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Knowledge Sharing with SHM · The SHEA Podcast

• 0:07
  SPEAKER_00: Welcome to the podcast series, We're All in This Together, COVID-19 Allies in Infection Prevention, as part of the Society for Healthcare Epidemiology of America's SHAY's Rapid Response Program.
• 0:18
  SPEAKER_00: I am Dr.
• 0:18
  SPEAKER_00: Valerie Vaughn, Assistant Professor of Medicine and Hospitalist at the University of Michigan and VA Ann Arbor Healthcare System, and I will be serving as your SHA moderator and speaker for today's podcast.
• 0:29
  SPEAKER_00: I'm also happy to welcome Dr.
• 0:30
  SPEAKER_00: Joseph Sweigart, Associate Professor at the University of Kentucky Division of Hospital Medicine, who will serve as your Society of Hospital Medicine or SHM speaker for today's podcast.
• 0:41
  SPEAKER_00: Discussion on the podcast does not reflect SHAY or SHM's perspective, but does facilitate communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:51
  SPEAKER_00: Today's episode will focus on collaborations between healthcare epidemiology and hospital medicine and how we as a team can work together to address the most important questions surrounding the COVID-19 outbreak.
• 1:03
  SPEAKER_00: Dr.
• 1:04
  SPEAKER_00: Sweiger, maybe you can get us started by telling us a little bit about your organization's experience with COVID-19 today.
• 1:10
  SPEAKER_01: Yeah, well, thank you very much.
• 1:11
  SPEAKER_01: Thanks for having me.
• 1:12
  SPEAKER_01: I'm excited to be here having this conversation, being a part of this conversation.
• 1:16
  SPEAKER_01: In Kentucky, we've been fairly lucky that we haven't had huge outbreaks.
• 1:19
  SPEAKER_01: We sort of have effectively flattened the peak, so to speak.
• 1:22
  SPEAKER_01: And what that's meant for us is we've been sort of in and out of surge mode as this has gone on.
• 1:27
  SPEAKER_01: As of right now, today, there's currently a small outbreak in a federal prison facility here in town, and also a couple of cases coming out of a nursing home here in town.
• 1:36
  SPEAKER_01: So everyone's pretty nervous about it.
• 1:37
  SPEAKER_01: But as of today, we are not in surge mode.
• 1:40
  SPEAKER_01: Surge mode for us is kind of the company model, you know, where platoons are activated and things.
• 1:44
  SPEAKER_01: So far, so good.
• 1:45
  SPEAKER_01: We're not in surge mode, but we have been before, and there's lots of fear and lots of anxiety that we will be again.
• 1:51
  SPEAKER_00: Well, that's great.
• 1:52
  SPEAKER_00: Yeah, I'm glad you guys are doing okay.
• 1:54
  SPEAKER_00: Is there anything that SHM has done as a society to help with COVID-19?
• 1:58
  SPEAKER_01: Yeah, they have.
• 1:59
  SPEAKER_01: As of early March, so when we were still getting sort of warmed up, still learning a lot about what's going on with COVID-19, SHM moved lots of content out from member-only access to temporarily being free for everyone.
• 2:09
  SPEAKER_01: So this included lots of content, but especially the critical care content for the hospitalists.
• 2:14
  SPEAKER_01: So there's a series on SHM's learning portal that includes things like mechanical ventilation and some other high-yield topics for ICU care.
• 2:20
  SPEAKER_01: And there's been over a 200% spike in new users since they did that in March.
• 2:25
  SPEAKER_01: And over a thousand people have started taking the mechanical ventilation module, which I think is a testament that hospitalists are doing a lot of critical care, helping sort of bear the critical care burden right now.
• 2:36
  SPEAKER_00: Yeah, wow, that's a big increase.
• 2:38
  SPEAKER_00: And I think really speaks to kind of the local experience we've had at the University of Michigan as well.
• 2:43
  SPEAKER_00: In Michigan, we're lucky in that we're finally in the downswing.
• 2:47
  SPEAKER_00: But obviously, we had some pretty tough time going earlier in the year.
• 2:52
  SPEAKER_00: At the University of Michigan, we peaked in mid-April at around 230 hospitalized patients, but had over 500 patients with COVID-19 over the kind of two-month period of our surge.
• 3:03
  SPEAKER_00: And I think really had a unique role in the pandemic.
