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COVID-19 Virtual Town Hall
Friday, March 20th (2 – 3 PM EST)
Introduction
Marschall Runge, MD, PhDChief Executive Officer, Michigan Medicine
COVID-19 National and Local Activity and
Forecasting
Jeff Desmond, MDChief Medical Officer – UMHS
Vikas Parekh, MDMedical 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 dayInfectious Period
7 days Hospital LOS for non-
ICU patients
9 days Hospital LOS for patients
requiring ICU care
DISEASE AND SPREAD HOSPITALIZATIONHOSPITAL 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, MDPresident – 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, MDChief 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, MDChief Clinical Officer – UH/CVC
Michael Mulholland, MDExecutive 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 MayChief 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, MDChief Medical Officer – UMHS
David Miller, MDChief Clinical Officer – UH/CVC
Michael Mulholland, MDExecutive 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/resources/coronavirus.html
Michigan external website: https://www.uofmhealth.org/covid-19-update