Trump says IG report finding hospital shortages is ‘just wrong’

https://thehill.com/policy/healthcare/491454-trump-says-ig-report-finding-hospital-shortages-is-just-wrong?utm_source=&utm_medium=email&utm_campaign=28856

Hospital Experiences Responding to the COVID-19 Pandemic: Results ...

President Trump on Monday claimed that an inspector general report finding “severe” shortages of supplies at hospitals to fight the novel coronavirus is “just wrong.”

Trump did not provide evidence for why the conclusions of the 34-page report are wrong.

He implied that he is mistrustful of inspectors general more broadly. He recently fired the inspector general of the intelligence community, which has drawn outrage from Democrats.

“Did I hear the word inspector general?” Trump said in response to the reporter’s question about the findings.

“It’s just wrong,” Trump said of the report.

The inspector general report, released earlier Monday, was based on a survey of 323 randomly selected hospitals across the country.

It found “severe” shortages of tests and wait times as long as seven days for hospitals. It also found “widespread” shortfalls of protective equipment such as masks for health workers, something that doctors and nurses have also noted for weeks.

“The level of anxiety among staff is like nothing I’ve ever seen,” one hospital administrator said in the report.

Brett Giroir, an assistant secretary of Health and Human Services, noted that the report’s survey of hospitals was conducted March 23 to March 27. He said testing had improved since then and that it was “quite a long time ago.”

Trump asked who the inspector general of the Department of Health and Human Services is.

“Where did he come from, the inspector general?” Trump said, adding, “What’s his name?”

The office is currently led by Christi Grimm, the principal deputy inspector general.

According to her online biography, Grimm joined the inspector general’s office in 1999. 
Trump said the U.S. has now done more testing than any other country. “We are doing an incredible job on testing,” he said.
He also berated the reporter asking the question, saying testing has been a success.
“You should say, ‘Congratulations. Great job’ instead of being so horrid,” Trump said.
The American Hospital Association (AHA) on Monday said the inspector general report was accurate.

The report “accurately captures the crisis that hospitals and health systems, physicians and nurses on the front lines face of not having enough personal protective equipment (PPE), medical supplies and equipment in their fight against COVID-19,” the AHA said.

https://oig.hhs.gov/oei/reports/oei-06-20-00300.pdf?utm_source=&utm_medium=email&utm_campaign=28856

 

 

 

 

Resilience, dedication, conviction: Hospital CEOs write thank-you notes to staff

https://www.beckershospitalreview.com/hospital-management-administration/resilience-dedication-conviction-hospital-ceos-write-thank-you-notes-to-staff.html?utm_medium=email

Words of appreciation: Thank-you notes from 15 health system CEOs ...

Healthcare workers have been on the front lines of the COVID-19 pandemic, providing care to ill patients and battling the public health crisis from various angles. In honor of these workers, Becker’s asked hospital and health system CEOs to share notes to their staff and team members.

Michael Apkon, MD, PhD
President and CEO
Tufts Medical Center & Floating Hospital for Children (Boston)

At Tufts Medical Center, we see some of the sickest people in Boston. Our teams routinely surround each of these patients with the extraordinary care and services they need to get well.

This pandemic is unprecedented.  I know our staff are balancing the concerns that we all have for our families and friends, our own health, as well as the changes to our lives outside of work at the same time they do everything they can to provide the level of care people have come to trust from our organization. I can tell you that over my 30 years in this industry, I have not seen more dedication, innovation and willingness to help than I have during these past few months, as we fight a largely unknown enemy.

I could not be more proud of our doctors, nurses, technologists, transporters, housekeepers, cooks, public safety officers and all others who have been vital to the care of all of our patients, including those with a COVID-19 diagnosis. I know that people are coming together across our industry in nearly every city and town. Many thanks to each of our team members and to the healthcare workers around our country as well as to their families, who have had to worry day after day about their loved one on the front lines. Please know your partners, mothers, fathers, sister, brother, sons or daughters have played a critical role in saving lives, and we are doing everything we can to keep them safe.