• 3:06
  SPEAKER_00: Kind of what you're speaking of with the firewall traffic that's or the content from SHM is that we really had to increase our ICU capacity because Ann Arbor itself, which is our local community for the university, didn't have that many cases, but Southeast Michigan was really hit.
• 3:24
  SPEAKER_00: And so the University of Michigan helped play kind of a critical role in taking intensive care patients, those who were either critically ill or or needed ECMO to the hospital.
• 3:34
  SPEAKER_00: And that meant over the course of 14 days, we increased our ICU capacity from 100 to 250 ICU beds.
• 3:42
  SPEAKER_00: And it wasn't just the beds, obviously, that meant you needed the staff to take care of it.
• 3:46
  SPEAKER_00: And so our hospitalists ended up forming kind of a unit with intensive care physicians where we'd have four to five hospital medicine teams with an ICU physician consulting.
• 3:56
  SPEAKER_00: And we had to rapidly up train hospitalists to serve as intensivists, how to manage ventilators, how to treat patients with heated high flow oxygen, pressors, sedation.
• 4:06
  SPEAKER_00: And now our big issue is actually tracheostomies because a lot of these patients have been on vents for you know weeks and finally got tracheostomies.
• 4:15
  SPEAKER_00: So learning a lot of that care, which is not usually in our wheelhouse.
• 4:19
  SPEAKER_00: So I know the work done by SHM has been really helpful to kind of help hospitalists across the country, I think, move into this new zone.
• 4:26
  SPEAKER_01: Yeah, I think so.
• 4:27
  SPEAKER_01: I hope so.
• 4:28
  SPEAKER_01: And it's interesting because as people like you and your group are moving from hospital medicine sort of into the critical care, into the ICU space, that's left a real void.
• 4:36
  SPEAKER_01: So that leaves floor patients, inpatients, general medical ward patients who need doctors and need care while their hospitalists are pulled away.
• 4:44
  SPEAKER_01: And I know there's been a lot of places who've had to pull in non-hospital medicine providers in order to get them to take care of the non-COVID inpatients.
• 4:52
  SPEAKER_01: And that's something that SHM's also been pretty involved in.
• 4:55
  SPEAKER_01: So we also, a group of us that I was happy to be a part of, got a bunch of people together, pulled a bunch of resources, and put together sort of an onboarding toolkit to help group leaders and group administrators think through some of the logistical difficulties of bringing in and rapidly onboarding people who aren't hospitalists but are going to be called upon, going to be asked to take care of medical inpatients during the crisis.
• 5:17
  SPEAKER_00: Yeah, no, that's really interesting.
• 5:18
  SPEAKER_00: Exactly like you said, you know, as as our hospitalists got pulled into the ICUs, that meant that a void was left behind.
• 5:25
  SPEAKER_00: We had to pull in a lot of outpatient or subspecialty docs onto our floors to serve as temporary hospitalists.
• 5:32
  SPEAKER_00: And one strategy we found helpful was to actually, we paired them with residents who may not be full-fledged physicians, but had a lot of experience with the system and especially with the electronic medical record.
• 5:45
  SPEAKER_00: You know, I think that's a big barrier, is there's a steep learning curve.
• 5:48
  SPEAKER_00: And so kind of uh pairing together outpatient docs and residents was one of our strategies that I think worked really well.
• 5:54
  SPEAKER_01: Yeah, and and I know that a lot of places, including Michigan, also publicized or gave everyone access to their handbooks.
• 6:01
  SPEAKER_01: And uh UCSF out in California did it as well.
• 6:03
  SPEAKER_01: Some of their sort of general medicine guidebooks or manuals, and there's a lot of other clinical resources as well, have just been made available to people publicly, partially to help deal with this situation where people who don't do this all day, every day are being asked to do it.
• 6:16
  SPEAKER_00: Yeah, yeah, no, absolutely.
• 6:17
  SPEAKER_00: I think the knowledge sharing has just been great.
• 6:19
  SPEAKER_00: What would you say has been kind of the biggest challenge that you've seen around COVID-19?
• 6:24
  SPEAKER_01: Yeah, I mean, I I think the thing that we're feeling the most all day, every day are the PPE shortages here.
• 6:29
  SPEAKER_01: People want to feel like they're active, they want to feel like they're protected.
• 6:32
  SPEAKER_01: I think by and large, people want to come to work, they want to be a part of it.
