In preparing for COVID-19 cases, plan early, communicate often

April 27, 2020

April 27, 2020 - Hospitals facing a growing population of COVID-19 cases need a coordinated approach with a multidisciplinary team to increase efficiency, conserve PPE and protect staff. In "American Journal of Respiratory and Critical Care Medicine - experts from Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center share their roadmap for meeting challenges posed by the pandemic, including an influx of critically ill patients.

As one of the nation's largest academic medical centers, Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center has a highly experienced team of specialists and robust resources, and physicians there used early lessons from existing data to help plan for a surge.

More than anything, hospitals should plan early, said Lindsay Lief, MD, lead author of the guide and medical director of the medical intensive care unit at NewYork-Presbyterian/Weill Cornell Medical Center, and assistant professor of clinical medicine at Weill Cornell Medicine.

"Plan early for beds, equipment and people. Listen to predictions from epidemiologists about the numbers to expect. Plan for daily remote communications platforms. Support front line staff. Food, scrubs, hand lotion, mental health support--it all counts."

The authors wrote, "Given rapidly evolving data on the infectiousness of COVID-19, including from asymptomatic or paucisymptomatic patients, initial highest priorities included obtaining an adequate supply of personal protective equipment (PPE) for the staff and evaluating/expanding intensive care unit and ventilator capacity, among numerous other measures."

"Although having appropriate PPE has been a concern for all health care personnel across the country during the COVID-19 crisis, Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell worked diligently to provide adequate PPE to protect our staff," Dr. Lief said. "In addition, as a hospital that regularly provides specialized, complex care, we have incredible resources as far as nurses, respiratory therapists and physicians in diverse specialties."

Dr. Lief and her colleagues, with the support of medical center administrators, called upon those resources to care for COVID-19 patients. The usual protocols were amended to expedite training of clinical staff to care for patients with acute respiratory distress syndrome, a disorder characterized by a build-up of fluid in the air sacs of the lungs, which deprives the body's organs of oxygen. Physicians (including residents and fellows), nurses, respiratory therapists, as well as essential non-clinical staff began sharing responsibilities.

Critical care doctors needed help and got it. "For example, physical and occupational therapists have incredible expertise," said Dr. Lief. "But when there aren't a lot of patients well enough to exercise, we collaborated with them to make a 'proning team' using their expertise on body positioning with the patients we have to flip on to their bellies to increase their oxygen levels."

The bottom line: "We learned that daily, clear communication is key, especially in a rapidly changing environment where we are learning more every day," noted Dr. Lief. "Hospital communication regarding infection prevention and control, PPE, state and CDC guidelines provides not only information but relieves staff anxiety. In addition, daily phone conferences among physicians caring for patients with COVID helps remind us of the essential and ideal care for respiratory failure and to put in context what we are learning from colleagues around the world and new research as it comes to light. "
About the American Journal of Respiratory and Critical Care Medicine

The AJRCCM is a peer-reviewed journal published by the American Thoracic Society. The Journal takes pride in publishing the most innovative science and the highest quality reviews, practice guidelines and statements in pulmonary, critical care and sleep medicine. With an impact factor of 16.494, it is one of the highest ranked journals in pulmonology. Editor: Jadwiga Wedzicha, MD, professor of respiratory medicine at the National Heart and Lung Institute (Royal Brompton Campus), Imperial College London, UK.

About the American Thoracic Society

Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society's 15,000 members prevent and fight respiratory disease around the globe through research, education, patient care and advocacy. The ATS publishes three journals, the American Journal of Respiratory and Critical Care Medicine, the American Journal of Respiratory Cell and Molecular Biology and the Annals of the American Thoracic Society.

American Thoracic Society

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