Here’s what you missed at the June 17 virtual Professional Staff Meeting

Here’s what you missed at the June 17 virtual Professional Staff Meeting

*Please note: this information was presented on June 17 at 7 a.m. As our work to respond to COVID-19 evolves, the information may have changed since the time of these presentations. Listen to a recording of the full webcast.

Presenters: Cleveland Clinic CEO and President Tom Mihaljevic, MD; Chief of Staff Herb Wiedemann, MD; South Pointe Hospital President Margaret McKenzie, MD; Cleveland Clinic Community Care Director Adam Myers, MD; Chief Financial Officer Steve Glass; Chief Experience Officer Adrienne Boissy, MD; Interim Chief Safety and Quality Officer Aaron Hamilton, MD, MBA; Pathology & Laboratory Medicine Institute Chair Brian Rubin, MD, Ph.D.

CEO update

Dr. Mihaljevic reiterated Cleveland Clinic’s commitment to diversity and inclusion. “We have to work together to eliminate the disparities that racism creates, in particular when it comes to people's health,” he says. He added that Cleveland Clinic is uniquely positioned to take action on these issues, which have been magnified by the COVID-19 pandemic.

Dr. Mihaljevic announced new initiatives: participation with civic leaders on a new Cleveland task force to address racial disparities; expansion of services at the Cleveland Clinic Langston Hughes Community Health and Education Center in Cleveland’s Fairfax neighborhood near our main campus (see details in Dr. Myers’ remarks below); and the launch of a Cleveland Clinic forum series, “Lift Every Voice,” providing caregivers opportunities to discuss racism and bias and to share ideas for change.

He said there is an overall system-wide decline in hospitalized COVID patients, representing an opportunity to increase non-COVID care. “Patients have to be encouraged to come back to hospitals for their regular care, checkups and screenings.” Protecting our caregivers remains a top priority. Fewer than 1% (470) have been infected and no cases are believed to have been hospital-acquired. A Caregiver Pulse Survey is underway to help leadership understand and improve caregiver experience and engagement.

Dr. Mihaljevic congratulated Cleveland Clinic Children’s for ranking among the top 50 children’s hospitals nationally in 10 pediatric specialties in U.S. News & World Report’s latest survey.

Chief of Staff Update

Dr. Wiedemann reports that the 2020 annual Caregiver Celebration awards will recognize “COVID-19 Heroes” — individuals and teams who “went beyond the call of duty during the pandemic” and served as role models of Cleveland Clinic values. Nominations can be submitted here.

Also, Cleveland Clinic will launch an initiative to support the career development of members of the Professional Staff through a structured program of career pathways that include master clinician, clinician scholar, clinician-educator, and clinician-scientist. Neurological Institute Chair Andre Machado, MD, PhD, will lead the program. Details will be forthcoming.

Professional Staff Diversity: Dr. McKenzie

Dr. McKenzie, says “We have been intentional about increasing the diversity of our Professional Staff. While we have made progress, we still have some ways to go with racial diversity. My aspiration is for the composition of the Cleveland Clinic Professional Staff to reflect the community it serves, with a focus on racial diversity.”

Dr. McKenzie noted Dr. Mihaljevic’s commitment, upon becoming CEO and President in 2018, to ensure diversity and inclusion at all levels of the enterprise, and the charge given to every search committee to address diversity in hiring decisions.

“This resolve does not stop with recruitment,” she says. “We strive to create sustainable pipelines to attract candidates of every color, as well as creating the environment to develop, retain, and advance staff of color when we recruit them.” Dr. McKenzie says she wants her Cleveland Clinic colleagues to “grow and develop a culture anchored in anti-racist practices.” She offered this visual aid to guide progress:

Community Support: Dr. Myers

Cleveland Clinic continues to regularly communicate with our community partners about the COVID-19 pandemic, Dr. Myers says, frequently sharing best practices, providing guidance on safely reopening public spaces, and partnering on community testing efforts.

More broadly, our strategy is “to meet the needs identified through our community health needs assessment and to combat racism.”

“Health equity is the goal,” Dr. Myers says. “Convenient access to care is only one factor. We're committed to promoting better educational outcomes, job growth, safer housing, and culturally inclusive healthcare free from implicit bias. We are committed to partnership with all stakeholders in the effort to remove structural racism from our community. We can't do this alone, but we alone can do our part.”

Specific activities include:

  • Expanding services at the Langston Hughes Community Health and Education Center to include full primary care access, a teaching kitchen, job support, literacy training, legal aid, and other community-facing activities. This site will also become the hub for Cleveland Clinic’s community relations team, which will relocate from Beachwood. “Our intent is that this will become a comprehensive model of a community center that we can adapt for other communities where we serve,” Dr. Myers says.

