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We're about to begin our November seminar with @HalliePrescott & @iwashyna - here's who they are and why we've called on them to talk about #criticalcare in #COVID19: #ihpi20
https://ihpi.umich.edu/our-experts/hprescot
https://ihpi.umich.edu/our-experts/tiwashyn
https://ihpi.umich.edu/our-experts/hprescot
https://ihpi.umich.edu/our-experts/tiwashyn
Want to join? Register here and we'll let you right in: https://ihpi.umich.edu/events/caring-critically-ill-during-1st-wave-covid-conversation-hallie-prescott-and-jack-iwashyna #ihpi20
. @iwashyna looks back to the very first days after #COVID19 arrived in #Michigan - "It's not that dissimilar from the feeling I'm having this week," as the hospitalization curve rises.
Both of our speakers focused on caring for #veterans at @VAAnnArbor during March - taking extra precautions at home and work to protect themselves and others. @iwashyna credits the Environmental Services team at the VA for making rapid modifications.
Prescott reflects back on how the VA created an entirely new ICU for non-COVID patients, pulling in staff from across the health system. "A lot of people were practicing outside their normal scope of business." No one knew what to expect. #IHPI20
The absence of families in the ICU was striking, because they've become part of ICU care in recent years, Prescott says (see work by @tsvalley & colleagues on this: https://ihpi.umich.edu/news/outside-looking-study-shows-variation-hospital-visitor-icu-communication-policies-due-covid-19)
#IHPI20
#IHPI20
Prescott tells the story of how the VA ICU team helped a long-term non-COVID patient celebrate his birthday in this @mcsweeneys piece: https://www.mcsweeneys.net/articles/a-surprise-birthday-party #IHPI20
There were worries that heated high flow oxygen would aerosolize the virus, so @iwashyna asked @ProfAmyCohn to work to study if that was actually happening. They used the Clinical Simulation Center & gear from @UMengineering to show it was safe: https://www.medrxiv.org/content/10.1101/2020.04.15.20066688v1
#IHPI20
#IHPI20
This meant the VA and U-M, and other hospitals, changed their practice and went back to using HHFNC in COVID patients - which meant fewer intubations. #IHPI20
Meanwhile, the nearly overnight shift to #Telemedicine at the VA was happening - with no canceled clinics. #IHPI20
Prescott notes that the ICU team committed to daily phone calls with families, and facilitated video chats. As the VA started accepting non-veteran patients for the first time ever, families of transferred patients expressed gratitude for the higher level of communication #IHPI20
"We provided spectacular care to these people," says Iwashyna of the non-veterans. Prescott remembers having to explain to patients as they awoke that they were at a VA hospital, and hearing their surprise. #IHPI20
The clinical experience in those few months generated many research ideas and questions, says @iwashyna. It also led to a need to create guides for providers who weren't used to providing ICU care, to help them as they stepped in to help and not harm. #IHPI20
The 'dirty dozen' list is the result - and @iwashyna remembers giving the talk many of times via Zoom to help groups of providers prepare to give ICU care: https://litfl.com/the-dirty-dozen-common-errors-on-discharging-patients-recovering-from-critical-illness/
Meanwhile, Prescott had just started leading efforts to improve #sepsis care across #Michigan via @HMS_MI, a collaborative quality effort led by @flandersumich. She pivoted quickly to harness data-gathering & analysis capacity to create Mi-COVID19: https://www.mi-hms.org/quality-initiatives/mi-covid19-initiative #IHPI20
The initiative has just produced its first paper, in @AnnalsofIM , which includes data from interviews with nearly 500 post-hospitalization COVID patients as well as data on hundreds more: …https://www-acpjournals-org.proxy.lib.umich.edu/doi/10.7326/M20-5661 #IHPI20
"When we just count hospitalization or deaths, we are underestimating the burden. It's not just dying or surviving, there are a lot of people who struggle for a long time." - Prescott #IHPI20
Despite a surge of interest to find new things to help critically ill COVID patients, the basics of good supportive ICU care have proven most effective so far, says Prescott. "We know how to take care of this. How do we stay attentive to ensuring the very best practice." #IHPI20
"Neither of us would be the least bit sad if there's a magic bullet" to replace evidence-based ICU care for COVID, says @iwashyna. But it doesn't appear to be happening soon. Meanwhile, mortality is dropping, though how to sustain it in the current surge is now a concern. #IHPI20
Iwashyna also referenced work led by @RyanPBarbaro to measure & report the impact of #ECMO on #COVID19 patients: https://ihpi.umich.edu/news/last-resort-life-support-option-helped-majority-critically-ill-covid-19-patients-survive #IHPI20
The effort to study the post-hospital period is revealing many financial challenges, lack of medical follow-up, and problems finding facilities that will take recovering COVID-19 patients. Advice & support for home caregivers is also needed such as https://heart.isr.umich.edu/resources/ #IHPI20
Another key area needing attention is scarce resource allocation, which @iwashyna & colleagues wrote about in this piece. "It was never about scarce ventilators. It's nurses and dialysis.":
https://litfl.com/a-practical-approach-to-running-a-scarce-resource-allocation-team-srat/ #IHPI20
https://litfl.com/a-practical-approach-to-running-a-scarce-resource-allocation-team-srat/ #IHPI20
Prescott notes that it's important to not wait until the thick of a crisis to work out how to handle scarcity, and have agreement on the fairest and best way to do it, including data collection & calculating scores. #IHPI20
Iwashyna: Thinking creatively about how to avoid actual scarcity, by evaluating as a team what they could run out of and working to avoid that, was incredibly important. #IHPI20
The new third surge is upon us, and our speakers are thinking about what's to come and how to use systems thinking to address it. @iwashyna wrote this piece for @nytopinion about patient transfers: https://www.nytimes.com/2020/10/30/opinion/coronavirus-treatment-hospitals.html?searchResultPosition=1 #IHPI20
Getting sickest #COVID19 patients to hospitals that can handle their care - the ones that have experience caring for ARDS - is critical, says @iwashyna. Keeping people from being left behind, especially in people of color, should be a key goal for academic medical centers #IHPI20
Going forward with #COVID19, Prescott reiterates that using evidence-based practices and overcoming barriers to them will be critical - and implementation scientists could help units and teams provide this kind of care. #IHPI20
Thank you @iwashyna & @HalliePrescott for such a compelling seminar - and for the reminder that we should all work to stay safe and support one another safely over the weeks to come so that we don't need to call on your clinical expertise! #IHPI20
If you missed our seminar, or want to share it with others, we'll have a recording up on our YouTube playlist tomorrow: https://www.youtube.com/playlist?list=PLNxqP-XbH8BLi5K_2giRk0NeJTLct7ybl #Ihpi20
