Department Airway Response Teams (ART) reducing to one/transition process
Due to the declining case load for COVID and based on review of airway response activations, our department will be able to transition from 2 to 1 ART team over the coming weeks! Thanks to all who have volunteered to cover the front lines, especially at nights and on weekends. Your contributions during this pandemic cannot be overstated! We are doing this transition with appropriate caution, starting with weekdays, but if the trajectory continues we will be down to 1 ART faculty lead airway team and one AIC/trauma lead airway team 24/7 by May 4. We will have 2 ART teams at night this week and weekend.
The following logistical changes will occur to facilitate this transition. The main difference is the ART team/faculty will cover known or suspected COVID patients, while non-COVID suspected airways and codes will go back to the resident/AIC. We will continue to cover all non-ED airways.
Please note, changes are written for the combination of 1 AIC + 1 ART attending teams, for weekends and nights with 2 ART attendings, intubations can be alternated sequentially or split based on mutual decision from the two ART faculty.
Calls will designate COVID + or COVID – status. We will continue to use PPE which includes a respirator for all intubations, as directed by infection prevention. Please keep your eye out for changes to PPE.
COVID+/Suspected Patients: the RRT RN or ICU Charge RN will give an affirmative of COVID status when activating ART. A page will go out to both teams with COVID + or NEGATIVE. These calls will generally, if not always be coming from MICU/9NT. These patients should be managed by ART attending as opposed to resident/AIC.
COVID Negative/Non-Suspected patients: the page will go out as NEGATIVE or COVID NEGATIVE.
- These intubations should be managed by the PACU resident with the AIC as supervising faculty during the day. At night/on weekends either a resident or CRNA will be assigned to this role with AIC. We will maintain the ART attending’s availability for COVID patients whenever possible.
- The PACU resident should notify AIC for all calls
- This has been selected to be the resident role for a variety of reasons, particularly to ensure that the ART faculty anesthesiologist is available if a concurrent COVID call was activated and to preserve resident education for out-of-OR intubations during indefinite COVID period. It is far less likely a second COVID airway is called concurrently based on RRT and MICU triaging and awareness of ART team needs.
- Code4’s are not yet able to page based on COVID status, but suspect COVID positivity for 9NT and MICU calls.
- Please consider that this is page designation does not represent a formal clinical assessment. If clinical condition is suspicious for COVID (even if initial testing negative) the patient may need to be re-labelled as a PUI, in which case ART team can be called (51542). Our test performance has improved, but still isn’t 100%, so clinical judgement remains important! We are phasing in resident involvement for out-of-OR airways for patients who are not suspected to have COVID paralleling OR intubations in non-COVID suspected patients.
- For periods of 90 minutes or less, PUIs can be on any unit.
If more than two calls occur within 30 minutes, an overhead page will go out. this will not denote COVID status, but physical pages will occur as well. Security will also call the ART1 phone in these scenarios, if no answer, the AIC phone will be called, with a 3rd attempt to PACU resident. If the ART faculty is activated and a COVID patient is called, the AIC should intubate (not resident).
At 7 am, please leave ART2 phone and pager on airway cart – the PACU resident will carry the trauma pager and PACU phone, but these will still be needed for nights.
Please continue to attend 7:45 am and 7:45 pm huddles outside of the MICU (including AIC and PACU resident).
Thank you for your flexibility during this rapidly evolving process!
Michael A. Fierro, MD
Department of Anesthesiology
Medical College of Wisconsin