Patient Access: Dr. Wiedemann

Dr. Wiedemann reports that the amount of available slots for physicians and advanced practice providers has now rebounded to pre-COVID budgeted baseline levels. As of the first week of June, the percentage of available slots that were filled was 70%, which is slightly below the pre-COVID baseline of 80%, indicating “there's still some hesitancy or barriers to our patients coming back.”

Virtual visits peaked in April at more than 10,500 per business day, representing 72% of filled slots. In the second week of June, virtual visits had declined to 5,500-6,000 per day, representing 20%-30% of filled slots.

“Our goals are to maintain and facilitate the use of virtual visits when they best serve the patient, and to identify and remove barriers that may exist for providers and patients, recognizing that the utility of virtual visits varies quite a bit by service line,” Dr. Wiedemann says.

Turning to the topic of extended hours for in-person and virtual appointments, Dr. Wiedemann offered the following rationale:

  • To accommodate patient preferences, especially due to family considerations, work schedules, and reduction or loss of paid time off.
  • To respond to limits on the number of visits Cleveland Clinic can accommodate during daytime hours due to social distancing requirements.
  • To improve physician engagement by providing schedule flexibility.

Cleveland Clinic survey results show patients in all age groups are significantly interested in extended weekend appointment hours, early morning hours from 6 to 7 a.m., and evening hours from 6 to 7 p.m.

In January and February, 3.7% of the 1.3 million available appointment slots across Cleveland Clinic were for extended-hours appointments, with a fill rate of 81% — identical to the fill rate for daytime appointment slots. Cleveland Clinic Community Care, which includes general pediatrics and adult primary care, accounted for more than half of the 50,000 available extended-hour appointment slots, and 90% of those slots were filled. That represents an opportunity for expansion, Dr. Wiedemann says.

Also, specialty care traditionally has not offered extended-hour appointments, which represents another expansion opportunity, Dr. Wiedemann says.

Patients Served and Financials: Steve Glass

In May, with the resumption of non-essential care, patient activity was significantly higher than in April, although still well below budgeted levels: May admissions were 17% below budget; patient visits 29% below budget, inpatient surgical visits 24% below budget and outpatient surgical visits 41% below budget. May’s case mix index is at the budgeted level, which indicates that patients with acute conditions are returning for care.

Cleveland Clinic’s financial recovery from the pandemic faces significant challenges, even as patient activity increases, Mr. Glass says. “We are seeing significant increases in charity care and bad debt. We're seeing declines in commercial payer activity, largely related to the increase in unemployment,” and a higher percentage of Medicare and Medicaid patients, for whom reimbursement for care is significantly lower than commercial payer reimbursement.

So focusing on managing operating expenses and restoring normal levels of patient activity will be critically important to our recovery, Mr. Glass says.

Visitation Policy: Dr. Boissy

Last week, Cleveland Clinic revised its visitation policy to allow both parents to accompany a child in all medical settings and to allow a single designated visitor for patients being treated in emergency rooms. Both changes are going well, Dr. Boissy reports.

This week, we allowed a single designated visitor to accompany patients undergoing major outpatient procedures, defined as those that might require sedation, such as colonoscopy, bronchoscopy or cardiac, catheterization. We also allowed a single designated visitor to accompany women undergoing fetal ultrasound exams.

Visitors are not allowed to accompany patients receiving lab tests, medical imaging, and routine outpatient care.

Planning is underway to allow a single designated visitor for patients in intensive care units.

“We continue to make [visitation] decisions based on data, keeping empathy and safety at the forefront,” Dr. Boissy says. “Compassionate exceptions remain paramount and local teams need to be empowered to continue to make these calls. We believe that family and friends are a part of the [healthcare] team, integral to healing, safety, and communication, and we'll bring them back thoughtfully while recognizing there is no roadmap. As with the patients we serve, [visitors] are not a distraction to what we do. They are why we are here.”

Masking Policy and Staff Safety: Dr. Hamilton

Dr. Hamilton thanked the Professional Staff for the example they have set by complying with the requirement that all caregivers wear masks. “There's strengthening evidence that face coverings help to prevent the spread of COVID-19,” he says. “And we felt that a face-masking requirement aligned with that evidence and helps to protect other vulnerable populations that are within our walls.”

The policy to strongly encourage but not require that patients wear masks, although visitors must wear masks, is because “visitors and patients are distinct and we've considered them in that fashion,” Dr. Hamilton says. “Our patients come seeking our care and are vulnerable and ill. They're often distressed. We do not want to be in a position to turn away members of our community from receiving world-class care” because of a mask-wearing issue.

