Physician-in-Chief's Message March 26, 2020

Dear Colleagues, Thank you for being patient during these times of ambiguity. I continue to be impressed with everyone’s dedication to teamwork and our mission of caring for the children across the state.

UNC COVID Updates

Inpatient Care Multiple patients are under investigation - none positive Please note that if you are not feeling well for any reason do not report to work. Visitor restrictions are in effect please refer to news for employees for details

....... Inpatient Rounding A new Inpatient Rounding Policy is attached below. The policy was developed with input from the WTC’s and several subspecialty attendings (General, Pulm, Nephro, Hem/Onc).  Nurse Managers on 5, 6, & 7 Childrens have been asked for dedicated use of the conference rooms during the early morning rounding times. Jenn McElroy was able to reserve the conference room on 6CH

Pediatric Inpatient Rounding Policy during COVID-19 - March 26, 2020

....... NCCC Wellness Checks In an effort to protect the safety and well-being of staff, providers, patients and families, all employees and visitors will be subject to a wellness check prior to entering the NCCC starting Friday evening, 3/27. The wellness check will include a brief set questions and temperature screening.  Those individuals with symptoms of illness will be asked not to enter the unit and be referred to Occupational Health or their PCP/UNC Healthlink. This may be expanded to other areas over the weekend.

Telehealth and Visual Care We want to rapidly switch from cancelling or delaying visits to offering phone calls or video visits. UNC will soon have 2 video visit options---the current one in Epic and one where the video is outside of Epic for those that haven’t finished video training! The first two batches of Children’s providers will be ready for official video visits by the end of Friday and all equipment is set up in the multispecialty clinics on campus and the primary care clinic. CLICK HERE for a simple description of how to open, document and bill for patient outreach encounter (phone or video), Phone Visit (phone or video) and Video Visit in Epic.

Ambulatory Care

The Chapel Hill Primary Care and Heme-Onc clinics will continue to run as they have been, but the multispecialty clinic on ground floor Children’s is working to shift care to the Raleigh clinic. This will help minimize numbers of people coming into the hospital and make clinic operations easier (as well as being a GREAT experience for families). The schedulers will be following a New Flow for Scheduling patients. This is a pilot of having more up-front nursing triage as new appointments are made to hopefully get patients into the right visit type in the multi-specialty clinics. What Does This Mean For Me? Division Chiefs---please reach out to Kellei Agostinelli to clarify which nurse/APP/doctor or other licensed clinician will triage new referrals for now. Providers---keep looking through your schedule before your clinic day and make notes of whether you need an in-person visit or a Phone Visit type or Video Visit if you have that visit type pushed to you now. Remember to connect with Ryan Haushalter who will either be able to help you with Epic workflow or connect you to the right person.

Emergency Department and Urgent Care The ED PED COVID Respiratory Pathway is being updated online 1-2x daily. We are actively working on efforts to minimize unnecessary exposure and to step up for the advocacy of our patients and ourselves.  All pediatric patients are going to the PED now: The Team D vs. PED sorting was causing too much confusion for nursing staff. Confusion breeds error. Any pediatric respiratory patient will be masked (their parent/guardian too) and the triage nurse will call the PED to determine which room to place the child. They will then escort the patient through Team D and place the patient in the predetermined room. If there are no rooms available then the patient will wait in the Team D waiting area. All parties have been updated of this change and we think this will reduce ambiguity and triage mistakes. See updated pathway. “Clean ED” vs “Respiratory ED”: We are actively exploring the use of the Children’s Short Stay Unit for our immunocompromised patients and non-respiratory patients. Pediatric gatekeepers: Also looking into the use of a pediatric provider (perhaps double coverage attending but open to suggestions) in Tent Triage to more appropriately triage our patients The COVID reflex tests are now on the Peds Quicklist.

Information Regarding the Definition of High-Risk Clinical Providers - Faculty & Staff   We want to emphasize that we have sufficient PPE stock to meet our immediate needs when caring for patients with suspected or known COVID-19. However, as possible, local units will work to minimize COVID-19 risk to mandatory employees who are members of these vulnerable population groups. Examples of how that may be accomplished include assigning lower risk clinical duties, virtual work, or other tasks. If disease burden increases, all mandatory employees may be expected to serve clinically where they are needed.   Based on input from our experts in Infectious Disease and Infection Prevention, we are approaching this as outlined below:  High Risk Groups: Immunosuppressed or Age > 65 or Pregnant women Special considerations as of March 24: At this time, employees and providers in one of the high-risk groups above may request to not be assigned to a high risk patient facing duties station (e.g., Emergency Department, Inpatient care of COVID patients, Intensive or Procedural Care of COVID patients, Walk in Settings for Respiratory Complaints, etc.). At this time, upon request, employees in one of the high-risk groups will be assigned to other duties where available (e.g. Lower risk patient care settings, telework, training activities, administrative responses, and other tasks). If an employee falls into one of the high risk categories, they may voluntarily continue current job duties at their discretion.   These reassignments must be coordinated at the unit/service level, in coordination with the Human Resources Department.  Please discuss concerns with your division chief.

Your COVID-19 Questions & Answers Response from Tom Belhorn Q : I have a question about how to clean ourselves when we come home to lessen the possibility we make our families ill … I go from my car to an outdoor shower, then put that day’s clothes into the washer. Probably should leave my shoes in the garage. Is this what others are doing?   A : To be honest, transmission from your hands is the most likely means of transmission in a setting like this – much more than clothing. I did run this by some of my friends in infection prevention. Hand hygiene is the most important thing you can do. Do it often – while working, when you leave work, and right when you get home. Showering is certainly fine but may not be an important part of needed prevention - all data point to droplet transmission predominance and much less the touch contact component. Likewise, clothing is not believed to be a factor of transmission, but several common sense best practices with laundry could be followed in the abundance of caution. Consider separating personal attire worn at work from other clothing in the household Use commercially prepared detergents according to manufacturer’s guidance to wash clothes; no special wash cycle is required. Dry clothes on high heat for at least 30 minutes Some work places are providing scrubs for those in high risk situations, and scrubs can be removed prior to travel home. Hope this helps!

More support from our UNC family UNC Women's Basketball Head Coach Courtney Banghart and UNC Men's Basketball Head Coach Roy Williams express their gratitude and pride to have US on their teams.

Courtney Banghart on Twitter For you, healthcare providers (especially in NC). Sent with our whole heart. 💙👇 https://t.co/barZBLlrhI Read more twitter.com

Roy Williams thanks UNC Health employees... Message from UNC Basketball Coach Roy Williams thanking UNC Health Employees for their hard work during the COVID-19 / coronavirus outbreak... Read more www.youtube.com

Finally, I would like to share this beautiful message highlighted on CNN from a patient with COVID-19 who was ultimately discharged from the ICU.

Coronavirus patient left touching message for hospital staff While the patient was being treated in isolation for Covid-19, his caregivers at the Cleveland Clinic left him messages on his room's glass door. Read more www.cnn.com

Gratefully, Stephanie Cell: 919-417-3130