• 6:36
  SPEAKER_01: Um, but that sort of fervor is measured against what have been very real, very sort of palpable concerns about running out of PPE.
• 6:43
  SPEAKER_01: And that I think has really contributed to a lot of the anxiety around not only taking care of patients who are COVID positive, but just, you know, sort of coming to work and being a part of healthcare now.
• 6:54
  SPEAKER_00: Yeah, I think the PPE shortages have been difficult and especially managing kind of the fear.
• 7:00
  SPEAKER_00: I think kind of building off of that, the uncertainty in general has been one of the hardest things.
• 7:04
  SPEAKER_00: You know, as we spoke about, if you're having people work in units that they're not used to, dealing kind of with the uncertainty, the constantly shifting roles has just been really hard.
• 7:13
  SPEAKER_00: And I mean, even leadership doesn't know what's going to happen, you know?
• 7:17
  SPEAKER_00: So this isn't a case of not sharing knowledge, it's the fact that no one knows what the future is gonna look like with COVID-19.
• 7:23
  SPEAKER_00: And during the surge, you don't know what six hours from now is gonna look like, and definitely not what two weeks from now is gonna look like.
• 7:30
  SPEAKER_00: So I think that's been a really hard thing, both for frontline staff and and for for leadership as well.
• 7:37
  SPEAKER_00: How do you kind of keep morale up when people have no idea what tomorrow morning is gonna look like?
• 7:42
  SPEAKER_01: Yeah, no, I think that's real, and I think people are are really anxious about it.
• 7:46
  SPEAKER_01: I I am happy that some things are sort of starting to get back to what some of us here are calling the sort of new normal.
• 7:51
  SPEAKER_01: So um, you know, everything's remote now.
• 7:53
  SPEAKER_01: So I do a lot of work with residency education and med student education.
• 7:57
  SPEAKER_01: All of those meetings, all of those talks, all of that content is now being delivered remotely.
• 8:01
  SPEAKER_01: So I gave a lecture to a whole class of med students via Zoom a couple weeks ago.
• 8:05
  SPEAKER_01: So I just sat in my office and talked into a blank computer screen.
• 8:08
  SPEAKER_01: It was it was terrifying, but I think I think we're gonna do more and more of that.
• 8:13
  SPEAKER_00: Yeah, how did you enjoy that?
• 8:14
  SPEAKER_01: Uh it was scary.
• 8:16
  SPEAKER_01: It's you know, none of them um share their video, so you're just talking to a bunch of silhouettes of uh of med students.
• 8:22
  SPEAKER_01: And then clinically, you know, it's been really dramatic.
• 8:24
  SPEAKER_01: And you've probably felt this too.
• 8:26
  SPEAKER_01: You know, there's no visitors anymore in the hospital.
• 8:29
  SPEAKER_01: And so I guess I really hadn't thought through what that would look like or feel like when I heard the announcements that visitors were kind of no longer gonna be allowed in any of the hospitals.
• 8:37
  SPEAKER_01: But, you know, for the non-COVID patients, they're still sick, they still need help, they're still sometimes old, sometimes confused, and we're still sometimes delivering really, really bad news, really, really heavy diagnoses.
• 8:50
  SPEAKER_01: You know, as a hospitalist, you kind of take for granted that there's gonna be people in the room, family, friends, whatever, or that when you step out after delivering a huge piece of bad news, that there's gonna be a support structure there, the patient's normal life support structure that can come in and sort of help pick them back up.
• 9:05
  SPEAKER_01: But but that's gone now.
• 9:06
  SPEAKER_01: And it's I think it's really isolating for them.
• 9:09
  SPEAKER_00: Yeah, no, absolutely.
• 9:10
  SPEAKER_00: I I've felt that isolation and and devastation, both as a provider and I know patients feel it, but also just as a clinician, you're used to, I usually get my energy and excitement from conversations with patients and from family, and and you take that away and it's just not the same over video.
• 9:29
  SPEAKER_00: It's just not the same when you're behind a mask and you can't hold someone's hand when you're giving them bad news or or something like that.
• 9:35
  SPEAKER_00: It's it makes the whole job very different.
• 9:38
  SPEAKER_01: Yeah.
• 9:38
  SPEAKER_01: I I also spend a lot of time at the VA where um many people have hearing deficits and rely on reading lips, which is of course impossible in the time of uh of masks with everybody covering their face up and their mouth up.
