COVID-19 Updates: Hospital Medicine

Friday, April 3, 2020

With the increase of COVID-19 cases in our community, Duke hospital medicine has been making several updates in order to stay in front of the pandemic. 

Isolation Units 

Early on, the Duke hospital medicine team recognized the need to create isolation units to separate and group suspected patients with COVID-19. This work occurred at all 3 hospitals (Duke University Hospital, Duke Regional Hospital, and Duke Raleigh Hospital) with input from hospitalists, intensivists, infectious disease specialists, nursing, respiratory therapists, engineering, materials & supplies management and many others.  

Within a short time span, isolation units were open at all 3 hospitals and are being staffed by hospitalists and intensivists.​ These units have new teams and workflows that are developing an amazing work culture. The supporting teams have been dedicated to meeting the needs of our patients and their families during these troubling times.

Hospital Workflows & Processes

Hospitalists at all 3 sites have been participating with the myriad of policy and process changes that affect flow in hospital practices. This includes clinical patient flow, updates to rapid response teams/code blues for COVID-19 patients, transfer requests into DUHS, and what kind of resources need to be purchased for various units. Our administrative teams have also been working shifts to help screen visitors to the hospital for COVID-19 during the initial visitation restrictions. Hospital medicine leadership is embedded as key leaders in the incident command structure of the hospitals. 

PPE Preservation

Hospitalists have been engaged with plans for personal protective equipment (PPE) preservation efforts. The hospital medicine team is participating in a plan to sterilize N95 masks using aerosolized hydrogen peroxide and reuse them. They have also been bundling care with nursing so that only one person enters a COVID-19 isolation room when possible to conserve PPE. 

Research Trials

Dr. Noel Ivey, a hospitalist at Duke University Hospital, has been partnering with Dr. Cameron Wolfe, of Duke Infectious Disease, to help enroll patients in clinical trials for possible COVID-19 treatments.

"This is a major area for us to support given the lack of effective treatments for this illness," says David Gallagher, MD, Chief of Hospital Medicine programs. 

Resiliency

Several Duke hospitalists have developed a series of online/virtual group chats, including cocktail hours, to address the loneliness of social isolation. These have been well received by the group and many have found them as a great support tool. 

A structured support system to help providers who need childcare has also been created. Contact Dr. Joanna Kipnes for more info. 

COVID-19 Surge Projections

The hospital medicine team anticipates significant increases in hospitalizations at all 3 Duke hospitals, due to the projected surge in our communities of COVID-19 infections. Duke hospitalists have been partnering with colleagues in Departments of Medicine, Surgery, Anesthesiology, GME, and others to help meet the need for an increased number of providers to care for these patients.

Did We Miss Anything? 

Be sure to reach out to DGIM Communications Strategist, Clare Il'Giovine, with any other hospital medicine updates.