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March 18, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Wednesday, March 18, 2020

Dear colleagues

It has been a busy day for all of us and it’s amazing to see the professionalism that members of the Department are displaying. Here is a brief update.

  1. Tracking COVID-19 in Canada: Here is a link that will you to allow tracking of cases by region in Canada (click on link to see country/region).
  2. We held our DOM meeting as a virtual meeting using ZOOM and it was attended by over 100 faculty and leaders form KHSC and SEAMO. I have attached the agenda below. The process of running a Zoom meeting was handled flawlessly by Mr Bill Deadman and Mr Ralph Connors.

ITEM

TOPIC

TIME

LEAD

PURPOSE

1.0

REVIEW OF AGENDA AND MINUTES

1.1

Adoption of Agenda

5 mins

Dr. Stephen Archer

Decision

1.2

Approval of Minutes of February 19, 2020

2.0

COVID-19 Planning

2.1

Remarks from the Department Head on COVID-19 Planning

10 mins

Dr. Stephen Archer

Information

2.2

Update from Dr. Gerald Evans on COVID-19

10 mins

Dr. Gerald Evans

Information

2.3

Update from Dr. Chris Smith on DOM Contingency Planning for COVID-19

5 mins

Dr. Chris Smith

Information/Discussion

2.4

eVisit Plan for DOM/KHSC & “Reacts” Demo

30 mins

Dr. Ramana Appireddy / Dr. Stephen Archer

Information/Discussion

Your moment of Zen

Summary of Dr. Archer updates:

1) Elective patients to be postponed: We are having the Division Chairs coordinate a review of all patient lists to determine which patients’ care should be proactively delayed/postponed. The Chairs will provide high level oversight; the faculty members are expected to run their personal clinic lists and have their assistants make the call. The Chair will provide advice and guidance to physicians so we don’t make idiosyncratic determinations to cancel everyone (or cancel no-one). While it is hard to define some visits/procedures as elective, we estimate >60% of clinic visits will be deemed elective and deferred until after July 2020.

2) Patients who present for a scheduled visit will be screened and masked where appropriate, then sent to their appointment where we ask care teams to quickly determine whether or not to proceed with or delay the appointment upon assessment.

3) Regarding communication and following chain of command: Please do not send mass emails and work through myself as Department Head or your Division Chair if you wish to raise concerns about patient care matters or policies.

4) Regarding video visits: This is an important but elective extension of our practice. We have been working carefully with KHSC and SEAMO, under Dr. Apireddy’s leadership, and will be rolling out the REACTS platform, since OTN is unable to enroll any more physicians to their program. Physicians can be members of both services. This is the way health care is going and will help with avoidance of visits to clinics and the Emergency Department but is not relevant to management of life and death cases. Thus we must take the time to do the roll out (for staff, physicians and patients ) in a way that helps, rather than one that is rushed an creates confusion. Costs for REATCS subscriptions will be covered by SEAMO (per Danielle Claus) and/or KHSC and we have adequate subscriptions to include housestaff.

Summary of update from Dr Evans:

  1. We have not had a confirmed COVID-19 case in an admitted patient at KHSC thus far
  2. There are 3 cases of COVID-19 in the SELHIN (all recovering at home)
  3. PPE is not required for use unless a patient has or is suspected to have COVID-19. Please avoiding wasting our short supply of PPE by using it unnecessarily. PPE is not to be removed from the hospital.
  4. There are emerging treatments for COVID-19 including chloroquine but these are not yet approved for use and, if they are, will be released through Dr. Evans and the P&T committee.

Summary of update from Dr. Chris Smith

  1. The plans for staffing two COVID-19 wards is completed and most of the additional physician staffing has been arranged. We thank the many physicians who have volunteered for this service and our Medicine program managers and administrative counterparts who are managing patient flow, decanting patients and preparing for an anticipated need for these wards.
  2. Activities are being coordinated with the hospital and our colleagues in Critical Care and Emergency Medicine

Summary of update from Dr. Raman Appireddy

Dr. Appireddy explain how all physicians can create an account in REACTS and then use this platform to perform e-visits. OHN is not taking new subscriptions now so all physicians should sign up with REACTS is they wish to do video visits (which the DOM encourages). These visits must be associated with a clinical encounter in the electronic health record, which your clinical secretary can implement. This is required to allow dictation and billing. SEAMO has provided the new e-consult billing codes but all physicians need to do is use the billing sheet and track their time in 5 minute intervals. Ramana’s slides were distributed to all DOM members and the session was recorded to share with other Departments.

New Updates from KHSC:

  1. Blood products: We have received a recent notification from the Canadian Blood Services (CBS) that while current inventory remains adequate, they are anticipating possible shortage of all fresh blood products and plasma protein products. The anticipated shortage is secondary to the impact of the COVID-19 pandemic and significant cancellations at CBS donation centers: as a result, blood inventory levels may become reduced quickly, therefore judicious and conservative usage is required by all departments in order to conserve blood products for critical cases. Please:

- Limit routine blood work and phlebotomy volumes in anemic patients, where possible

- Avoid ordering Type and Screen or crossmatch unless evidence transfusion is indicated

- Ordering of blood products should be in line with evidence-based transfusion thresholds

Tomorrow: Please stay tuned tomorrow for a blog post “Covid-19: are their lessons from hockey as we enter the 1st period?”

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