“We will continue to visit this decision and we'll keep you closely apprised of any changes,” Dr. Hamilton says. “Your safety and that of our patients is has been and will continue to be our top priority.

Testing Capacity and Process: Dr. Rubin

As of June 16, Cleveland Clinic has performed a total of 92,393 COVID-19 tests, with 6,519 (7%) overall positive for infection. The infection rate for the most recent 24-hour period is 2.7%, compared with a peak of 20% in April. Turnaround time for the standard test is 11 to 13 hours and 2 to 3 hours for the rapid test. Current testing capacity in Ohio is 2,650 tests per day: 2,418 standard tests and 262 rapid tests.

The development of self-testing kits and saliva-based tests is underway.

Testing site availability has been expanding. The main campus drive-up testing site at the W.O. Walker building is open 10 a.m.-5 p.m. seven days a week, and the Akron General Health and Wellness Center in Green is open 11 a.m.-5 p.m. Preoperative COVID-19 testing for surgical patients is available at Willoughby Hills Family Health Center, Brunswick Family Health Center and Rocky River Urgent Care Center from 8 a.m.-4 p.m. seven days a week, and at the Mentor and Brooklyn Express Care locations from 8 a.m.-4 p.m. every day except Thursdays.

Cleveland Clinic does not offer serological testing due to concerns about current tests’ high false-positive rates and the lack of knowledge about whether individual patients with COVID antibodies are immune to re-infection. “When the science supports the use of serological testing, we will be prepared to launch testing immediately,” Dr. Rubin says.

A multidisciplinary team is forming to consider how Cleveland Clinic will conduct testing during the upcoming fall cold and flu season. “As you can imagine, this is going to be quite complicated and we want to be ready,” Dr. Rubin says.

Save the date: The next Professional Staff Meeting takes place at 7 a.m. on Wednesday, July 1.

Welcome home to caregivers who assisted at CCAD

Welcome home to caregivers who assisted at CCAD

On Sunday, 40 caregivers made the 7,000-mile journey back home from assisting at Cleveland Clinic Abu Dhabi during the pandemic.

About five weeks ago, nurses, physicians, a vascular technician and an ultrasound clinical manager from Ohio and Florida, boarded a plane headed to the Middle East. Their mission was to address the urgent needs of COVID-19 patients and families in Abu Dhabi.

Thank you to each of these caregivers for coming together with our Cleveland Clinic family in Abu Dhabi to share your expertise and best practices around treating COVID-19 patients. We value your passion and selflessness.

Welcome home!

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New inpatient visitation guidelines starting June 24

New inpatient visitation guidelines starting June 24

Updated at 4:25 p.m. on June 24, 2020.

Effective June 24, inpatient settings at all Ohio and Florida* locations will allow patients who are COVID-19 negative or asymptomatic to have 1 designated visitor daily. This individual will be the patient’s only visitor during hospitalization.

Starting June 22, care teams may begin to ask inpatients who are COVID-19 negative or asymptomatic who they would like to designate as their single individual visitor during hospitalization. (Learn how to document and find a designated visitor using this resource, located under the "Reactivation Toolkit" tab in the COVID-19 toolkit.) This individual must show their photo ID at the building entrance to verify identify before each daily visit. Designated visitors may leave the patient’s room to visit the cafeteria or other appropriate areas inside the hospital during each daily visit.

Visiting hours are from 7 a.m. to 9 p.m., unless a compassionate exception** applies.

To keep our patients and caregivers safe, all visitors must follow the guidelines below:

  • Limit the number of items they bring when visiting a patient.
  • Have their temperature taken upon entering our facilities.
  • Answer screening questions upon entry.
  • Wear a mask while inside, unless they have a health or behavioral condition which prevents them from wearing one.
  • Sanitize their hands before and after entering clinical areas and waiting rooms.
  • Remain in the same room as the patient they are visiting.
  • Stay near the patient they are visiting while inside their room, and avoid sitting at the end of the patient’s bed.
  • Respect SAFE: Six (feet) Away From Everyone.

If spacing constraints prevent social distancing from being maintained in a given area, we may need to redirect visitors. Teams in that area will have discretion to offer fair, consistent decisions to the families they serve. We ask our visitors to appreciate the measures we’re taking to keep our patients and caregivers safe.

For information on major surgery or procedure and fetal ultrasound visitation, review the June 15 visitation update.

For information on emergency and pediatric department visitation, review the June 8 reactivation update.

