As the argument of PPE preservation keeping you from seeing COVID/PUI patients is really no longer present with everyone in masks, and confidence from command that there is not an issue with gowns and gloves now, we are going to open a small feeding of COVID/PUI patients to the teams. This will occur in the following manner… COC patients (now being followed by the COC attending) with the A1 attending that are COVID/PUI will be potential admits/pickups for the A1/C1 ward team. Medicine clinic patients (being seen by medicine clinic staff now) admitted to any team with COVID/PUI status will be seen by the team with the medicine clinic attending. The hospitalist attendings for the A2, B1, B2, C1 services are not on COVID units, so in the current state wouldn’t have COVID/PUI patients to add to the teams anyways. The ICU team will also be open for COVID/PUI patients. Beyond the PPE argument, there is a question of why expose residents if you don’t have to yet? The answer to that question, is that I would rather residents get comfortable with donning/doffing, a sense of respiratory status urgency, just the “idea” of going in and out of a COVID+ room with a patient or two now, so that they are more comfortable when 10 out of 12 patients on their teams in a few weeks are COVID+ and things are a little more intense here. So, it is a balance of very low risk of exposure to a properly PPE’d provider combined with what I think is a significant benefit of getting used to the rain before the storm comes. Moonlighters continue to admit COVID/PUI patients. The ED residents continue to see COVID/PUI patients.
So in summary, there are no remaining COVID/PUI restrictions on resident patients moving forward. The volume will be low initially because of the hospitalist attendings not being on COVID units currently, but that will change with the hospitalist shift in schedules/assignments as we progress.
People will have questions about this, so we’ll take the first 10min of noon conference tomorrow (Thursday) to discuss. The chiefs will send out a Zoom for everyone to jump on at noon and then the G1s can stay on for EKG with bob after the first 10min of discussion on this. We will plan on this going into effect Friday AM.
1) Resident Ward/ICU Team: Patients known to have or being tested for COVID-19 should NOT be admitted to the resident teams regardless of time of day
2) 2nd and 3rd year Residents on Subspecialty Rotations: Residents on consult teams should NOT see patients known to have or being tested for COVID-19, the subspecialist attending should see these patients alone
3) Night time and weekend Moonlighting residents/G2 Long Call:
a. Moonlighting residents WILL provide necessary resident/hospitalist/ANGMA in-person cross coverage regardless of COVID-19 status
b. The role of the house officer response to see patients WILL continue regardless of COVID-19 status
c. When the night staff physician is able to admit a known or COVID-19 testing patient it should NOT be given to the moonlighter. If there are circumstances where staff is unable to perform the admission, the moonlighter WILL perform the admission.
4) Dr. Blue Team: Residents on the Dr. Blue team WILL respond to all Dr. Blue patients regardless of time of day. Medical students should not be in the room when respiratory/droplet precautions are in place (supply preservation).
5) Medical students in any role: with a goal of minimizing exposure and use of PPE supplies, students should NOT be entering rooms with precaution categories other than “contact precautions” in place (i.e. nothing that involves the utilization of masks)
Dave Tierney (IM Residency Program Director) – emailed 3/9/2020