UPDATED: COVID-19 Response: MCW & Department of Anesthesiology
In conjunction with the Interpretation of HR Policies
In effect March 24, 2020 through May 1, 2020. We continue to evaluate as situation progresses. We understand these are extraordinary times and everyone will be caring for patients in ways they had never anticipated. Policies to guide us are continuously updated on InfoScope and I encourage you to look there on a regular basis. Employee safety and reducing transmission of the virus is our top priority.
Surgery Cases & Intubation
- Surgeries across the health enterprise that are not time-sensitive will be delayed. Many of us likely expected a more rapid decrease in the numbers of non-urgent procedures. It does, though, require some time to move patients off of the schedule.
- We (the Department of Anesthesiology) will be intubating patients throughout the hospital.
- The Airway management team will include an anesthesiologist, a respiratory technician and an RN. For the anesthesiologist, this will be an in-house assignment. These individuals will be assigned daily to a 12-hour day shift or a 12-hour night shift. The night shift will replace the second call position and will be an in-house call; however, the primary assignment for this individual will be to be available for airway management requests from the ICU, Emergency Department (as a backup) and inpatient services. Depending on the extent of disease surge, we may have to add a second airway management team leader to the schedule. Assignment t this role will be reflected as a new category in Open Tempo.
- All other members of our department who do not have an Open Tempo assignment (clinical site, post-call, vacation) will be listed as available. Details of this designation are in the attached COVID 19 Response document.
PPE & Blood
- There is a shortage of PPE in the hospital and blood in the region (with cancellations of future drives) so, conservation is crucial.
- We are working to ensure the availability of N95 and power air purifying respirators (PAPR) for protection for our teams. N95 masks are available. Always use eye protection.
- Each day in the OR, the individual designated to do the intubations will wear an N95 mask. Other members of the anesthesia care team will us regular surgical masks for droplet precautions.
- We will adopt immediately, an intraoperative patient blood management protocol. Please see the policy for details.
- In brief, no blood should be transfused without prior discussion with the attending anesthesiologist responsible for patient care.
- Transfuse only once Hgb < 8 g/dL
- Transfuse 1 unit of blood at a time unless the Hgb < 5 g/dL
- To limit potential contamination of equipment as well as exposure of personnel to infections, you are encouraged to delay non-time sensitive procedures for patients who present on the day of surgery with any signs suggestive of COVID-19 infection. Viral filters will be added to our ventilatory circuits as they become available. – More information will follow.
Protocol for Calling in Sick
- As you enter the hospital buildings, you will be asked if you have any of the symptoms suggestive of COVID infection.
- If you have no symptoms of COVID-19, you are not excluded from work.
- For now, as per the CDC, unless you are required to self-quarantine or have symptoms suggesting infection, you can work.
- If you are symptomatic do not come to the hospital.
- Procedures for symptomatic staff and faculty will be based on the current recommendations of MCW occupational health and the CDCThe Day Of: If you are calling in sick because of symptoms suggestive of COVID-19 or are calling in sick with other symptoms, you must speak with the Anesthesiologist-In-Charge (50017). The AIC will notify Dr. Lien who will implement the appropriate procedure.Prior to your scheduled work day: If you are calling in sick because of symptoms suggestive of COVID-19 or are calling in sick with other symptoms, you must speak with Amanda Pichotta (414-805-8704). Amanda will notify Dr. Lien who will implement the appropriate procedure.
Quarantine in the case of Workplace Exposure:
- Please notify Internal Occupational Health immediately for instructions on required physical evaluation and clearance parameters for returning to work:
- email@example.com; 414-805-7997
- We will plan on taking you off the staffing schedule until we receive final recommendations from Occupational Health and/or quarantine requirements are met.
- We will record your time off as sick time until cleared to return to work and these days will be paid as regular (base pay) CSU payments.
- If Occupational Health determines you must be tested for COVID-19, they will provide you further instructions.
- If diagnosed COVID-19 positive, you must be quarantined for a minimum of seven (7) days. The formal quarantine period count starts with the day the sample for the COVID-19 positive test was obtained. If you are “fever and symptom free” without the use of antipyretics (such as Tylenol or ibuprofen) on the 7th day or thereafter, then you will require clearance by Occupational Health in regards to returning to work.
Workspace, Mask Fitting & Training
- Simplify set-up of your workspaces as much as possible to decrease the possibility of contamination of equipment.
- Use your surgical mask throughout the day to conserve resources.
- You may report to Occupational Health on the 5th floor of the Froedtert Specialty Clinics to be fitted for N95 masks.
- MCW strongly recommends suspending all personal domestic and international travel.
- If you choose to travel, let us know where you are going before you travel.
- Many of you may have had to adjust your previously approved vacations due to travel bans.
- We are currently evaluating our vacation procedures and will have more definition by April 1, 2020.
- If you were scheduled to attend a meeting/conference which now has Tele-or video conferencing options, please attend as scheduled
- If you’re meeting/conference was cancelled and does not have tele or video-conferencing capabilities, you may keep that time as meeting time.
- The allowed size of MCW meetings/gatherings has been further reduced to 10 individuals. So, where possible, these sessions will be conducted remotely. We will be cancelling all inperson meetings and teaching sessions – with the exception of Simulation Training for the management of patients with suspected COVID-19.
- If you have been scheduled for academic time – and are not required in the OR, use that time to do whatever work you can. Once we return to a regular schedule, academic time will again be limited.
- The Department of Anesthesiology does not pay for childcare
- For more information regarding available resources refer to the notice distributed yesterday describing www.care.com
- An additional source of information is Workplace page for options regarding childcare.
I appreciate each and every one of you and understand that this is a trying time. As we navigate the developing situation with COVID-19, every one of you is considered essential personnel and everyone will be asked to provide patient care. Please prepare for an “All Hands on Deck” approach to the coming days; accordingly:
- If you’re scheduled to work, report to work as normal
- If you’re not scheduled to work clinically, be prepared and ready to respond to a call or page within 30 minutes
- If you are scheduled and not required to work clinically – and we send you home, you will continue to receive your salary.
When we are back to business as usual, expect that OR volume will gear up with extended hours during the week and both weekend days.
To assist you in addressing patient questions and concerns, review the new AMA guide which has been curated by the CDC, JAMA, and the WHO: https://www.ama-assn.org/system/files/2020-03/physicians-guide-covid-19.pdf
This is the link for APSF guidelines for patient management: https://www.apsf.org/news-updates/perioperative-considerations-for-the-2019-novel-coronavirus-covid-19/
The latest information is available through InfoScope at: https://infoscope.mcw.edu/NewsCenter/MCWNews/Froedtert-Health-COVID-19-Information-Update—March-24-2020.htm
Please stay well and take care of each other.
Cynthia A. Lien, M.D.
John P. Kampine Professor and Chair
Department of Anesthesiology
Medical College of Wisconsin
9200 W Wisconsin Avenue
Milwaukee, WI 53226
Phone: (414) 805-8703