View our updated visitation guidelines flyer, now posted under the "Protecting Against the Spread of COVID-19" tab in the COVID-19 toolkit. Refer to our updated COVID-19 FAQs for caregivers (internal only).

*This guideline goes into effect at Martin Health on June 25.

**Compassionate exceptions continue to apply for outpatient settings and for inpatients who are COVID-19 positive or a Person Under Investigation for COVID-19. Decisions to offer compassionate exceptions to visitation should be part of a collaborative, team-based approach. If you or your teams encounter concerns, contact the Ombudsman Office for scripting and training, or refer to these communications resources.

We will continue to monitor the impact of our visitation guidelines on the rate of COVID-19 infections among our caregivers, patients and their families, and we may need to change visitation guidelines accordingly. Contact your manager if you have questions. Thank you for helping us maintain a safe environment for our patients, visitors and caregivers.

Hero of the Week: Persistence prevents more complicated procedure

Hero of the Week: Persistence prevents more complicated procedure

Using her expertise and diligence, Brenda Canterbury, BSN, RN, a nurse in the Endoscopy Department at Medina Hospital, prevented a patient from needing an additional procedure and undergoing anesthesia.

How was this possible? A patient with COVID-19 was scheduled for a procedure to have their percutaneous endoscopic gastrostomy (PEG) tube changed due to frequent clogging. (The PEG tube is used to help with feeding when oral intake is not adequate.) Due to the patient’s age and health conditions, the patient would have an increased risk receiving anesthesia.

Several caregivers attempted to remove the clog with no success.

“Canterbury was confident and persistent that she could get the PEG tube unplugged if she had the right tools,” says Michael Pace, RN, Nurse Manger.

Canterbury collaborated with nurses, physicians, Pharmacy and Materials Management to talk through the process and get what she needed to make it happen. Pharmacy suggested using a formulary to de-clog the tube. Materials Management requested a courier to deliver a CLOG ZAPPER syringe from Avon Hospital.

With this new approach, Canterbury successfully unclogged and restored proper function of the PEG tube.

In addition to preventing a more complicated procedure and decreasing the number of caregivers who would need to prepare to care for a patient with COVID-19, Canterbury’s persistence created a more cost-effective option for the patient.

“Canterbury routinely works diligently to ensure her patients and fellow caregivers always remain safe,” Pace says. “I describe Canterbury as a hero, and I am blessed to have her as a part of our team.”

As Canterbury says, “I am humbled for simply doing what a nurse does: take care of patients and each other.”

Congratulations to Brenda Canterbury!

Hero of the Week

Hero of the Week is a recognition program that showcases and celebrates the incredible care and work of our caregivers who give their all each and every day. Caregivers are first recognized in Hero Huddles as part of our tiered daily huddles. The Office of Patient Experience then selects one of the featured caregivers to be Hero of the Week.

For your colleague to be considered, share why your colleague should be celebrated in Hero Huddles during the daily tiered huddle. If your team does not directly participate, speak to your manager, who can share the recognition with the appropriate leader to share in the huddles.

Our patients are returning, REGLOW will be ending

Our patients are returning, REGLOW will be ending

When the pandemic emerged in early March, we took action to support our caregivers. Your personal and professional lives were disrupted by school closures, illnesses and deferment of nonessential care. Cleveland Clinic’s commitment to you has remained a continuous focus.

Today, as states reopen and service levels increase, we are discontinuing two temporary caregiver support initiatives:

  • REGLOW pay code:This pay code, used to compensate caregivers who experienced a lack of work as a result of COVID-19, will be discontinued June 30 for caregivers who are paid semi-monthly and July 4 for caregivers paid bi-weekly. After those dates, eligible caregivers who experience a lack of work will take paid time off (PTO), or the shift will go unpaid, following our standard Lack of Work Policy.
     
  • Negative PTO Balance:We permitted caregivers to go into a negative balance of PTO, up to -40 hours, as a result of widespread closures of child care centers and related businesses. Caregivers will no longer be permitted to go into a negative PTO balance beginning July 1 for those who are paid semi-monthly and July 5 for those paid bi-weekly. Caregivers who currently have a negative PTO balance will continue to accrue PTO to make up for any remaining deficit.

These generous programs were made possible by our fiscal responsibility and stewardship. We remain attentive to our caregivers’ needs and will continue to support them.

If you are experiencing difficulties as a result of COVID-19, please speak with your HR representative, Caring for Caregivers, the Office of Caregiver Experience, or make a referral to the Caregiver COVID-19 Hotline at 216.445.8246.

Thank you for your dedication and support.