Physician-in-Chief's Message
March 22, 2020
Dear Colleagues,

I hope you have had some relaxing time with your families this weekend. 
We thought it would be helpful to update everyone as we enter the week of March 23 rd.
UNC COVID Updates
Inpatient Care
  • No COVID positive patients seen in the inpatient setting. All rule-outs have ruled out.
  • All new processes rolled out last week, have been implemented. 
  • Please notify with questions
Outpatient Care
... Billing and Coding and New Visits in COVID Area
  • This national emergency has created new opportunities and pushed us in providing telehealth and virtual care.
  • We are updating the UNC Pediatrics COVID site to include instructions and tip sheets for different visit types and billing rules.
  • UNC Health Compliance and Coding has been doing a phenomenal job keeping up with different billing requirements and visit types. Those are available here https://unchcs.intranet.unchealthcare.org/dept/ACP/compliance/Pages/covid-19.aspx . However, be cautious that a lot of the guidance is directed toward virtual visits in Medicare and rules can be different for Medicaid and private insurers.
  • Outpatient virtual visits such as telephone or video visits will get 100% coder review, so there will be a layer of review similar to inpatient care.
  • Ryan Haushalter (ryan.haushalter@unchealth.unc.edu) is ready to provide at the elbow Epic support and is an expert in these new visit types.
... Subspecialty
  • Leadership is working on a plan for transition of clinic patients to the Raleigh Location. 
  • Our goal is to provide guidelines but allow Divisions to manage their schedules/patients in a way that will serve their patient population appropriately. 
  • The Chapel Hill Location will likely serve as a location for emergent patient add-ons, high risk infusions and urgent/emergent imaging and follow up in coordination with Division/Provider needs and availability.
  • Coming ask will include Division template management to include in-person visits, tele-visits and virtual visits. Once templates are adjusted, scheduling flow sheets will allow scheduling of patients per Division instructions into the appropriate slot with guidance by the provider if scheduling type is in questions. 
  • We ask that providers/divisions contact clinic leadership if there are questions or concerns. All recommendations and changes prior to implementation will be approved by our Physician-in Chief, Surgeon-in-Chief and Hospital leadership. 

... Primary Care
  • The Children’s Primary Care COVID Visit Work Flow was uploaded to the Peds COVID site this afternoon (3/22).
  • Currently we are working to ensure access for patients with urgent medical needs. Generally, we try to complete all visits via phone or video. We are hearing that some pediatric practices are closed completely to patients. We want to ensure that the community knows they can call us for help. We will continue to see newborns and offer immunizations in addition to urgent medical visits.
  • Providers review the schedule 2 days prior to visits and notify parents that their provider recommends one of the following:
  • video/phone visit only
  • nurse visit for immunizations followed by a video/phone visit
  • urgent medical visit in clinic
  • urgent care or emergency room visit
  • Patients who decline visits are asked to speak with nurses or providers. Patients who call requesting visits, medical advice or refills are referred to nurses to triage the call. Nurses recommend video or phone visits whenever possible. Visits that they think are necessary in person are transferred to the COVID provider to assess further.
  • All patients and caregivers are screened for fever and/or cough. The COVID visit workflow (see separate document) refers patients with no other urgent medical needs directly to the RDC. 
  • We will work to eliminate any time in the waiting room, likely through asking families and patients to wait in their cars until we can escort them directly into a room. We are also considering providing immunization only visits to patients in their cars.
  •  If patients with cough or fever need urgent medical evaluation, the COVID provider evaluates them wearing PPE as described below:
  • Fever or cough w/known exposure à Full PPE (N95, face shield, gown, gloves)
  • Fever or cough w/no known exposure à Surgical mask, gown, gloves
Visit Numbers (This does not include Patient Outreach Encounters)
Emergency Department
  • Overall Pediatric ED and Peds Urgent Care visits are way down. 10 visits total yesterday in the PED and 3 in Peds Urgent Care. 
  • Teletriage trial yesterday and today to identify respiratory patients that can be triaged from home vs. come to the ED. We are refining the process overall and particularly for pediatric patients. I expect it to be up and running full force on Monday. 
  • Medical Student volunteer donning and doffing observers (PPE monitors) training this weekend in Team D in the Main ED  and will be deployed in the PED and the rest of the ED and Hillsborough later this week.
  • New ED to Psych Express Care process for evaluating psych patients over the age of 5 presenting to the ED has started. This process tremendously helpful in keeping psych patients out of the ED to have room for medical patients.

Surgery
  • Surgery continues to limit cases to only urgent and emergent cases. This is being implemented with minimal staff in the Children’s operating rooms.

Ophthalmology Consults
As many of you have probably read, ENT and eye doctors had the highest risk of contracting coronavirus during the China outbreak. This is thought to be due to the close proximity needed to examine our patients, measured in inches rather than feet, away from the patient’s face. In order to protect our resident learners and consult attendings, the American Academy of Ophthalmology has recommended temporary guidelines for requesting “appropriate” consults during this pandemic. Below is the version drawn up by the UNC Department of Opthalmology.  Please direct questions to the Ophthalmology Residency Program Director, Amy Fowler, MD , who is happy to answer any specific questions.
Thank you again for all of your hard work and flexibility during these challenging times.

Please try to attend the Tuesday’s noon webinar entitled “The Impact of COVID-19 in Children." I think you will find this webinar helpful! Tom Belhorn will review what we know about COVID-19 in Children and we will also review UNC Children’s response to this pandemic.

I just want to personally thank Tom Belhorn for his leadership during this challenging time!
We will get through this together!
 
Gratefully,

Stephanie
Cell: 919-417-3130