COVID-19 Physician Town Hall · Steve Svoboda Telehealth Dana Gilbert Nursing / Post - Acute Care Michelle Hereford Care Design/ Creative Care Delivery Models Mary Murphy Engagement

April 3rd, 2020

COVID-19 Physician Town Hall

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ReflectionDr. Colleen Hagen, CIN Medical Director

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Pandemic

What if you thought of it

as the Jews consider the Sabbath–

the most sacred of times?

Cease from travel.

Cease from buying and selling.

Give up, just for now,

on trying to make the world

different than it is

Sing. Pray. Touch only those

to whom you commit your life.

Center down

And when your body has become still,

reach out with your heart.

Know that we are connected

in ways that are terrifying and

beautiful

(You could hardly deny it now.)

Know that our lives are in one another’s

hands.

(Surely, that has come clear.)

Do not reach out your hands.

Reach out your heart.

Reach out your words.

Reach out all the tendrils

of compassion that move, invisibly,

where we cannot touch.

Promise this world your love–

for better or for worse,

in sickness and in health,

as long as we all shall live.

--Lynn Ungar 3/11/20

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Meeting Agenda

ReflectionDr. Colleen Hagen

CIN Medical Director

Opening

Don Franke

SVP, Population Health and CEO, AMITA Health

Care Networks

Provider Well-BeingDr. David Roque

CIN Medical Director

AMITA COVID-19 Command CenterDr. Stuart Marcus

EVP, Chief Clinical Officer

Hospital Preparedness

Kenneth Jones

President, AMITA Health St. Francis Hospital

Evanston

Pulmonary and Critical CareDr. Neeraj Desai

Medical Director, Interventional Pulmonology

Testing Dr. Reinhold Llerena

President, AMITA Medical Group

Closing RemarksDr. Joseph Lagattuta

CIN Board Chair

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AMITA Physician Hotline Phone Number

224.273.3900 from 7 am to 7 pm weekdays for the foreseeable future

AMITA Physician Hotline Email

[email protected]

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Financial Support Opportunities Related to COVID-19

• Financial Relief For Medicare Providers:https://www.cms.gov/newsroom/press-releases/trump-administration-

provides-financial-relief-medicare-providers

• Accelerated and Advanced Payments Program for

Providers:https://www.cms.gov/files/document/Accelerated-and-Advanced-

Payments-Fact-Sheet.pdf

• Temporary regulatory waivers and new rules for

Clinicians to respond to the 2019 Novel Coronavirus

(COVID-19) pandemic:https://www.cms.gov/files/document/covid-19-physicians-and-

practitioners.pdf

• Small Business Association Loan Program: https://covid19relief.sba.gov/#/

• Physicians looking for practice alternatives are welcome

to contact Drew Palumbo [email protected]

Summary document can be found at AMITAhealth.org/covid-19-AMITA

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NEW: Physician Frequently Asked QuestionsAMITA Health COVID-19 Playbooks can be found here: AMITAhealth.org/covid-19-AMITA

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Available Resources and PlaybooksAMITA Health COVID-19 Playbooks can be found here: AMITAhealth.org/covid-19-AMITA

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COVID-19 Infection Prevention Playbook AMITA Health COVID-19 Playbooks can be found here: AMITAhealth.org/covid-19-AMITA

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Provider Well-beingDr. David Roque, CIN Medical Director

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Virtual Support Group for AMITA Providers

• Groups are a confidential and voluntary forum to share COVID-19 anxieties and apprehensions,

as well as strategies to manage discomfort with colleagues

• Intended to be a place to share and reinforce evidence-based strategies to manage anxiety

• These are not webinars or tip sheets, and do not take the place of informational town halls

• Also planning a Saturday, 3 pm group starting on April 18, and considering groups with

specialized topics such as dealing with death and dying

• Three virtual group meetings have already occurred with favorable response

• Physicians are welcome to invite their staff and colleagues

Virtual Support Group for AMITA

Providers

Wednesdays 4/8 – 4/29

7:00 AM to 8:00 AM

Dial-in: (331) 303-8777,,697305272#

Virtual Anxiety Support Group for

Associates and Providers

Fridays 4/10 – 4/24

12:00 PM to 1:00 PM

Dial-in: (331) 303-8777,,593396039#

Dr. Cliff Saper from Behavioral Medicine will be facilitating a series of Virtual Support Groups for AMITA

providers.

