Latest / The SHEA Podcast / Practice Of Obstetric Care during COVID - 19 with ACOG

Transcript

Practice Of Obstetric Care during COVID - 19 with ACOG · The SHEA Podcast

• 0:10
  SPEAKER_01: Welcome to the We're All in This Together COVID-19 Allies and Infection Prevention podcast series as part of the Society for Healthcare Epidemiology of America Rapid Response Program.
• 0:22
  SPEAKER_01: I am Dr.
• 0:23
  SPEAKER_01: Anestic Samuels, an assistant professor of pediatrics at the Johns Hopkins University School of Medicine and Associate Hospital Epidemiologist for the Johns Hopkins Hospital.
• 0:33
  SPEAKER_01: I will serve as your Shay moderator and speaker.
• 0:36
  SPEAKER_01: I'm also happy to welcome Dr.
• 0:38
  SPEAKER_01: Denise Jameson, James Robert McCord Professor and Chair of the Department of Gynecology and Obstetrics at Emory University School of Medicine.
• 0:48
  SPEAKER_01: She will serve as your American College of Obstetricians and Gynecologist, ACOG speaker, for today's podcast.
• 0:55
  SPEAKER_01: Discussion on the podcast does not reflect Jay or ACOG's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 1:06
  SPEAKER_01: Today's episode will focus on collaborations and how we as a team can work together to address the most important questions surrounding the COVID-19 outbreak.
• 1:16
  SPEAKER_01: Let's get started with our first question.
• 1:19
  SPEAKER_01: So, Dr.
• 1:19
  SPEAKER_01: Jameson, please describe what you or your organization is doing to address COVID-19.
• 1:26
  SPEAKER_00: Sure.
• 1:26
  SPEAKER_00: So I wear kind of two hats.
• 1:28
  SPEAKER_00: I am a member of ACOG's immunization, infectious disease, and public health preparedness work group, which during the pandemic has really morphed into a COVID work group as well.
• 1:40
  SPEAKER_00: And in my role with ACOG, we have been examining evidence as it becomes available and making recommendations and guidance.
• 1:49
  SPEAKER_00: So we issued a our work group issued a practice advisory fairly early on in the pandemic that basically answers questions that obstetrician gynecologists need to know about COVID.
• 2:00
  SPEAKER_00: We also have FAQs for both providers as well as patients.
• 2:05
  SPEAKER_00: We have an assessment and management algorithm that was built upon an influenza algorithm.
• 2:11
  SPEAKER_00: The website links to relevant resources such as the CDC and other organizations.
• 2:17
  SPEAKER_00: My second hat is that I am the chair of a fairly large department of gynecology and obstetrics at Grady.
• 2:24
  SPEAKER_00: We have four hospitals that are delivery hospitals where we have labor delivery units.
• 2:29
  SPEAKER_00: And so I've had the opportunity to implement some of the changes and implement some of the recommendations that have been coming out of our ACOG preparedness work group.
• 2:38
  SPEAKER_01: So it sounds like you've had a lot of experience and kind of a multifaceted response.
• 2:44
  SPEAKER_01: What do you think has been the biggest challenge around COVID-19 for the field of obstetrics and gynecology?
• 2:51
  SPEAKER_01: How has ACOG or your institution handled the situation?
• 2:55
  SPEAKER_01: How has it worked?
• 2:56
  SPEAKER_00: I think there have been a number of large challenges in our field.
• 3:01
  SPEAKER_00: I think one of the first challenges is the lack of evidence, the lack of data.
• 3:07
  SPEAKER_00: Although we learn more every day, there are still large gaps in what we know about COVID and pregnancy.
• 3:14
  SPEAKER_00: And part of that is lack of a nationwide systematic surveillance system that collects information on pregnant women.
• 3:23
  SPEAKER_00: That has really hindered our ability to quickly gather information and then make evidence-based recommendations.
• 3:31
  SPEAKER_00: So we're now getting more and more reports in, but again, the lack of a national surveillance system for pregnancy and COVID has really hindered our ability to provide evidence-based recommendations.
• 3:45
  SPEAKER_00: The second major stress has really been on our providers, on our obstetric providers.
• 3:51
  SPEAKER_00: This is a terribly challenging time.
• 3:54
  SPEAKER_00: There's financial strain, many families have lost income, there's disproportionate stress on women who may be the primary caregivers for children who may be out of school.
• 4:06
  SPEAKER_00: There are concerns about vulnerable family members such as elderly parents.
• 4:10
  SPEAKER_00: There have been concerns in the hospital about resources, not only worry and concern about are we going to have enough PPE, but other shortages in the hospital in a way that I have not seen in the 23 years I've been practicing since residency.
• 4:25
  SPEAKER_00: There has also been a lot of anxiety and concern about the national response to COVID.
• 4:31
  SPEAKER_00: Every week during my chair update, which I give after grand rounds on Wednesday mornings, I remind the faculty that their professional responsibility extends beyond the walls of the hospital and beyond their official EMRI activities.
• 4:46
  SPEAKER_00: And as physicians, we have an ethical obligation to do all we can to keep our patients safe.
• 4:51
  SPEAKER_00: And if we take risks outside the hospital, these risks can result in inadvertent exposures to our patients and to our colleagues.
• 4:59
  SPEAKER_00: And so we feel tremendous professional responsibility, both inside the hospital where we're exposed to COVID patients, as well as outside the hospital.
• 5:10
  SPEAKER_00: When we look around and people are not wearing masks, or there's not national leadership following public health advice to wear a mask, to do the things that we know are important from a public health perspective, to quarantine and contact trace of exposed, it's really, really hard on healthcare providers.
