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March 17, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

To colleagues in the Department of Medicine and the Medicine program.

I am starting a regular communication with you to update you on the Departmental and programmatic response to the COVID-19 pandemic. The goal is to provide updates on where we are in managing this disease and supporting our staff, trainees and faculty.  This does not supersede advice from KHSC or the FHS but hopefully is tailored to your needs. If you have questions or comments please send them my way.

Today’s news:

Today the Division Chairs and leaders from KHSC met to deal with some important issues facing our patients and our program. Here are the highlights:

  1. Wednesday am check in: Beginning next Wednesday, I will use the 0800 M&M slot to run a ZOOM conference updating faculty on the state of the DOM and Medicine program. You will be able to join this remotely through a link that Stephanie Hartwick will send out. Dr. Gerald Evans has been instrumental in keeping us current with breaking news on the pandemic and will present at these sessions.
  2. Preparation for opening COVID-19 wards: There are currently no COVID-19 cases in KHSC. However, we are preparing for an anticipated case surge in the next 1-2 weeks. Under the leadership of Dr. Chris Smith we have organized 2 wards for future patients. These wards will be staffed by our CTU physicians. Their roles will be backfilled by many volunteer doctors from all Divisions. We have assembled a comprehensive coverage schedule (Thank you team DOM!).
  3. Division chairs to oversee postponement of elective clinic visits and procedures butensure timely provision of care to all non-elective patients: Division Chairs will be reviewing all cases scheduled for outpatient visits and procedures between now and July 2020. This responsibility lies with the Division Chairs and individual doctors should not make unilateral changes in their clinics without consulting and receiving approval from the Division Chair or Department Head.  This is to ensure consistent and safe practices are followed and will enhance our coordination. All non-elective patients, defined as those who should be seen within 3 months (based on clinical judgment that this visit/procedure is necessary for control or timely diagnosis of their conditions and/or to avoid Emergency Dept visits) will be seen/cared for in a timely manner. All elective cases will be contacted and told their appointments will be rescheduled. We estimate that elective care will be rescheduled for dates after July 2020. Once we have a better sense of how the rescheduling of elective cases affects clinic volumes, we may alter clinic location and staffing models
  4. E-visits: We are planning (with support from KHSC and SEAMO) to expand our video visits program to allow more patients to be seen in their homes. Faculty can join our virtual DOM meeting tomorrow at noon. Dr. Ramana Apireddy will be delivering a “how to” session on the use of a new system (REACT) to support this form of care. Stephanie Hartwick has already sent a link to faculty to invite them to join the meeting.
  5. Telephone contacts with patients: Remember that if you are dictating a note related to a telephone contact with a patient, a visit must be created in the electronic health record. Your clinical administrative assistant can do this, as they would for an in person visit.
  6. Simplifying hospital access for physicians and other healthcare workers: We provided feedback to KHSC leadership that access to the hospital needs to be simplified for physicians and other health care workers who are required as part of their role to repeatedly access our facilities. This has become cumbersome because of repeated screening at each entry. KHSC is considering how best to simplify access for physicians who must repeatedly enter the building.
  7. Request for testing of sick quarantined health care workers: We have the capacity to test subjects for COVID-19 but this test is only useful for symptomatic patients. In a symptomatic patient a negative test excludes COVID-19 with 99% specificity. The test is not useful in asymptomatic people.  We have asked KHSC to consider testing of all quarantined, symptomatic, health care workers to expedite their return to clinical service.  This request is pending response.
  8. Administrative staff: KHSC and the DOM still require administrative staff who are healthy to be at work to support the clinical and education mission. The FHS approach (and ours) is  distinct from Queen’s University policy which advises staff to work from home “when possible”. Our policies may change but these changes should be coordinated through Dr. Archer and Ms Anita Ng (for Queen’s employees) and Mr. Chris Gillies (for KHSC employees).
  9. Medical students offer childcare support: Queen's medical students are offering their support to our physicians during this difficult time. They are offering services such as childcare, pickups/drop-offs, errands, etc.You can sign up using the Online Staff Form and they will do their best to connect you with an available student in a timely manner. Please note: while this initiative is organized by Queen's medical students, it is NOT officially affiliated with Queen's University.

I conclude with a huge thank you to our trainees, who are dealing with a massive disruption of their schedules due to rescheduling of their Royal College exams, our administrative assistants, who work tirelessly to support our mission and to all our allied health professional friends and colleagues, without whom we could not function.

These are unique times that call on us all to be patient, kind, and understanding. We can handle this together and should do so without fear. I have no doubt we will look back on 2020 as the year we showed what we are made of.

I am proud of you all!