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Counseling Support for Physicians

Choose one of these psychologists to partner with you on your journey to well-being, anonymously:

Your AMITA Health Medical Staff Office provides physicians up to six (6) complimentary sessions with a non-

affiliated, licensed psychologist.

Cher A. Geiger, Psy. D.

11 N Grant Street, Suite 204

Hinsdale, IL 60521

630.631.9523

Kristin Krueger, PhD

110 East Schiller Street, Suite 306

Elmhurst, IL, 60126

312.343.8660

Steven P. Johnson, PhD

3405 N Kennicott Avenue #B

Arlington Heights, IL, 60004

847.508.2926

Dr Terrence Koller

1740 Ridge Ave., Suite 200C

Evanston, IL, 60201

847.475.5551

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AMITA COVID-19 Command Center Dr. Stuart Marcus, EVP, Chief Clinical Officer

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AMITA Health COVID-19 Command Center StructureCOVID-19 AMITA HEALTH Command Center Structure/Task Forces

Dyad Leadership

AMITA Clinical Lead | Incident Command

Dr. Stuart Marcus | Craig S Kuhl

Liaison Officer

Jeff Butler

Updated 3/30/2020 v1

[email protected]: 224-273-0163

IT/Technology

Sherrie Russell

Analytics & Project

Management

Hetal Desai

Nursing/Post-

Acute Care

Michelle Hereford

Finance

Thor Thordarson

Logistics

Scott Teffeteller

Infection Control

Mary Ann Palermo

Incident Command and Task Force Leads meet twice daily

Medical Staff

Don Franke

PM: Alyssa Howell

& Patricia Mencia

Medical Group

Drew Palumbo

Dr. Reinhold

Llerena

Hotline/ Medical

Staff

David Hurter

Ambulatory

Testing

Robyn Parker

Pharmacy

Sun Lee-Such

Credentialing

Jeanne LaBee

Svc Ln: Neuro/

Ortho/Onc

Alexis Barbour

Critical Care

Kim French

Svc Ln: Cardiology

Noel Araneta/

Cathie Biga

Svc Ln: Digestive/

Women’s/Peds

Darcy Lorenzen

GME

Steve Svoboda

Telehealth

Dana Gilbert

Nursing / Post-

Acute Care

Michelle Hereford

Care Design/

Creative Care

Delivery Models

Mary Murphy

Engagement

Shawn O’Connor

Angela Moy

Care Continuum/

Post-Acute

Ron Austin

Dr. Tim McCurry

Debra Ayanian

Beth Jelesky

Planning

Kenneth Jones

PM: Stephanie

Capanna

Acute Care Gap

Analysis

Kenneth Jones

Mary Murphy

Analytics

Shruti Nathan

Dr. Guy Dugan

Monika Tickoo

Alternative Care

Sites

Robert Dahl

HR Workforce

Mary Jo Smith

PM: Peggy Staudt

Assoc Benefits &

Resources (Child

Care, Dep, EAP)

Tracy Mendoza

Volunteer

Resource Pool

Shelli Simms

Housing

Pam Mitchell-Boyd

Transportation

Shannon Jermal

Associate Health

Carla Casia

Task Forces

Finance

Thor Thordarson

PM: Omar Ordaz

Communications

Olga Solares/

Tim Nelson

CFO Chicago

Mike Mulay

CFO Northwest

Kevin Larkin

CFO South

Shasha Chen

Nursing Labor, Pay

Practices, Staffing

Trisha Musich

Supply Chain

Ryan Jennens

Site Nursing

Operations

Site CNOs

CIN/ACO

Don Franke

Logistics

Scott Teffeteller

Facilities

Brian Radakovitz

TouchPoint

Todd Head

Security

Melissa Granato

Infection Control

Mary Ann Palermo

Playbooks

Stephanie Teets

PPE

Mary Ann Palermo

Ryan Jennens

Patient Result

Notification

Shannon Lynch

Patient Exposure

Notification

Melissa Wilson

Each hospital has a physical or

virtual command center as well

AMITA Executive Sponsor

Keith Parrott, CEO

Ethics

John Halstead

Local Ethics

Support (ELC)

