Updated: Mar 31, 2020
(Written For Chief Medical Officers and Chief Operating Officers of Hospitals & Health Systems to Review With Their Infectious Disease Teams & CEO's)
Thanks to Dr. Ron Li Clinical Assistant Professor, Division of Hospital Medicine at Stanford University School of Medicine who hosted a talk presented by Dr. Doo Ryeon Chung Director of Infection Prevention and Control at Samsung Medical Center in Seoul, SK on their very successful response to COVID-19.
If you take a step back 30K feet and "ingest" all of the top line data from China, Italy, Singapore, Hong Kong, New York, Washington, and South Korea --patterns begin to emerge. We know that those of you driving hand to hand combat with the disease every day don't have this seeming luxury of taking a step back. At the same time, we would be wise being that this is a "novel" coronavirus, to rapidly ingest the lessons learned from others that went right before us.
So many physicians, nurses, mid-levels, managers, staff, healthcare leaders, public health, county, state, and other officials are doing so many things right and well. This is in the face of extraordinary challenges, dense fog and unpredictable road. It seems correct so far to focus on "flattening the curve" and simultaneously driving increases to hospital capacity. You can't have the latter without the former. The "meta" lesson from Dr. Chung's presentation is the importance of not underestimating the hospital itself as "high transmission terrain". His talk was all about what seemed to us at least, to be actionable and attainable, primarily operational and management tweaks (as opposed to supply chain re-engineering). This is to radically reduce the risk of and to stomp out in-hospital infection of clinicians.
He shared key lessons and strategies for preventing COVID19 transmission within hospitals, This includes PPE standards, workflows, infrastructure, and workforce management.
Looking Around the Corner: Managing Against In-Hospital Transmission
Our favorite slides from his presentation are pasted below. You can find a link to his talk at the end.
Overall Response Strategy Summary
Dr. Chung emphasized the hospital itself as a relatively high infection risk environment and emphasized the importance of managing that risk well. What I gleaned from his presentation is that if not aggressively managed, spread from within hospitals could itself overwhelm the health system.
Team Structure Was Emphasized:
These Key Clinical Skills and Operational Workflows Were Highlighted as Essential:
The reason why his insights are important is that they’ve been through it already. Some of their seven adaptations:
1) For one example, the in-hospital cafeteria only has one side of chairs; people sit side by side and no talking is allowed to prevent spread.
Clinicians and Hospital Workers Do Not Socialize or Face Each Other in the Hospital Cafeteria to Prevent Spread:
2) Simple clear plastic barriers are erected between intake staff and patients.
3) Covid+ patients can be highly infectious and likely to cough or vomit; therefore transport protocol transport specific PPE protocols are very important.
Transport of Covid+ Patients Has Its Own Protocol and PPE
4) Having organized isolation units as close to emergency departments as you can to minimize covid+ patient travel distance was implemented to reduce virus spread in the hospital.
5) The isolation rooms were all in one unit so providers treating COVID-19 patients stayed in same contained geography of hospital.
6) Providers don and doff upon both entering and exiting rooms of Covid patients. Full body suit PPE was used for certain high risk procedures.
PPE Standards Are Risk Based & Use Case Specific. Note: Anyone in the building, both patients and staff wear masks (Patients that are outside of isolation rooms). This is regardless of if they have symptoms because of the huge factor and risk of asymptomatic transmission. The main purpose of wearing a mask is to protect others from yourself.
7) Training elements were designed and delivered to make it all work.
The webinar video is available on YouTube for watching:https://youtu.be/JtDQkaTXC0A
It is our goal for this summary to help you think about prioritizing in hospital Coronavirus transmission and what you may expect to get out of Dr. Chung's presentation.
New Information March 31: Institute an urgent policy for toilets to be flushed only with the lids down "A Hong Kong Study has just recently found that a single flush could release about 80K dirty droplets that are left in the air for hours whenever you flush without closing the lid."
Sherri Douville CEO & Board Member at Medigram, Inc. Prior to her current work in the mobile privacy, security, health IT and AI industry, Sherri worked in the medical device industry consulting on the areas of physician acceptance and economic feasibility of medical devices. Prior to that, Sherri worked in Field Marketing, Sales and as a National Sales Trainer for over a decade in over a dozen disease states; including with a variety of products indicated for respiratory infections. During that time, she leveraged her multi-disciplinary STEM background to help physicians understand the microbiology behind the sensitivity and effectiveness of specific and different pathogens to a range of anti-infective agents.
Dr. Art Douville, CMO at Medigram and Attending Neurologist. In addition to practicing Neurology, Dr. Art Douville has held several leadership and administrative positions in healthcare including helping physicians understand and leverage the data by which they're measured. He also has experience as a hospital Chief Medical Officer for two separate health systems. He oversaw both infection control and biohazard governance in hospital environments. Dr. Douville has expertise in clinical integration and was recently Regional Vice President/ Chief Medical Officer at Verity Health System. In this position, Dr. Douville oversaw physician relations, patient safety & quality, regulatory compliance, and the development of innovative clinical programs. He was part of the leadership team to spearhead bundled payment and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) initiatives. Dr. Douville has over a decade of experience leading physician culture and developing leadership, performance improvement, regulatory compliance, clinical process design and implementation, as well as physician alignment.