• 9:50
  SPEAKER_01: It's been really challenging.
• 9:51
  SPEAKER_01: I think many of us have taken to speaker phone rounding.
• 9:54
  SPEAKER_01: So we come into the room, it's like, you know, hey, good morning.
• 9:57
  SPEAKER_01: Call your wife or call your kids or call whoever you want to call and put them on speakerphone right now, trying to pull them in that way.
• 10:03
  SPEAKER_01: Or um, you know, otherwise we're all just back in our offices calling families all afternoon, um, giving them updates that they otherwise could have heard when we came around on rounds, but they're not allowed to come in.
• 10:13
  SPEAKER_00: Yeah, you know, I think it's actually one of the cool things that has come out of this is that I've seen a lot of really interesting technological adaptations to try to help facilitate communication.
• 10:24
  SPEAKER_00: One of the things we're doing now is kind of video rounding and video visits with family.
• 10:29
  SPEAKER_00: Um, and even for patients who are in the hospital, you know, to try to reduce, especially during the surge when we were limited with PPE to try to reduce room entrances, we were using like drop-in video services into patient rooms.
• 10:44
  SPEAKER_00: So you could actually still get a pretty decent physical exam.
• 10:46
  SPEAKER_00: You know, I remember having patients, you know, stand up, walk across the room, you know, get back in bed.
• 10:52
  SPEAKER_00: And, you know, the ability to watch them do that gives you a pretty good idea of, you know, what's their pulmonary status.
• 10:57
  SPEAKER_00: If you have them on telemetry, you know, what their heart rate does in response to movement, and you can get a lot of information.
• 11:03
  SPEAKER_00: And actually the fun part about that is you can video visit into the room with you know, mask off and actually smile and laugh and they can see your face.
• 11:12
  SPEAKER_01: Yeah, and they probably love that.
• 11:14
  SPEAKER_00: Yeah, yeah, exactly.
• 11:15
  SPEAKER_00: It takes a little bit to get used to, I think, to have them, you know, this face on the wall that suddenly starts talking to you.
• 11:21
  SPEAKER_00: But yeah, um, I hope some of those things can continue.
• 11:24
  SPEAKER_00: I know, you know, even when you're in massive hospitals, if you have a patient that's like eight floors away, you know that you're less likely to go up there and having something where you can like drop in and like say hi and have a video visit might be a good thing to keep around for a bit.
• 11:40
  SPEAKER_01: Yeah, that's really cool.
• 11:41
  SPEAKER_00: But you know, largely this pandemic has really hit, I think, hospital medicine hard.
• 11:46
  SPEAKER_00: Hospital medicine has been on the front line of this, but obviously healthcare epidemiologists as well.
• 11:51
  SPEAKER_00: Yeah.
• 11:51
  SPEAKER_00: What do you see as some of the ways that kind of the two groups can work together to handle this pandemic now and and later?
• 11:58
  SPEAKER_00: Yeah.
• 11:58
  SPEAKER_00: What what do you need the most?
• 12:00
  SPEAKER_01: Yeah, I guess I'll I'll take those separately.
• 12:02
  SPEAKER_01: Uh the first one is sort of short term or now.
• 12:04
  SPEAKER_01: You know, I think we need to continue to refine our thresholds for moving in and out of surge mode.
• 12:09
  SPEAKER_01: And I think that that's happening at the society level.
• 12:12
  SPEAKER_01: We see different states and different communities taking different approaches, and I know there's a lot of data coming from that.
• 12:16
  SPEAKER_01: You know, and I think that we need that same kind of guidance and that same kind of iterative approach to reopening our hospitals, to figure it out, you know, when we can move from a company or from platoons back to our normal staffing models, how we can ease into reopening up some of our elective procedures and things like that.
• 12:34
  SPEAKER_01: And if and when we do, when do we need to flip back?
• 12:37
  SPEAKER_01: When do we need to go back sort of into surge mode or into crisis mode?
• 12:41
  SPEAKER_01: So I think helping define and maybe more importantly, over time refine some of those approaches is going to be really critical in the short term.
• 12:49
  SPEAKER_01: I guess in the longer term, one of the things that I've heard people starting to talk about and a little bit of chatter about is do we need to think about redesigning our workspace?
• 12:57
  SPEAKER_01: So as a hospitalist myself, like many hospitalists, I we sort of thrive in shared workspaces.