Cavan Doyle

Stan Kedzior

Scarcity Review

Team

Cavan Doyle

Spiritual/

Psychosocial

Chris Novak

Matt Thibeau

Central Staffing

Office

Elaine Kemper

Associate Testing

Robyn Parker

Physician

Leadership

Council

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PPE / Supplies

• Excluding non-essential personnel from care areas

• Suspending non-urgent procedures

• Disinfecting and reusing PPE items such as goggles and face shields

• Employing extended use and re-use of face masks

• Cohorting of COVID-19 patients to conserve PPE

• Moving IV pumps out into the hallway

• Utilizing telemedicine

• Piloting reprocessing of masks

AMITA Health has implemented the PPE Conservation strategies mentioned below.

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Pharmacy Drug Conservation Efforts

Strategies to manage drug shortage:

1. Meeting with AMITA-wide pharmacy leadership daily to update inventory levels on our drug tracker

2. Leveraging Ascension and The Resource Group buying power

3. Engaging our primary vendor/wholesaler

4. Deploying around the clock critical medication procurement strategies

5. Working directly with drug manufacturers

6. Reaching out to state and local government

Conservation strategies have been developed for:

1. MDIs: Refer to the Pulmonary and Critical Care Playbook for guidance on when to use nebulized

options vs. MDIs

2. Tocilizumab: Criteria can be found on the AMITA Health COVID-19 Website under “Pharmaceutical

Guidance”

AMITA Pharmacy Services continues to focus on managing inventory and utilization of all vital medications,

including pharmacologic options for COVID-19 treatment, paralytics, analgesics, sedatives, etc.

Inventory Levels

as of 4/1/20

Northwest

RegionMetro Region South Region

Antibiotics Normal Normal Normal

IV Fluids Normal Normal Normal

Paralytics Critically Low Critically Low Critically Low

Benzodiazepines Low Low Low

Narcotics Low Low Low

Propofol Low Low Low

AMITAhealth.org/covid-19-AMITA

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AMITA Health COVID-19 Daily Dashboard – At a GlanceUpdated: April 2nd

AMITAhealth.org/covid-19-AMITA

Our request to you -When appropriate, please develop accelerated admit

and discharge plans for stable patients to increase bed

availability in the Emergency Room and our floors

during the surge

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Hospital PreparednessKenneth Jones, President, AMITA Health St. Francis Hospital Evanston

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Hospital Preparedness – Surge PlanningAMITA Health has developed a five phase Surge Plan. Each phase contemplates a progression from cohorting

in place to use nontraditional spaces for the care of patients requiring treatment. Figure 1 demonstrates the

progression and venue types considered for surge planning.

Traditional:Phase I Cohort in place

Phase II Expand into other clinical spaces/Potential

Cohort Covid acute patients

Non-traditional:Phase III Expand into non-acute space within hospital

(e.g., cafeterias, conference rooms, fitness centers)

Phase IV Expand into owned, non-owned, hospital-

based acute patient care facilities (within a 10-minute

proximity)

Phase V Expand into non-healthcare use space

• Phase V a. | off-campus, ambulatory, subacute

spaces, hotels, schools, or dormitories (min.

capacity 50 beds)

• Phase V b. | large open spaces like school and

college gymnasiums, and convention centers (min

capacity 200 beds)

• Phase V c. | large modular built COVID-19

Treatment Facilities (Bear Construction) or

other types of large venues, such as the McCormick

Place, Copernicus Center, Allstate Arena, Sears Ce

ntre Arena, etc.

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Chicago Metro Region/Draft – Phase IV, Phase Va, Phase VbCurrently the Alternative Options Workgroup is gathering information on all community organizations and

establishments offering partnership.

