Progressive Planning - OB Massive Surge Plan... · Gestational age ≥ 20 weeks: • Direct patient...

Progressive Planning - OB

Contents

• Progressive planning• OB provider lists

– Gyn providers to be credentialled for OB• Delivery volume for planning• Facility – available rooms• Rounding teams• Accommodations for providers

Perinatal Services Progressive Planning (Surge)

Visitor Phasing

Critical visitor exceptions: • Ante/L&D/Postpartum: Patient with developmental delays – one support person• Pregnant pediatric patient (

Provider lists

See attached excel spreadsheet for contact information:

– Providers with OB privileges– Gyn providers with OB credentials

CPC Fellows and NPs

Nameemail

April Eddyapril.eddy@unitypoint.org

Liz Kiehlelizabeth.kiehl@uwmf.wisc.edu

Jenny Jacobsonjjacobson2@uwhealth.org

Jenna Racinejracine@uwhealth.org

Jackie Adamsjadams@uwhealth.org

Jade Olsonjolson@uwhealth.org

mailto:april.eddy@unitypoint.orgmailto:elizabeth.kiehl@uwmf.wisc.edumailto:jjacobson2@uwhealth.orgmailto:jracine@uwhealth.orgmailto:jadams@uwhealth.orgmailto:jolson@uwhealth.org

Anesthesia

Nameemail

Melissa Anglinmanglin@macllp.com

Christine Biedermanncbiedermann@macllp.com

Jill Cardwelljcardwell@macllp.com

Barb Caropresobcaropreso@macllp.com

Thomas Dryetdrye@macllp.com

Michael Kelmmkelm@macllp.com

Georgios Kirvassiliskirvassilis@wisc.edu

Girish Kumargkumar@macllp.com

Steven Lagmanslagman@macllp.com

Christopher Mandelcmandel@macllp.com

Eugene Milleremiller@macllp.com

Asta Mulhollandamulholland@macllp.com

Peter Norstedtpnorstedt@macllp.com

Thomas Pellinotpellino@macllp.com

Peter Prydeppryde@macllp.com

Heather Pulvermacherhpulvermacher@macllp.com

Peter Qualeypqualey@macllp.com

Lisa Reinkelreinke@macllp.com

Michael Zolinskimzolinski@macllp.com

mailto:manglin@macllp.commailto:cmandel@macllp.commailto:emiller@macllp.commailto:amulholland@macllp.commailto:pnorstedt@macllp.commailto:tpellino@macllp.commailto:ppryde@macllp.commailto:hpulvermacher@macllp.commailto:pqualey@macllp.commailto:lreinke@macllp.commailto:mzolinski@macllp.commailto:cbiedermann@macllp.commailto:jcardwell@macllp.commailto:bcaropreso@macllp.commailto:tdrye@macllp.commailto:mkelm@macllp.commailto:kirvassilis@wisc.edumailto:gkumar@macllp.commailto:slagman@macllp.com

MFMs

Nameemail

Kathleen Antonykantony@wisc.edu

Dinesh Shahdmshah@wisc.edu

Dr. Igoriruretagoyen@wisc.edu

Kara Hoppekhoppe2@wisc.edu

Jackie Adamsjadams@uwhealth.org

Janine Rhodesjrhoades@wisc.edu

Jenna Racinejracine@uwhealth.org

Jennifer Jacobsonjjacobson2@uwhealth.org

Justin Bohrerjcbohrer@wisc.edu

Kathy Stewartksstewart@facstaff.wisc.edu

mailto:kantony@wisc.edumailto:ksstewart@facstaff.wisc.edumailto:dmshah@wisc.edumailto:iruretagoyen@wisc.edumailto:khoppe2@wisc.edumailto:jadams@uwhealth.orgmailto:jrhoades@wisc.edumailto:jracine@uwhealth.orgmailto:jjacobson2@uwhealth.orgmailto:jcbohrer@wisc.edu

