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  • COVID-19 Virtual Town Hall

    Friday, March 20th (2 – 3 PM EST)

  • Introduction

    Marschall Runge, MD, PhD Chief Executive Officer, Michigan Medicine

  • COVID-19 National and Local Activity and

    Forecasting

    Jeff Desmond, MD Chief Medical Officer – UMHS

    Vikas Parekh, MD Medical Director, Capacity Management – UMHS and ACCO – UH/CVC

  • United States: 13,680 Confirmed Cases as of March 19, 2020

  • State of Michigan: 334 Confirmed Cases as of March 19, 2020

  • Epidemiological Model for Forecasting Potential Impact

    6

    Susceptible Infections Recovered

    Population and Model Assumptions: Severe Spread

    3 day Doubling Time

    (rate of disease

    spread)

    12% Hospitalization Rate

    of Infected

    Individuals

    14 day Infectious Period

    7 days Hospital LOS for non-

    ICU patients

    9 days Hospital LOS for patients

    requiring ICU care

    DISEASE AND SPREAD HOSPITALIZATION HOSPITAL RESOURCES

    20% ICU Use of those

    Hospitalized

  • Predicted COVID-19 Patient Census: Severe Spread Model

    Current Model is accurately tracking against our actual experience

    Total COVID-19 patient census

    ICU Census

    >600 beds by April 11th

    32 ICU Beds by April 6th

    32 Beds by March 29th

    Actual Census = 7 beds on March 20

    Model Prediction=6 beds

  • Our Principles

    David Spahlinger, MD President – UMHS

  • Michigan Medicine Principles

    • Principled approach

    – Safety of our patients and team members

    – Maintain critical access for patients requiring essential procedures

    – Resource preservation

    – Limiting staff, patient, and clinician exposure

    • Critical review of cases

    – “Non-essential” cases that will not result in patient harm if postponed

    • Postponement of all non-essential, elective procedures

    • Universal Skills

  • Incident Command/Team Structure

    Jeff Desmond, MD Chief Medical Officer – UMHS

  • Tiered Huddles

    • Daily ACU huddles with report out at 9:45AM to segment leadership

    • CoVid 19 daily huddles at end of day with operational leaders

    • Participation in CoVid 19 Command Center

  • What We Have Done to Prepare

    David Miller, MD Chief Clinical Officer – UH/CVC

    Michael Mulholland, MD Executive Director – UMMG

  • Changes to Clinical Activity

    Step 1: Categorize urgency of the health program

    • Patients that require urgent and in-person evaluation and treatment

    • Patients for whom short-term deferral of care is safe

    • Patients for whom longer postponement is safe

    Step 2: Match scheduling to urgency

    • Urgent in-person evaluation and treatment

    • Video visit

    • Telephone

    • Appointment deferred, by re-rescheduled

  • 14

  • Virtual Care Work

    • Expanded e-visits to Michigan Medicine Patients without UM PCP

    – Coordinated with COVID hotline and testing plans

     300% in video visits and 150% in e-Visits

    • Doubled number of available simultaneous video visits

    • Video Visit use of any platform during pandemic (FaceTime, Zoom, etc)

    • Approval to expand video visits to Adolescents (11-17y) via portal proxies

  • Invasive Procedures

    • Expanded e-visits to Michigan Medicine Patients without UM PCP

    – Coordinated with COVID hotline and testing plans

     300% in video visits and 150% in e-Visits

    • Doubled number of available simultaneous video visits

    • Video Visit use of any platform during pandemic (FaceTime, Zoom, etc)

    • Approval to expand video visits to Adolescents (11-17y) via portal proxies

  • Case Volumes

    0

    10

    20

    30

    40

    50

    60

    70

    80

    90

    100

    3/9/20 3/10/20 3/11/20 3/12/20 3/13/20 3/14/20 3/15/20 3/16/20 3/17/20 3/18/20

    Actual Case Volumes Across Sites

    UH C&W CVC ASCs

  • Increased Clinical Capacity

    150 beds 58 beds

    ICU Capacity, 3/19, 7pm

  • PPE & Testing Clarity

    Laraine Washer, MD

  • COVID-19 Hotline & Testing

    • Hotline 734-763-6336

    • Ambulatory testing at Brighton Health Center, Canton and West Ann Arbor

    – Michigan Medicine patients

    – Scheduled new patients

    – Michigan Medicine employees

    • Curbside testing available Monday-Saturday 8AM to 6PM

    • Yesterday, Hotline triaged 214 patients, average wait time 55 seconds

    • Yesterday Curbside tests for 94 patients

  • Regional Infectious Containment Unit (RICU)

