Daily CEO Update | What happens if the curve begins to flatten?
Promising signs are emerging through our response to the pandemic. In Ohio, the number of patients we are caring for remains stable. The public is asking what will happen next if this curve begins to flatten and when can healthcare providers resume nonessential procedures.
The reality is there are no quick or easy answers. We will be responsible in our decision making to preserve overall public health.
In talking with other health systems and the Ohio Governor’s office, I am confident that conditions will soon be met in Ohio to resume some clinical activities. This is as long as social distancing, cough etiquette and sheltering when ill continue to be practiced.
A Cleveland Clinic task force is analyzing the potential path to resume surgical cases in the event the Governor’s office releases new guidance.
To guide our analysis, we developed a new predictive model that assesses the impact of lifting social distancing. We also have strong surge plans in place. Today, we put the finishing touches on our “Hope Hospital” at the Health Education Campus. We will maintain this tremendous asset until we fully understand the implications of lifting statewide orders.
Hospitals in other states need help with the surge. At the White House yesterday, we discussed a national ventilator exchange with other hospital leaders. This is a unifying moment among our peers as we all collaborate for the health of Americans.
In Cleveland, more than 500 caregivers applied for voluntary reassignment to help at hospitals in Michigan and New York. Our first group of 20 nurses and doctors now travels to New York on Friday. It is a remarkable example of the selflessness of our caregivers and their desire to do good.
Of course, that is what heroes do. All of our caregivers are heroes. Here are some recent stories told through our new Hero Huddles:
- A team at Hillcrest Hospital raised money to buy gifts for their colleagues working in the ICU.
- Our Avon team raised thousands of dollars in donations to support caregiver efforts.
You can also give back to other caregivers in need and support our COVID-19 research. Learn more about our Caregiver Hardship Fund and COVID-19 Emergency Fund. Thank you for any gift you make.
I am very proud to represent each of you. You are deserving of every praise Cleveland Clinic has received during this pandemic. I am firmly convinced we will get through this together.
Tom Mihaljevic, MD
CEO and President
Point of Care Blood Glucose Testing Reminders
When performing point of care (POC) blood glucose testing, please remember the following:
- Accu-Chek Inform II meters are required to be cleaned and disinfected after every patient use. This is especially important in the current environment.
- Refer to the Point of Care Testing intranet site for cleaning instructions.
- Do not perform POC blood glucose testing with Accu-Chek Inform II devices on patients receiving high dose ascorbic acid (Vitamin C) or N-acetyl cysteine (NAC); these therapies may be under consideration for COVID-19-related issues.
High dose ascorbic acid or N-acetyl cysteine may falsely elevate blood glucose results. Perform lab-based glucose testing on patients receiving high doses of ascorbic acid or N-acetyl cysteine.
Questions? Contact Ed Reineks at 216.219.0950 or Maureen Carr at 216.618.1519.
Expanded COVID-19 Testing Capabilities and Guidelines for Surgeries and Procedures (Updated)
Updated April 20, 1:40 p.m.
Up until now, rapid COVID-19 testing has only been available for symptomatic patients in Labor and Delivery and in the Emergency Department (ED) who were:
- Admitted to the Intensive Care Unit (ICU)
- In need of emergency surgery
- Undergoing behavioral health treatment
- Transplant recipient patients
Effective April 13, we are now able to order rapid COVID-19 tests for symptomatic patients:
- In the ED who were admitted from post-acute facilities
- In the ED who are immunosuppressed/have cancer
Rapid testing capabilities will also be expanded to include asymptomatic inpatientsrequiring an emergency surgery or interventional radiology procedure within 24 hours.
Please note that as we make efforts to expand, rapid testing is still necessarily limited to allow for the most urgent patient needs.
COVID testing is not mandatory prior to surgeries or procedures and should be ordered if testing would change the management of the patient in the perioperative period.
Rapid testing for emergency surgery and procedure patients
If you need to request rapid COVID-19 testing for asymptomatic inpatients who are undergoing emergency surgery or procedure within 24 hours, you can now utilize the rapid COVID order in Epic.
To do this:
- Select the button that states “Emergency Surgery/Procedure within 24 hours.”
- The test will be obtained by a clinician on the inpatient floor using appropriate Personal Protective Equipment (PPE). The patient should be treated as a PUI while awaiting the test result.
- Test results will be followed up by the surgical/interventional radiology team via Epic. Positive test results are called to the inpatient floor as well. The decision to perform the surgery or procedure is made by this team based on the results.
Routine testing capabilities for outpatient essential pre-operative surgical evaluations
Routine testing capabilities are available to outpatient essential pre-operative surgical and procedural evaluations (regardless of symptoms) in a phased rollout beginning April 13 for the following: colorectal surgeries, Dentistry procedures, Adult and Pediatric ENT, Adult and Pediatric Gastroenterology procedures, Heart and Vascular surgeries, Interventional Radiology procedures, Neurological surgeries, Orthopedic surgeries, Pulmonary procedures, Thoracic surgeries and general surgeries.
Beginning May 11, this testing capability will expand to include adult and pediatric eye surgeries, as well as any other surgical groups not mentioned above.
Routine testing prior to essential outpatient surgery
Surgeons and proceduralists who need to request routine COVID-19 testing for essential outpatient surgery and procedures should send an in-basket message through Epic to the COVID-19 Hotline Pool requesting testing for their patient.
This message should be sent through the patient chart and include the following information by using the dot phrase “.COVIDelectsurg” which includes:
- Statement about the need for testing for pre-operative purposes
- Surgery and date of surgery
- Surgeon/proceduralist name for routing of results
- Mode of patient arrival
The Hotline pool will enter the order for regular COVID-19 testing immediately — symptoms or chart review are not needed. The Hotline pool also enters request comments into the order instructions regarding preoperative surgical patient and mode of arrival (car vs. pedestrian appointment).
The order is then sent to the scheduling pool, which reviews orders from 7 a.m. to 10 p.m.
The scheduling pool calls the patient to arrange a time for testing at the Walker Building (can be same day if needed) within 5 days of surgery.
The patient is tested at the Walker Building (pedestrian appointment available if needed) and sample is fast-tracked to the lab with a green sticker. The patient is also informed to follow standard precautions (avoid close contact with other individuals, hand hygiene, and cough etiquette) pending the test result. COVID-19 testing should be the last item in the pre-operative evaluation if other testing is needed.
The surgery or procedure team will follow up on the test result. They will make a decision about proceeding with the surgery/procedure. If the test result is positive, the surgical/IR team will arrange for proper patient follow-up.