regards to sensitive discussions like goals of care and hospice care. As typically these discussions involve multiple team members/providers and family members. Arranging these conversations remotely is challenging both logistically and emotionally to patients and their families. This has led to extra responsibility for hospitalist physicians to bridge the gap.

Q: What advice would you like to give to SGIM members to encourage them in their efforts to contribute to the response?
A: These are unprecedented and difficult times. But at the same time, these challenging times are an opportunity to be creative and courageous. This is the time to unleash the best within us..

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