    Nancy May Chief Nurse Executive – UMHS

  • RICU – Physical Space

    • Located in the Children’s and Women’s Hospital on 12th floor, East end

    • Designed as a 32-bed inpatient unit with primary medical/surgical unit for pediatric patients during normal operations

    • Unit was converted to RICU on Monday, March 16th

    • RICU unit now serves as a 32-bed, negative-pressure, mixed model unit (adult and pediatric patients, including general and intensive care) for patients tested positive for COVID-19 or those patients under investigation (PUI)

    • Unit has a secured perimeter with one locked entrance serving as a normal point of entrance/exit of the unit

  • RICU – Physical Space

    • The RICU system within is stable with a consistent pressure

    gradient difference between its patient rooms and other spaces

    within the unit This enables staff to wear PPE while caring for

    patients but able to remove PPE upon exiting the room.

    • Unit design is a collection of isolation rooms allowing us to

    cohort patients and to manage PPE conservation

  • RICU – Staffing & Leadership

    • Staffed with volunteer medical providers, nurses, assistive

    personnel and ancillary staff.

    • Over 200 of our registered nurses volunteered to staff the RICU

    • Medical Director: Vineet Chopra

    • Nursing Directors: Mary Ann Adamczyk and Julie Juno

    • Additional leadership support:

    – Vikas Parekh

    – Nicole Sroufe

    – Kelly Baird-Cox

    – Julie Grunawalt

  • Additional Patient Management Information

    • COVID-19 patients are also being cared for on units outside of

    the RICU in negative pressure rooms

    • Care is the same regardless of location (RICU, ICUs, General

    Care)

    • Exceptional work being done by our Emergency Department and

    Ambulatory Care staff whose vigilance and attention to

    screening protocols have resulted in timely identification and

    subsequent safe transport of patients requiring special

    precautions

  • The Next Two Weeks – What to Expect

    Jeff Desmond, MD Chief Medical Officer – UMHS

    David Miller, MD Chief Clinical Officer – UH/CVC

    Michael Mulholland, MD Executive Director – UMMG

  • COVID-19 Hotline & Testing

    • Beginning March 23rd COVID hotline and curbside testing available to pediatric patients

    • Continue to improve efficiency for patients and providers

    • Integrate telehealth into process as more providers are trained

  • Virtual Care Ongoing Work

    AmWell video visit platform. Target date: 3/30/20

    – Provider training, Training target date: 3/26/20

    – Advantages of AmWell

    • Higher visit volume capacity

    • Embedded within Hyperspace-can be used from laptops/desktops or mobile devices

    • HIPAA compliant

    Expansion of portal help desk hours and services

    – 7a-7p, 7d per week, Target Date: 3/24/20

    Enabling Quick Appt function for providers to schedule Video Visits

  • Procedures Looking Forward

    • Consolidate ambulatory surgical and procedural services to

    Brighton and Kellogg

    • Ongoing inventory and re-distribution of supplies and resources

    • Evaluating potential decompression of cases from UH/CVC/C&W

  • Surgery Center Case Volumes

  • Moving Forward Together

    Sustained care

    delivery and

    safety

    Maintain capacity management

    strategies

    Preserve access to essential non-

    COVID care

    Support clinical teams

    Create plans for managing high

    patient volumes

    Maintain supply chain, including PPE

    Continue PPE training and best

    practices

    Expand testing for patients and

    team members

    Support team members impacted by

    COVID

    Continuous communication and

    collaboration

  • Question & Answer

  • Thank You for Joining Us

    COVID-19 Resources

    U-M Public Affairs: https://coronavirus.umich.edu/

    Michigan Medicine Headlines: https://mmheadlines.org/covid-19-updates/

    Michigan Medicine IPE: http://www.med.umich.edu/i/ice/re

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