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