Marna Borgstrom
CEO Yale New Haven (Conn.) Health

During these unprecedented times I welcome the opportunity to reflect on all that our staff at Yale New Haven Health are doing for each other and for our communities. We have a team of more than 27,000 hardworking and talented people to care for communities in Connecticut, New York and Rhode Island. I am truly humbled and honored to work alongside these amazing individuals.

Our staff, like healthcare workers everywhere, are being tasked in seemingly conflicting ways during this pandemic. Not only are they continuing to do their jobs by caring for the sickest patients, but they are also managing extremely challenging issues at home. Children of all ages are home from school, some need to be home-schooled. Businesses are closed, impacting many spouses and other family members. Staff worry that they may not have an adequate amount of protective equipment and supplies while at work.

But Yale New Haven Health staff are strong, they are resilient and most of all they are caring. As we do everything in our power to keep our staff safe, they are doing everything in their power to care for very ill patients in a world where new information is coming in real time and changing rapidly. We all hope and pray that this pandemic will end soon, but until it does, we are all in this together. I have never been more proud to work with this this wonderful Yale New Haven Health team.

Audrey Gregory, PhD, RN
CEO of the Detroit Medical Center

We know that the current situation around COVID-19 is unnerving, and as things continue to change rapidly every day, it can also be overwhelming.

I want to take this opportunity to thank all the front-line staff at every level in our organization and at healthcare facilities all across the country.

I also would like to say thank you to all of the providers, including residents, fellows and advanced practice providers. I recognize the commitment that you have to provide care to our patients. Not only do I want to acknowledge that, I never want to take that for granted. As healthcare workers, this is the time that we courageously stay on the front lines.

Please be safe and do your part to protect each other. If you have any flu-like symptoms such as fever, cough, sore throat, body aches or shortness of breath, please stay home. I know that as healthcare workers we have a tendency to ignore symptoms, and work through them, so that we do not let the team down. This is the time that I implore you not to do so.

Thank you for your commitment and dedication to the patients and families that depend on us during this challenging time.

R. Guy Hudson, MD
CEO of Swedish Health Services (Seattle)

As we come together to fight this unprecedented pandemic, I am continually impressed by the resilience, professionalism and dedication of our community’s healthcare workers, first responders and other providers of essential services. Without their selfless commitment to serving others, we would not be able to weather this crisis.

Though we have yet to see the full costs that COVID-19 will exact on our region, I am confident that our community will continue to come together, support each other and manage through this situation with resolve.

I am grateful to the community’s outpouring of support for healthcare providers on the front lines, including the 13,000 dedicated caregivers at Swedish. It is often in times of crisis that our humanity, resilience and compassion shine brightest.

The pandemic poses the greatest risk to the most vulnerable members of our community. There are hundreds of nonprofits and other organizations that are doing heroic work to help our neighbors who struggle with mental illness, housing instability, food insecurity and other challenges. Their efforts are more critical than ever and need our support.

In this unchartered territory, I find strength in the dedication and conviction of the caregivers I have the privilege to work alongside. Providing care to our community in a time like this is exactly why we chose careers in healthcare. In the face of this pandemic, we will continue to serve the needs of our community, and we will not waver in our commitment to our patients.

To all our Swedish caregivers: I am proud to work with you.

Alan Kaplan, MD
CEO of UW Health (Madison, Wis.)

We find ourselves in an unprecedented time. We are preparing for a global pandemic, an insidious virus, that is already at our doorstep. To do this, the physicians and staff at UW Health are adjusting every aspect of our standard service to care for those who need us now, to prevent the spread of COVID-19 and to save as many lives as possible.

Despite these dire circumstances, I remain optimistic and proud. The faculty and staff at UW Health, from our diligent technicians to our expert physicians and nurses, are all working incredibly hard to ensure we are doing everything in our power to care for the communities we serve. Your early actions and quick flexibility gave our health system the best chance to manage this crisis. I am especially impressed by the ongoing collaboration, because it shows how much we are capable of accomplishing together. This work is highly valued and deeply appreciated, both within our walls and beyond.

I know this is a trying time for everyone in our organization and so many others around the world. Much of our specialty care has been put on hold, clinics have closed, and regular schedules are nonexistent. I appreciate the long hours and commitment it takes to serve patients and the public good in a time like this. For those on the frontlines of COVID-19, know that our entire organization and our community are proud of the work you are doing.

