Welcome to HTT Hospitalists in a Pandemic Lessons

Welcome to HTT!!

Hospitalists in a Pandemic: Lessons from Leading through COVID Charles Pizanis, MD @Cpi zanis E ileen B arrett, MD , MPH, S FH M, F AC P @Eileen. Barrett. NM Taylor Goot, MD, FACP

Objectives • Learn how hospitalists can serve as change agents within a health system • Identify how crisis can be a driver for innovation • Understand several core leadership principles – swarm leadership, leading with empathy, avoidance of sunk cost fallacy

Prepare for 100 COVID admissions per day, 400 inpatient IM census

SWARM LEADERSHIP

COVID HM Executive Team §Keeping our healthcare team safe and well • • What is the correct PPE for this novel disease How do we assure we have appropriate PPE for our clinicians How do we prevent coworker transmission How do we preserve PPE supply How do we prevent burnout amongst our team What is the interface with residents and other trainees Are there practices we have which we should change to minimize other HCW risk (e. g. RNs) §Providing framework for adequate staffing • • • What is the workload of caring for patients with COVID How do we find enough staffing to address surge How do we onboard non-hospital medicine faculty How do we communicate updates to our group and those outside How do we support other services involved in COVID management §Assuring highest quality care to patients and families • • • How do we treat patients with COVID What is appropriate testing for patients with COVID How do we treat complications from COVID (e. g. VTE) How do we balance non-COVID patient care for PUIs How do we address communication gaps with families not visiting

Zinc Service Timeline Zinc 1 Zinc 2 Zinc 3 Zinc 4 Zinc 5 19 18 1818 17 17 16 16 15 15 14 13 15 15 14 1414 13 13 13 12 12 1212 11 11 11 10 10 10 9 9 9 8 88 13 13 12 11 10 10 9 8 7 7 66 5 5 4 4 4 1111 14 14 13 12 1212 10 10 99 8 777 7 5 44 44 33 333 1 8/ 6/ 20 2 0 0 30 /2 02 0 7/ 23 /2 02 0 7/ 7/ 16 /2 02 0 20 2 9/ 7/ 7/ 2/ 20 2 0 0 6/ 25 /2 02 0 18 /2 02 0 6/ 02 /2 11 6/ 6/ 4/ 20 2 0 0 28 /2 02 0 5/ 21 /2 02 0 5/ 02 /2 14 5/ 5/ 7/ 20 2 0 0 4/ 30 /2 02 0 4/ 23 /2 02 0 16 /2 02 0 4/ 20 2 9/ 4/ 4/ 2/ 20 2 0 0 02 /2 26 3/ 3/ 19 /2 02 0 000 0 02 /2 12 3/ 17 16 16 15 15 14 141414 1414 13 13 13 12 12 11 1111 1 1 6 3 3 22 2 22 0 18 18 17 16 16 17

Build community within UNM, throughout NM M&M, grand rounds Preferred language, city, payer in cache Expanded interpreter services Plain language scripts Foster empathy Safer interhospital transfers

Data is evolving – What do we do? q Deep breath q Examine your skepticism q Examine your hopefulness q Biologic plausibility q Safety/Harm/Cost q Efficacy

Is Incidence Increased?

* Stroke and arterial thrombi also have increased incidence. Fox SE, Akmatbekov A, Harbert JL, Li G, Brown JQ, Heide RSV. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Medicine. Published online 2020. doi: 10. 1016/s 2213 -2600(20)30243 -5

Who Gets a VTE?

D- Dimer Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020; 18(4): 844 -847. doi: 10. 1111/jth. 14768 Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, Merdji H, Clere-Jehl R, Schenck M, Gandet FF, Fafi-Kremer S, Castelain V, Schneider F, Grunebaum L, Anglés-Cano E, Sattler L, Mertes P-M, Meziani F. High risk of thrombosis in patients with severe SARS-Co. V 2 infection: a multicenter prospective cohort study. Intens Care Med. 2020; 46(6): 1089 -1098. doi: 10. 1007/s 00134 -020 -06062 -x

Should We Increase The Dose of Prophylaxis?

Klok FA, Kruip MJHA, Meer NJM van der, Arbous MS, Gommers DAMPJ, Kant KM, Kaptein FHJ, Paassen J van, Stals MAM, Huisman MV, Endeman H. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. Published online 2020. doi: 10. 1016/j. thromres. 2020. 04. 013 Klok FA, Kruip MJHA, Meer NJM van der, Arbous MS, Gommers D, Kant KM, Kaptein FHJ, Paassen J van, Stals MAM, Huisman MV, Endeman H. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID 19: An updated analysis. Thromb Res. 2020; 191: 148 -150. doi: 10. 1016/j. thromres. 2020. 041

Implementing Change q Agile not rushed q Deliberate not reactive q Don’t fall into the “Sunk Cost Fallacy”