• 13:02
  SPEAKER_01: Like we love to be with our friends, be with our colleagues, be with our coworkers in you know, ward workrooms or or hospital medicine workrooms where there's just a lot of energy.
• 13:11
  SPEAKER_01: And I I love that environment.
• 13:13
  SPEAKER_01: I feed off that energy.
• 13:15
  SPEAKER_01: But that's a whole lot of people in really close quarters sharing computers and keyboards and mouses and just kind of sharing space.
• 13:22
  SPEAKER_01: So I think creative ways to think about recreating or or maybe redesigning some of those workspaces might be something that becomes really important in the longer term future that Shay could really help out with.
• 13:35
  SPEAKER_00: Yeah, that's a really interesting point.
• 13:37
  SPEAKER_00: You know, I've talked to some of my colleagues who have gotten COVID-19, and you know, you always assume it's going to be from a patient.
• 13:43
  SPEAKER_00: And some have actually mentioned that they think they got it from other colleagues who uh were sick because you know the guards are a little bit down when you're, you know, in the team room and and chit-chatting and laughing and eating lunch together, and maybe not especially early on, being as physically distanced as maybe we should be.
• 14:02
  SPEAKER_00: And obviously, I think continuing to understand the best way to use PPE, the best way to social distance both in the hospital and outside, and how to reopen hospitals and bring back patients and staffs and and the visitors is gonna be huge.
• 14:17
  SPEAKER_01: Yeah, absolutely.
• 14:18
  SPEAKER_01: And I I know all of us are looking forward to that.
• 14:20
  SPEAKER_01: I think, like you said, that's where so many of us draw our inspiration, our energy.
• 14:24
  SPEAKER_01: It sort of nourishes our souls to go and sit and talk with patients and talk with families.
• 14:28
  SPEAKER_01: And I think we're all missing it right now.
• 14:30
  SPEAKER_00: Yeah.
• 14:31
  SPEAKER_00: I know one of the cool experiences, I just want to take a moment to give a shout out to kind of our local epidemiologists and infection preventionists, because I feel like normally they're kind of the behind-the-scenes people.
• 14:43
  SPEAKER_00: And, you know, this has just been a really cool experience because obviously they've been down on the front lines with us, you know, and our hospital surge just really critical in how we planned and predicted our surge, really helped us think through PPE shortages.
• 14:58
  SPEAKER_00: And then, you know, whether it was the infection preventionists or safety monitors or other staff, like actually being on site.
• 15:05
  SPEAKER_00: So when we said, you know, now we have to start reusing N95s, that people are being kind of trained and monitored real time to keep us safe.
• 15:13
  SPEAKER_00: So I think that's just been a really fun kind of collaboration that has come out of this because normally, normally we don't work side by side, but we definitely were during the surge.
• 15:23
  SPEAKER_01: Yeah, that's really cool.
• 15:24
  SPEAKER_00: Well, I want to thank you so much for all of your time and for joining us today and sharing your perspectives and experiences.
• 15:31
  SPEAKER_00: I think this has been a really fun conversation to hear about your thoughts and what's been going on in Kentucky.
• 15:37
  SPEAKER_01: Yeah, absolutely.
• 15:38
  SPEAKER_01: It's it's my pleasure.
• 15:39
  SPEAKER_01: I think uh anything that might help contribute to sort of rebuilding the sense of community that we're all missing out on so much right now is is absolutely something that I'm excited to be a part of.
• 15:47
  SPEAKER_01: So this has been a lot of fun.
• 15:48
  SPEAKER_01: I really appreciate it.
• 15:48
  SPEAKER_01: Thank you.
• 15:49
  SPEAKER_00: And a sincere thank you from Shay to all of the healthcare personnel for all that you've been doing to respond to COVID-19.
• 15:56
  SPEAKER_00: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 16:02
  SPEAKER_00: You'll also find additional resources such as the recorded webinars, healthcare facility outbreak preparedness, and the Shay COVID-19 town halls, as well as the additional podcast series, COVID-19 updates, what we need to know, which is released every Thursday.
• 16:17
  SPEAKER_00: That concludes this episode of the COVID-19 Allies and Infection Prevention podcast series.
• 16:22
  SPEAKER_00: Thank you for tuning in, and thank you so much again, Dr.
• 16:25
  SPEAKER_00: Swigart, for joining us.