Finally, I hope you all do what you can to stay healthy, refresh and take time for yourself and to be with loved ones however possible during this new and challenging time. Thank you for everything you do. You are a daily inspiration.

Sarah Krevans
President and CEO of Sutter Health (Sacramento, Calif.)

The healthcare profession attracts those who want to make a difference in the lives of others. They all have a higher calling and always rise to the challenges in front of them. This happens every day, but it’s very apparent during this time in our history. There is no part of our organization that is untouched by this public health emergency. And yet, our teams stand tall. They don’t back down. From front-line health workers, to food and nutrition services staff, to information services personnel — they are committed to keeping our communities safe. Words will never be able to adequately thank them for their dedication, their perseverance and their heart, but all of us across our organization are forever grateful.

Jody Lomeo
President and CEO of Kaleida Health (Buffalo, N.Y.)

As we face these historic and challenging times, it is vitally important that we come together and stick together as a community. It’s just as important that we remain unified as the Kaleida Health family.

That said, let me thank everyone for their incredible dedication and teamwork this past week.

This is an unprecedented issue for healthcare providers to have to deal with; yet the response by the organization as a whole is what we have come to expect: nothing short of remarkable and solely focused on taking care of our community.

On behalf of a grateful community, the board of directors and the Kaleida Health leadership team, we thank you all for your incredible dedication these past few weeks. I have said it numerous times this week: You are the true heroes of this pandemic. And while our way of life has been forever changed, one constant that remains the same: the outstanding work that is done by the Kaleida Health team!

A special note of gratitude goes out to all of those who have volunteered to care for COVID-19 patients within their respective hospitals and across the Kaleida Health system. We could not do this without you!

In closing, thanks again. Stay healthy, stay safe.

We remain #KaleidaStrong.

Elizabeth Nabel, MD
President of Brigham Health (Boston)

We face an unprecedented challenge — possibly the greatest we will ever experience in our careers, maybe even our lifetimes. I am inspired by the indomitable dedication, courage and innovative spirit of our medical and scientific community as we navigate through these most trying events. From providers working on the front lines of patient care to investigators racing to discover an effective treatment for COVID-19, we are surrounded by countless demonstrations of commitment, collaboration and compassion. We will get through this together and come out on the other side stronger than ever.

 

 

 

 

First Sign of Civilization in a Culture

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Years ago, anthropologist Margaret Mead was asked by a student what she considered to be the first sign of civilization in a culture. The student expected Mead to talk about fishhooks or clay pots or grinding stones.

But no. Mead said that the first sign of civilization in an ancient culture was a femur (thighbone) that had been broken and then healed. Mead explained that in the animal kingdom, if you break your leg, you die. You cannot run from danger, get to the river for a drink or hunt for food. You are meat for prowling beasts. No animal survives a broken leg long enough for the bone to heal.

A broken femur that has healed is evidence that someone has taken time to stay with the one who fell, has bound up the wound, has carried the person to safety and has tended the person through recovery. Helping someone else through difficulty is where civilization starts, Mead said.”

We are at our best when we serve others. Be civilized.

– Ira Byock.

Hospitals consider universal do-not-resuscitate orders for coronavirus patients

https://www.washingtonpost.com/health/2020/03/25/coronavirus-patients-do-not-resucitate/?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most

Image result for Hospitals consider universal do-not-resuscitate orders for coronavirus patients

Worry that ‘all hands’ responses may expose doctors and nurses to infection prompts debate about prioritizing the survival of the many over the one.

Hospitals on the front lines of the pandemic are engaged in a heated private debate over a calculation few have encountered in their lifetimes — how to weigh the “save at all costs” approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion of coronavirus.

The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment — such as masks, gowns and gloves — may be too great to justify the conventional response when a patient “codes,” and their heart or breathing stops.

Northwestern Memorial Hospital in Chicago has been discussing a do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members — a wrenching decision to prioritize the lives of the many over the one.

Richard Wunderink, one of Northwestern’s intensive-care medical directors, said hospital administrators would have to ask Illinois Gov. J.B. Pritzker for help in clarifying state law and whether it permits the policy shift.