FMs

Nameemail

Adrienne Hamptonadrienne.hampton@fammed.wisc.edu

Alison Milleralison.miller@fammed.wisc.edu

Allison Coutureallison.couture@fammed.wisc.edu

Amy Grelleamy.grelle@uwmf.wisc.edu

Amy Kalekaakaleka@ghcscw.com

Andrea Martonffyildi.martonffy@fammed.wisc.edu

Ann Eglashanne.eglash@uwmf.wisc.edu

Ann Evensenann.evensen@uwmf.wisc.edu

Ann Steinastein@ghcscw.com

Anne Kolananne.kolan@fammed.wisc.edu

Anthony Sturmasturm@wildwoodclinic.com

Bethany Howlettbethany.howlett@uwmf.wisc.edu

Bret Benally Thompsonbbthomps@medicine.wisc.edu

Brian Arndtbrian.arndt@fammed.wisc.edu

Catherine Jamescatherine.james@uwmf.wisc.edu

Chris Kastmanckastman@ghcscw.com

Christina Hookchook@wildwoodclinic.com

Claire Gervaisclaire.gervais@uwmf.wisc.edu

David Queoffdavid.queoff@uwmf.wisc.edu

David Ringdahldavid.ringdahl@uwmf.wisc.edu

Derek Clevidencederek.clevidence@unitypoint.org

Derek Hubbardderek.hubbard@uwmf.wisc.edu

Dorothy Malloryjmallory@wildwoodclinic.com

Dylan Ledforddylanledford@gmail.com

Elizabeth Schaefereschaefer@ghcscw.com

Eric Hilquistehilquist@ghcscw.com

Erin Trostetrost@ghcscw.com

Eve Paretskyeve.paretsky@fammed.wisc.edu

George Leydongleydon@ghcscw.com

Gina DeGiovannigina.degiovanni@fammed.wisc.edu

Hampton, Jason A.JHampton@ghcscw.com

Jacob Bryanjacob.bryan@uwmf.wisc.edu

Jeffrey Huebnerjhuebner@uwhealth.org

Jennifer Edgoosejennifer.edgoose@fammed.wisc.edu

Jensena Carlsonjensena.carlson@fammed.wisc.edu

Jessica Dalbyjessica.dalby@fammed.wisc.edu

Jillian Landeckjillian.landeck@fammed.wisc.edu

John Hawkinsjohn.hawkins@uwmf.wisc.edu

Jonas Leejonas.lee@fammed.wisc.edu

Jonathan Takahashijonathan.takahashi@fammed.wisc.edu

Joseph Eichenseherjoseph.eichenseher@accesshealthwi.org

Karen Lentferklentfer@wildwoodclinic.com

Katherine Porterkatherine.porter@uwmf.wisc.edu

Kathryn Ledfordkate.heideman@gmail.com

Katie Dunbarkdunbar@wildwoodclinic.com

Kirsten Rindfleischkirsten.rindfleisch@fammed.wisc.edu

Kyle Minerkyle.miner@uwmf.wisc.edu

Laura Kuhnlaurie.kuhn@uwmf.wisc.edu

Lauren Mixtackilmixtacki@wisc.edu

Lee Dresanglee.dresang@fammed.wisc.edu

Leila Midelfortlmidelfort@wildwoodclinic.com

Lesley Coertlesley.coert@uwmf.wisc.edu

Louis Sannerlou.sanner@fammed.wisc.edu

Lynda Siewertlsiewert@wildwoodclinic.com

Magnolia Larsonmaggie.larson@fammed.wisc.edu

Mary Thompsonmary.thompson@uwmf.wisc.edu

Matthew Swedlundmatthew.swedlund@uwmf.wisc.edu

Michele Malloymichele.malloy@fammed.wisc.edu

Michelle Bryanmichelle.bryan@uwmf.wisc.edu

Nancy Deatonndeaton@ghcscw.com

Nathan Hayesnhayes@ghcscw.com

Nisha Rajagopalanlrajagopalan@ghcscw.com

Pamela Olsonpamela.olson@uwmf.wisc.edu

Patricia Tellez-Gironpatricia.tellez-giron@fammed.wisc.edu

Peter Pickhardtpeter.pickhardt@uwmf.wisc.edu

rebecca bullrbull@ghcscw.com

Rob Edwardsredwards@ghcscw.com

Rob Matthewrmatthew@ghcscw.com

Robert Luchsingerrwluchsinger@gmail.com

Robyn Titelrobyn.titel@uwmf.wisc.edu