Key considerations:

1. PPE and supplies

2. Ventilators and associated critical care equipment/supplies

3. Telemedicine capability

4. Staffing: Critical care expertise/Respiratory Therapy

5. Facilities/negative pressure availability

6. Continuum of care/geographic scale

7. Pharmacy: supply of Propofol, Benzos, Morphine, Fentanyl

Surge Planning Model Assumptions:

First-come-first-serve scenario

1. Existing capacity is filled with patients regardless of illness

acuity.

2. Offering low risk patients Phase IV and Phase V capacity from

day 1 would allow ample designated areas for moderate to high

risk patients

3. Will examine triage based on severity of illness rather than

location availability

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IP Predictive Analytics Dashboard

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IP Predictive Analytics Dashboard

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IP Predictive Analytics Dashboard

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Redeploying Physician Volunteers

PHYSICAN VOLUNTEERS NEEDED: • Do you have extra capacity to volunteer your clinical skills or provide support?

• Do you have expertise in pulmonary, critical care or emergency medicine?

If yes to either of these questions, we may need your help!

Employed FM / IM Physicians OR

Inpatient Hospitalists

Employed Specialists OR

Non-Employed / Independent Physicians

Please contact Amy Kinnett-Calhoun at

[email protected]

1.) Complete form:

Click Here for Form

OR

2.) Call: AMITA Physician Hotline at

224.273.3900 weekdays 7am-7pm for

foreseeable future

OR

3.) Email: MedStaff-COVID19-

[email protected]

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Pulmonary and Critical CareDr. Neeraj Desai, Medical Director, Interventional Pulmonology

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Pulmonary Critical Care Playbookhttps://www.amitahealth.org/covid-19-amita/

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Pulmonary Critical Care Playbook:https://www.amitahealth.org/covid-19-amita/

• COVID-19 Screening, how to address patient

calls

• COVID-19 Testing Decision Algorithm –

Patients Being Admitted

• Diagnosis: testing, Imaging, lab abnormalities

• Caring for Critically Ill Patients with COVID-19

• Airway Management, Aerosol producing

procedures

• Ventilator Management

• Code Blue Staffing & Preparation

• Transportation of COVID-19 patients

Requiring Mechanical Ventilation

• Recommendation for Use of COVID-19 and

Risks with Shared Canister

• Bronchoscopy Pathway

• Frequently Asked Questions

• Resources

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Guidelines and Decision trees in Playbook

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Innovations

INTUBATION PROTECTION BOX

CONSERVING PPE

IV POLE OUTSIDE

THE ROOM

COVID WHITE BOARD

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Task Forces that PCCM Supports Across the System

• Local and system multidisciplinary COVID-19 teams

• Analytics (Dashboards and Modeling)

• Critical Drug Task Force

• Medical Group (inpatient and outpatient workflows)

• AMITA Hotline support for PULM CC questions

• Inpatient COVID-19 order sets

• Ethics

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Testing UpdateDr. Reinhold Llerena, President, AMITA Medical Group

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Testing for COVID-19

• IDPH currently recommends against testing those with mild illness who can be

safely managed at home.

• The Illinois Department of Public Health (IDPH) will only accept specimens from:

• Hospitalized patients with severe acute lower respiratory illness (e.g.,

pneumonia)

• Clusters in a congregate setting that serves more vulnerable populations,

such as a supportive care facility, assisted living facility, group home,

homeless shelter or correctional setting.

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CDC Guidelines for Testing Prioritization

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Testing Algorithm for Suspected COVID-19 Patients

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Closing RemarksDr. Joseph Lagattuta, CIN Board Chair

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Ways You Can Help

• Volunteer through our Medical Staff

• Stay with AMITA, please

• Only write Rx for appropriate COVID-19 testing

• Avoid sending patients to the Emergency Department when

possible

• Develop an accelerated admit / discharge plan for stable

patients to increase bed availability during the surge

• Address annual wellness visits through Telehealth

• Thoughts and prayers for those on the frontline

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Thank you to all who are called to serve

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Thank you!

AMITA Physician Hotline Phone Number

224.273.3900 from 7 am to 7 pm weekdays for the foreseeable future

AMITA Physician Hotline Email

[email protected]