“It’s a major concern for everyone,” he said. “This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances.”

Officials at George Washington University Hospital in the District say they have had similar conversations, but for now will continue to resuscitate covid-19 patients using modified procedures, such as putting plastic sheeting over the patient to create a barrier. The University of Washington Medical Center in Seattle, one of the country’s major hot spots for infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.

Several large hospital systems — Atrium Health in the Carolinas, Geisinger in Pennsylvania and regional Kaiser Permanente networks — are looking at guidelines that would allow doctors to override the wishes of the coronavirus patient or family members on a case-by-case basis due to the risk to doctors and nurses, or a shortage of protective equipment, say ethicists and doctors involved in those conversations. But they would stop short of imposing a do-not-resuscitate order on every coronavirus patient. The companies declined to comment.

Lewis Kaplan, president of the Society of Critical Care Medicine and a University of Pennsylvania surgeon, described how colleagues at different institutions are sharing draft policies to address their changed reality.

“We are now on crisis footing,” he said. “What you take as first-come, first-served, no-holds-barred, everything-that-is-available-should-be-applied medicine is not where we are. We are now facing some difficult choices in how we apply medical resources — including staff.”

The new protocols are part of a larger rationing of lifesaving procedures and equipment — including ventilators — that is quickly becoming a reality here as in other parts of the world battling the virus. The concerns are not just about health-care workers getting sick but also about them potentially carrying the virus to other patients in the hospital.

R. Alta Charo, a University of Wisconsin-Madison bioethicist, said that while the idea of withholding treatments may be unsettling, especially in a country as wealthy as ours, it is pragmatic. “It doesn’t help anybody if our doctors and nurses are felled by this virus and not able to care for us,” she said. “The code process is one that puts them at an enhanced risk.”

Wunderink said all of the most critically ill patients in the 12 days since they had their first coronavirus case have experienced steady declines rather than a sudden crash. That allowed medical staff to talk with families about the risk to workers and how having to put on protective gear delays a response and decreases the chance of saving someone’s life.

A consequence of those conversations, he said, is that many family members are making the difficult choice to sign do-not-resuscitate orders.

Code blue

Health-care providers are bound by oath — and in some states, by law — to do everything they can within the bounds of modern technology to save a patient’s life, absent an order, such as a DNR, to do otherwise. But as cases mount amid a national shortage of personal protective equipment, or PPE, hospitals are beginning to implement emergency measures that will either minimize, modify or completely stop the use of certain procedures on patients with covid-19.

Some of the most anxiety-provoking minutes in a health-care worker’s day involve participating in procedures that send virus-laced droplets from a patient’s airways all over the room.

These include endoscopies, bronchoscopies and other procedures in which tubes or cameras are sent down the throat and are routine in ICUs to look for bleeds or examine the inside of the lungs.

Changing or eliminating those protocols is likely to decrease some patients’ chances for survival. But hospital administrators and doctors say the measures are necessary to save the most lives.

The most extreme of these situations is when a patient, in hospital lingo, “codes.”

When a code blue alarm is activated, it signals that a patient has gone into cardiopulmonary arrest and typically all available personnel — usually somewhere around eight but sometimes as many as 30 people — rush into the room to begin live-saving procedures without which the person would almost certainly perish.

“It’s extremely dangerous in terms of infection risk because it involves multiple bodily fluids,” explained one ICU physician in the Midwest, who did not want her name used because she was not authorized to speak by her hospital.

Fred Wyese, an ICU nurse in Muskegon, Mich., describes it like a storm:

A team of nurses and doctors, trading off every two minutes, begin the chest compressions that are part of cardiopulmonary resuscitation or CPR. Someone punctures the neck and arms to access blood vessels to put in new intravenous lines. Someone else grabs a “crash cart” stocked with a variety of lifesaving medications and equipment ranging from epinephrine injectors to a defibrillator to restart the heart.

As soon as possible, a breathing tube will be placed down the throat and the person will be hooked up to a mechanical ventilator. Even in the best of times, a patient who is coding presents an ethical maze; there’s often no clear cut answer for when there’s still hope and when it’s too late.