Ronni Hayonronni.hayon@fammed.wisc.edu

Samantha Sharpsamantha.sharp@uwmf.wisc.edu

Sarah Jamessarah.james@fammed.wisc.edu

Sarah Loweryslowery@wildwoodclinic.com

Sarina Schragersarina.schrager@fammed.wisc.edu

Sean Duffysean.duffy@fammed.wisc.edu

Sreevalli Atluru, MDsreevalli.atluru@uwmf.wisc.edu

Stefen Bartonsbarton@ghcscw.com

Stephanie Skladziensskladzien@ghcscw.com

Stephen Almasisalmasi@ghcscw.com

Steven Siewertssiewert@wildwoodclinic.com

Thomas Hahnthomas.hahn@fammed.wisc.edu

William HeifnerBill.heifner@uwmf.wisc.edu

OBs and CNMs

Nameemail

Amanda Schwartz, MDaes@apmadison.com

Anastasia Dohertyanastasia.doherty@uwmf.wisc.edu

Andrew Schmittaschmitt@wildwoodclinic.com

Anna Yearous-Algozinanna.yearousalgozin@uwmf.wisc.edu

Ashley Durward, M.D.adurward@madisonwomenshealth.com

Ashley Jenningsajjennings@wisc.edu

Berghahn, Lauraber@apmadison.com

Bozzuto, Laurabozzuto@wisc.edu

Cardwell, Michaelmcardwell@mscwomenshealth.com

Carr, Carolccarr@uwhealth.org

Christenson, Callycchristenson@uwhealth.org

Denise Fryzelkadfryzelkacnm@hotmail.com

Dickmeyer, Karlakdickmeyer@madisonwomenshealth.com

Greg Billsgdbills@wisc.edu

Grzebielski, PatriciaGrzebielski@wisc.edu

Hannah Copphcopp@uwhealth.org

Henry, Joeljoel.henry@uwmf.wisc.edu

Jacqueline Peeblesjopeebles@wisc.edu

Jennifer Karnowskijkarnowski@wisc.edu

Kathryn Sarnoski, MDksarnoski@wisc.edu

Kern Steffen, Christineckernsteffen@gmail.com

Kiley HewettKiley.Hewett@uwmf.wisc.edu

Laura Jacqueslhhoff@wisc.edu

Lick, Jayjclick@wisc.edu

Luther Gaston, MDlgaston@wisc.edu

Maria Sandgrenmsandgren@wisc.edu

Mary McNicholas, CNMmmcnicholas@ghcscw.com

Masana, Jilljmm@apmadison.com

Melius, Fredfmelius@mscwomenshealth.com

Molly LepicLepic@wisc.edu

Ruth Yemaneryemane@wisc.edu

Ryan McDonaldrcmcdonald@wisc.edu

Sampene, Katherineksampene@wisc.edu

Sample, Katherineksample@madisonwomenshealth.com

Schmehil Micklos, Amandaals@apmadison.com

Schoeneker Erineschoenecker@madisonwomenshealth.com

Schurr, Juliejschurr@mscwomenshealth.com

Sharp, Kristenksharp2@wisc.edu

Shefaali Sharmassharma@madisonwomenshealth.com

Shelly Weisheiplshelly.weisheipl@uwmf.wisc.edu

Stoffel, Marymstoffel@madisonwomenshealth.com

Sullivan, Phoebepsullivan@uwhealth.org

Wagner, Jodijwagner@uwhealth.org

Wautlitt, Cynthiecwautlet@wisc.edu

Wiedel, Bethbwiedel@madisonwomenshealth.com

Williams, Makebamwilliams28@wisc.edu

Yanke, Sarahsyanke@madisonwomenshealth.com

Others with OB Credentials

Namee-mail

Laurel Ricelwrice@wisc.edu

Dobie Gilesgiles2@wisc.edu

Heidi Brownhwbrown2@wisc.edu

Christine Heislercheisler@wisc.edu

Ashley JenningsAJennings@uwhealth.org

Jeff RodzakJRodzak@uwhealth.org

Bala Bhagavathbbhagavath@wisc.edu

Laura Cooneylcooney2@wisc.edu

Aleks Stanic-Kosticstanickostic@wisc.edu

Kristen Sharpksharp2@wisc.edu

Nicole ShapiroNShapiro@uwhealth.org