• 5:29
  SPEAKER_00: I read a great article recently on a musher of sled dogs in the New York Times by Blair Braverman.
• 5:37
  SPEAKER_00: And Blair said the following: here's the thing about sled dogs.
• 5:40
  SPEAKER_00: They never know how far they're going to run.
• 5:42
  SPEAKER_00: As a musher, the human driver of a dog sled team, this is one of my main challenges.
• 5:48
  SPEAKER_00: So, in the same way that sled dogs don't know where the finish line is, I think we don't know where the finish line is.
• 5:53
  SPEAKER_00: We don't know when this pandemic is going to be over, and that creates tremendous stress for our healthcare providers who feel like they're running 100 miles an hour and they don't know when they get to finish.
• 6:04
  SPEAKER_01: Yeah, this pandemic has certainly led to a lot of changes for both leadership as well as healthcare providers.
• 6:13
  SPEAKER_01: Have you made any other changes to your practice as a result of the pandemic?
• 6:18
  SPEAKER_01: What has driven some of those changes?
• 6:20
  SPEAKER_01: And have those changes themselves then presented any new challenges?
• 6:24
  SPEAKER_00: So, yes, we have made changes to all aspects of our practices, some which I think will go away after this pandemic is over, and some which I think will remain.
• 6:35
  SPEAKER_00: In terms of changes to inpatient care, you know, we don't allow visitors, we allow one support person on labor and delivery.
• 6:43
  SPEAKER_00: We're testing all our patients on labor and delivery.
• 6:46
  SPEAKER_00: Our healthcare workers are wearing masks and eye protections for off contacts with all patients.
• 6:52
  SPEAKER_00: Everyone is in a mask.
• 6:53
  SPEAKER_00: There's physical distancing, you know, in elevators and in waiting areas and in lines.
• 6:59
  SPEAKER_00: We're frequently cleaning in high-touch areas.
• 7:02
  SPEAKER_00: We've got plexiclass barriers up all over the hospital.
• 7:06
  SPEAKER_00: Many of these changes extend into our outpatient settings where we're spacing visits, we're minimizing or eliminating people waiting in the waiting room.
• 7:15
  SPEAKER_00: One positive thing that I hope will live past the pandemic is we've implemented telehealth in a large way, in a way that we talked about for years and never quite got around to doing, and now we're doing it.
• 7:26
  SPEAKER_00: And we're learning that some areas of OBGYN practice are very well suited to telehealth, such as our reproductive endocrinology and infertility practice.
• 7:35
  SPEAKER_00: And some areas are much less amenable to telehealth.
• 7:41
  SPEAKER_00: We're thinking about when it's necessary for a patient to come in and when visits can be decreased.
• 7:46
  SPEAKER_00: For example, our prenatal care schedule.
• 7:49
  SPEAKER_00: We're not seeing patients necessarily as often if it's not needed.
• 7:53
  SPEAKER_00: And then there have been all sorts of challenges with implementing these changes.
• 7:57
  SPEAKER_00: Some of the PPE is cumbersome, it can be uncomfortable, it can limit your site, we worry about the supply chain for many of the items of PPE.
• 8:07
  SPEAKER_00: So we had some solutions, but challenges remain.
• 8:11
  SPEAKER_00: Yes, they certainly do.
• 8:13
  SPEAKER_01: Do you think there are opportunities for individuals working in healthcare epidemiology and hospital medicine to work together to help handle this pandemic in the upcoming year or even long term?
• 8:26
  SPEAKER_00: It's interesting.
• 8:27
  SPEAKER_00: Here at Emray, our hospital epidemiologists have taken on a whole new stature.
• 8:34
  SPEAKER_00: They have a whole new stature in our healthcare system.
• 8:37
  SPEAKER_00: Their input has been so incredibly valuable and reassuring.
• 8:41
  SPEAKER_00: We have had, for example, one of our hospital epidemiologists talking with us about how to do contact tracing in a healthcare setting.
• 8:50
  SPEAKER_00: There was concern about who needs to be quarantined and tested and when can people people come back, safely come back to work.
• 8:57
  SPEAKER_00: And so I think this has really provided a whole new opportunity for us to collaborate with our healthcare epidemiologists in a way we didn't think about before.
• 9:08
  SPEAKER_00: I spent 20 years at the Centers for Disease Control and Prevention at the CDC and had a lot of opportunity to interact on a daily basis with epidemiologists and then came to Emery three years ago.
• 9:20
  SPEAKER_00: And really, this pandemic has led me to collaborate and partner with healthcare epidemiologists in a way that I have not before.
• 9:30
  SPEAKER_00: So I hope that that's one long-lasting positive thing that can come out of this pandemic.
• 9:36
  SPEAKER_01: Yeah, ongoing collaboration would be certainly a positive outcome.
• 9:40
  SPEAKER_01: Well, thank you so much to Dr.
• 9:42
  SPEAKER_01: Jameson for joining us today and sharing your perspectives and experiences.
• 9:48
  SPEAKER_01: We really appreciate the opportunity to speak with you.
• 9:51
  SPEAKER_01: And we would also like to extend a sincere thank you from Shay to all healthcare personnel for all that you're doing to respond to the COVID-19 pandemic and caring for patients.
• 10:01
  SPEAKER_01: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 10:09
  SPEAKER_01: You'll also find additional resources such as the recorded webinars and Shay COVID-19 town halls and the additional podcast series COVID-19 update, What We Know Now, which is released every Thursday.
• 10:23
  SPEAKER_01: This concludes this episode of the Allies and Infection Prevention Podcast Series.
• 10:28
  SPEAKER_01: Thank you for tuning in.