In the process, heaps of protective equipment is used — often many dozens of gloves, gowns, masks, and more.

Bruno Petinaux, chief medical officer at George Washington University Hospital, said the hospital has had a lot of discussion about how — and whether — to resuscitate covid-19 patients who are coding.

“From a safety perspective you can make the argument that the safest thing is to do nothing,” he said. “I don’t believe that is necessarily the right approach. So we have decided not to go in that direction. What we are doing is what can be done safely.”

However, he said, the decision comes down to a hospital’s resources and “every hospital has to assess and evaluate for themselves.” It’s still early in the outbreak in the Washington area, and GW still has sufficient equipment and manpower. Petinaux said he cannot rule out a change in protocol if things get worse.

GW’s procedure for responding to coronavirus patients who are coding includes using a machine called a Lucas device, which looks like a bumper, to deliver chest compressions. But the hospital has only two. If the Lucas devices are not readily accessible, doctors and nurses have been told to drape plastic sheeting — the 7-mil kind available at Home Depot or Lowe’s — over the patient’s body to minimize the spread of droplets and then proceed with chest compressions. Because the patient would presumably be on a ventilator, there is no risk of suffocation.

In Washington state which had the nation’s first covid-19 cases, UW Medicine’s chief medical officer, Tim Dellit, said the decision to send in fewer doctors and nurses to help a coding patient is about “minimizing use of PPE as we go into the surge.” He said the hospital is monitoring health-care workers’ health closely. So far, the percentage of infections among those tested is less than in the general population, which, he hopes, means their precautions are working.

‘It is a nightmare’

Bioethicist Scott Halpern at the University of Pennsylvania is the author of one widely circulated model guideline being considered by many hospitals. In an interview, he said a blanket stop to resuscitations for infected patients is too “draconian” and may end up sacrificing a young person who is otherwise in good health. However, health-care workers and limited protective equipment cannot be ignored.

“If we risk their well-being in service of one patient, we detract from the care of future patients, which is unfair,” he said.

Halpern’s document calls for two physicians, the one directly taking care of a patient and one who is not, to sign off on do-not-resuscitate orders. They must document the reason for the decision, and the family must be informed but does not have to agree.

Wyese, the Michigan ICU nurse, said his own hospital has been thinking about these issues for years but still is unprepared.

“They made us do all kinds of mandatory education and fittings and made it sound like they are prepared,” he said. “But when it hits the fan, they don’t have the supplies so the plans they had in place aren’t working.”

Over the weekend, Wyese said, a suspected covid-19 patient was rushed in and put into a negative pressure room to prevent the virus spread. In normal times, a nurse in full hazmat-type gear would sit with the patient to care for him, but there was little equipment to spare. So Wyese had to monitor him from the outside. Before he walked inside, he said, he would have to put on a face shield, N95 mask, and other equipment and slather antibacterial foam on his bald head as the hospital did not have any more head coverings. Only one powered air-purifying respirator or PAPR was available for the room and others nearby that could be used when performing an invasive procedure — but it was 150 feet away.

While he said his hospital’s policy still called for a full response to patients whose heart or breathing stopped, he worried any efforts would be challenging, if not futile.

“By the time you get all gowned up and double-gloved the patient is going to be dead,” he said. “We are going to be coding dead people. It is a nightmare.”

 

 

 

 

“We’re looking at a tsunami”

https://mailchi.mp/a3d9db7a57c3/the-weekly-gist-march-20-2020?e=d1e747d2d8

Yesterday we spoke with a senior healthcare executive leading the COVID-19 response for a regional health system on the West Coast. Their area is now experiencing exponential growth of new cases, with the number of local diagnoses doubling every couple of days. In all likelihood, they’re less than two weeks from having the number of cases seen in harder-hit areas like San Francisco, Seattle and New York City. She said the “anticipation of what is about to happen” is the scariest part of the around-the-clock work they are doing to prepare.