mailto:lwrice@wisc.edumailto:ksharp2@wisc.edumailto:NShapiro@uwhealth.orgmailto:giles2@wisc.edumailto:hwbrown2@wisc.edumailto:cheisler@wisc.edumailto:AJennings@uwhealth.orgmailto:JRodzak@uwhealth.orgmailto:bbhagavath@wisc.edumailto:lcooney2@wisc.edumailto:stanickostic@wisc.edu

Delivery by practice – projections*% of total

Projected by Group Del/mo Del/wk

Associated 5.64% 272 23 5GHC 5.45% 263 22 5

PFW MW 1.81% 87 7 2PFW OB 4.24% 205 17 4

MWH 11.31% 546 46 11UW FM 8.05% 389 32 7

UW MFM 1.30% 63 5 1UW OB 50.59% 2443 204 47

UW CNM 10.62% 513 43 10Wildwood 1% 48 4 1

*Calculated by 2019 actual projected by group with % of volume by practice from 2018

2019 cesarean delivery rate = 27.7%Births = 4724Deliveries = 4830Avg/day = ~13

2019 Preterm Deliveries12.1% of all deliveries are

Deliveries/month by GA

STEP BY STEP

Appendix 2: UW OB Screening Process

• Phone screen for potential COVID-19 illness (Box 1 and 2) for EVERY patient that calls serviceo If patient reports symptom concerning for COVID-19 -> Assess for

(1) severity of respiratory illness and (2) necessity for in person evaluation

o Category 1: If COVID-19 Sx screen is positive and respiratory Sx appear life threatening (See Severity Assessment in Box 1): Instruct patient to call 911 and go to ER/L&D ER to page OB for consultation on arrival

o Category 2: If COVID-19 Sx screen is positive and respiratory symptoms are not life threatening AND patient needs to be seen urgently for Obstetrical Care (consider gestational age): Gestational age < 20 weeks Category 1 To ED (as above) Gestational age ≥ 20 weeks:

• Direct patient to come to OB triage • Inform patient of restricted visitor policy• Patient to be masked upon arrival, placed in a private room, keep door closed• All staff interacting with the patient should don PPE (Contact + Droplet Isolation + eye protection (N95 and

negative pressure room not needed unless aerosol generating procedure))• Determine if testing is appropriate for patient

o Category 3: If COVID-19 Sx screen is positive and respiratory symptoms are not life threatening AND patient does not need to be seen urgently for Obstetrical Care (consider medical co-morbidities): Assess for medical co-morbidities (Box 2) If POSITIVE medical co-morbidities Category 2 (to ED or L+D as above) If NEGATIVE medical co-morbidities:

• Advise patients to stay at home, quarantine, hydrate, anti-pyretic• Be advised: Some patients not meeting criteria for testing may be instructed to self-isolate. If need for COVID

testing the patient will be contacted and instructed where and when to go to get tested

Box 2: Medical Co-morbidities – recommend an in-person evaluation

HypertensionDiabetesAsthmaHIVChronic heart diseaseChronic liver diseaseChronic lung diseaseChronic kidney diseaseBlood dyscrasiaPeople on immunosuppressive medicationsInability to care for self or arrange follow-up if necessary

https://www.acog.org/-/media/Practice-Advisories/COVID-19-Algorithm5.pdf?dmc=1&ts=20200316T2219362729