But that two-week lead time has given them precious time to organize, and she generously shared key elements of their action plan. Their preparation work—surely similar to what hundreds of health systems around the country are doing—impressed us not only with its breadth, depth and comprehensiveness, but also the level of energy and confidence conveyed by the hundreds of actions and decisions, large and small, the system is making every day. Here are some of their important learnings so far:

  1. Even though the surge of patients has yet to begin, staff are “worried and scared”. They are concerned about PPE shortages and personal safety and stressed at home with schools and daycare closed. Detailed and regular communication is more critical than ever—and they’re trying to answer every inbound concern or question from associates directly. They are funding and expanding childcare options for staff, through partnerships with community organizations and daily stipends for home-based care.
  2. As the system works through worst-case scenario planning, they anticipate the need for critical care nurses, respiratory therapists, and emergency physicians will be the worst bottlenecks, and they are working to cross-train adjacent clinicians and build new staffing models to increase capacity. While most providers are deeply dedicated to providing care for COVID-19 patients, a small number have already “called off” and refused to report—creating unanticipated questions around how to manage these difficult situations.
  1. As they prepare to implement new surge staffing models, the system is now navigating through a period of downtime. With elective procedures cancelled and some ambulatory sites closed, they currently need fewer nurses and clinical staff than a month ago, and are creating policies, like allowing staff to go negative into PTO, to maintain income while they wait for the surge. Staff who must work in-person are working variable shifts to reduce crowding. They are also working to credential nurses and staff furloughed from local ambulatory surgery centers, so they have them ready to deploy when needed.
  1. IT staff are working nonstop to quickly make it possible for all eligible employees to work remotely, and to enable staff to safely gain access to the system’s intranet while guarding against new cybersecurity threats. The system is training and enabling hundreds of doctors to deliver care virtually, including affiliated independents.
  1. Guidelines for coronavirus patient management and recommended PPE practices change daily; it’s a full-time job for clinical leaders to keep up. Doctors are eager to try novel and creative treatments for very sick patients. (For instance, one doctor is developing a 3-D printed device that will allow one ventilator to be used for four patients simultaneously.) This eagerness to “do something” is understandable but creates a bit of chaos as leaders work to create policies around how to best manage patients.
  1. While leaders communicate with other health systems and local and state authorities daily, the vast majority of decisions are made internally, on the fly. For instance, the system is connecting with now-empty local hotels and universities to provide options for low-acuity patient capacity, but leaders hope that parallel efforts at other organizations can be brought together into a more unified regional response. For now, however, coordination would likely create unacceptable delays.
  1. Long-term health and stamina of staff is top among the system’s concerns. “If I borrow worry from the future”, this leader said, “I am worried that we are facing years-long trauma, both emotional and financial, and I’m not sure how we will sort it out”. For now, efforts to support staff and provide moments of relief and joy, are critical, and very appreciated by front-line team members.

We left this conversation emotionally overwhelmed ourselves, and with a huge sense of gratitude for clinicians and health system leaders. Americans can take comfort in the amount of work that is taking place even before critical patients begin to appear—and that doctors, nurses and hospitals are truly dedicated to providing us the best possible care under circumstances they have never faced before. If you know about creative approaches or new ideas organizations are putting in place to contend with the current situation, please let us know. We’re eager to share great ideas!

 

 

 

We may need retired doctors and nurses

https://www.axios.com/newsletters/axios-vitals-57b7c8cf-bfca-4900-845a-7a841790f39d.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Image result for axios We may need retired doctors and nurses

Hospitals are asking retired doctors and nurses to come back and help with operations as they prepare for a rush of severe coronavirus cases, Axios’ Bob Herman reports.

The bottom line: Retired clinicians likely won’t be placed in intensive care units or coronavirus testing stations, because older adults are at higher risk of falling ill and dying from the virus. But they could help stabilize hospitals that will need as many hands on deck as possible over the coming months.

Where it stands: The Association of American Medical Colleges floated this idea last week with hospitals and federal agencies.

  • “The question is: How can we bring people up to speed and bring them in?” said Janis Orlowski, a physician and executive at the AAMC. “They will … [likely] backfill in areas where it’s not direct patient care.”

What they’re saying: Some retired clinicians are willing to take on other necessary care, while residents and other doctors funnel into coronavirus cases.

By the numbers: 41% of doctors are 55 or older, according to American Medical Association data provided to Axios, and 38% of nurses are 55 or older.