Box 1: Symptom Severity Assessment: Any positive answers require emergency care

Does she have difficulty breathing or shortness of breath? Does she have difficulty completing a sentence without gasping for air or needing to stop to catch

breath frequently when walking across the room? Does patient cough more than 1 teaspoon of blood? Does she have new pain or pressure in the chest other than pain with coughing? Is she unable to keep liquids down? Does she show signs of dehydration such as dizziness when standing? Is she less responsive than normal or does she become confused when talking to her?

https://www.acog.org/-/media/Practice-Advisories/COVID-19-Algorithm5.pdf?dmc=1&ts=20200316T2219362729

https://www.acog.org/-/media/Practice-Advisories/COVID-19-Algorithm5.pdf?dmc=1&ts=20200316T2219362729https://www.acog.org/-/media/Practice-Advisories/COVID-19-Algorithm5.pdf?dmc=1&ts=20200316T2219362729

Triage to Labor & Delivery Workflow

Patient is screened in triage or is received in

triage from ED as a PUI or COVID +

HUC will mask patient; call OB Triage RN to

escort patient to Triage 1-4

Or Room 9 or 10

YES Patient will bypass

triage and be directly admitted to

Labor Room 483 – 486

NO

Implement isolation and follow testing

criteria algorithm as needed

Labor?

Induction?

Cesarean Delivery?

Routine triage care and PPE

Determine reason for triage visit

YES

NO

NO

Transport from OB triage to OB OR #3

YES

YES

Massive surge options1. Use triage for labor and delivery2. Use CPC for triage and/or labor & delivery overflow3. Use labor room(s) as ORs4. Use main OR for all cesarean deliveries

COVID + /PUI Admission to

discharge Workflow

Management of the Infant born to COVID + /PUI Mother

NICU rooms 18-23 with PPE & isolation requirements (Newborn

Hospitalist Service)

Expressed breast milk

Mother may not visit until negative test*; healthy adult support person

may visit & must wear clean mask and gloves

Expressed breast milk or breastfeeding with PPE

Room precautions

Feeding

Visitation

CDC recommends separation of mother and infant

Parents agrees to recommendations Parents declines recommendations or Separate rooms not available

6N rooms 670-682; infant in open crib (or isolette) > 6ft from mom

PPE & isolation requirements

Healthy adult support person wears mask and stays in room to

provide newborn cares

*If mother has negative test, asymptomatic infant may be transferred from NICU to Newborn and return to mothers room and resume couplet care

Hospital Facilities – room availability

Inpatient (COVID+ designated)

• OB triage – 10 beds (1-4 + 9 & 10)• 3 North – 10 beds (392, 393)• 4 North – 17 beds (483 – 486)• 5 North – 24 beds• 6 North – 24 beds (670-682)• NICU – 42 beds (18 – 23)

Outpatient (potential triage or L&D space)

• CPC – 8 clinic rooms• Ultrasound – 9 US rooms

All exam tables have stirrups

Provider accommodations

• 5 Center & 3 East – 1 call room/practice group + 2 call rooms/UW Ob-Gyn

General considerations

• Bypass triage for active labor patients • Discharge ASAP

– Vaginal birth within 24 hours– Cesarean birth within 36 hours

• COVID + moms and baby will be separated after birth; if not able to do so due to space or staffing, cohort mom & baby together; baby 6-feet apart

COVID – 19 Team

Tier 1: Low risk

Resident + one of the following:Family MedicineMidwife

Tier 2: High riskResident + one of the following:OB-GYNFellowMFM

COVID + /PUI Admission to

discharge Workflow

Slide Number 1Slide Number 2ContentsPerinatal Services Progressive Planning (Surge)Visitor PhasingProvider listsDelivery by practice – projections*2019 Preterm DeliveriesDeliveries/month by GASTEP BY STEP Slide Number 11Slide Number 12Triage to Labor & Delivery WorkflowCOVID + /PUI Admission to discharge WorkflowSlide Number 15Slide Number 16Management of the Infant born to COVID + /PUI Mother Hospital Facilities – room availabilityProvider accommodationsGeneral considerationsCOVID – 19 TeamSlide Number 22COVID + /PUI Admission to discharge WorkflowSlide Number 24