Physician-in-Chief's Message
May 22, 2020
Dear Colleagues,
 
These past 2 months have certainly been challenging, but our Children’s providers have certainly risen to this challenge. This week, we admitted a COVID positive child to the PICU; thank you to the COVID response team!

Please review the updates below and the message from Elisabeth Dellon about volunteer opportunities involving care conversations and advance care planning for adult patients hospitalized with COVID infection.
UNC COVID Updates
Inpatient Care
  • We have one COVID positive pediatric patient. 
  • Thanks to our amazing multi-disciplinary team for working to develop pediatric-specific pathways for evaluation and management. 
  • Please do not hesitate to reach out to the PED COVID ACUTE or PED COVID ID pagers if there are with questions regarding the care of COVID positive patients. Those individuals can best direct you the information or personnel you need.
Ambulatory Care
  • Instructions to ensure your clinic patient is scheduled for follow up were redistributed this week. This is not a new process but one that not everyone was using. Instructions are located on the UNC Pediatric COVID page. 
  • PLEASE review these instruction and if you have any difficulties, please contact Ryan Haushalter (Ryan.Haushalter@unchealth.unc.edu) for assistance. 
  • Please continue to provide feedback to Clinic leadership if you have any needs. We are working hard to get patients scheduled appropriately and providers supported by clinic staff. Feel free to reach out to Sherry Ross, Ceila Loughlin, Ed Spence, Kevin Brady, Kellei Agnostinelli or Will Kanipe if you have question or problems. 
Emergency Care
  • We’ve had 5 COVID positive patients in the ED this week- 2 just last night.
  • Of the five, one patient was evaluated, swabbed, and discharged by our Tele Triage team without checking into the ED. The remaining 4 patients were evaluated, swabbed, and discharged from the Pediatric Emergency Department.
  • One patient was 38 weeks pregnant and we worked collaboratively with the OB service to perform a fetal non stress test in the ED prior to discharge. 
  • The ED is working closely with Dr. Peyton Thompson from Peds ID as she leads several studies of pediatric COVID patients throughout the Children’s Hospital.
Surgical/Procedural Care
  • Kudos to Sara Lisinski and her team for being trained on how to schedule COVID-19 testing for our patients ‘added on’ the schedule in the less than 5 day time frame. Rob from the front desk made our first successful COVID-19 appointment!!
  • Please remember that our process for the Children's OR for patients that ‘fall in the gap’ of scheduling less than 5 days but you think are not urgent/emergent for the same day surgery, is for our COR charge nurses to call your patient and schedule their COVID-19 testing appointment at the RDC, within 48 hours of the operation or procedure. 
  • The 5 day process is also attached as a reminder.
Palliative Care
  • The adult palliative care service has partnered with the MICU and other COVID services to assist with goals of care conversations and advance care planning for patients hospitalized with COVID infection.
  • We have been asked to assist with development of a surge plan to include physicians and APPs who would be willing to be on call to back up the palliative care providers for a few hours each day, a week at a time, likely in the afternoons. 
  • All communication occurs virtually, and many conversations are with surrogate decision-makers as patients themselves may be too ill to participate. These conversations would be documented in an advance care planning note using an existing template. 
  • Volunteers who have completed the UNC "Shared Decision Making in Serious Illness" course would be ideal, but those who have not will receive training.
  • Please consider volunteering if you have a reduced clinical load in the coming weeks to months or if you are in a high risk group such that you are not currently providing in-person patient care. 
  • This is a nice opportunity to lend a hand and to brush up on serious illness communication skills. You will only be called to assist if the number of patients exceeds capacity for the palliative care team to provide services, which has not happened to date.
  • Thank you for considering helping care for COVID patients and their families. Please contact Elisabeth Dellon (elisabeth_dellon@med.unc.edu) if you might consider volunteering.
Travel Guidelines
Attached are new travel guidelines from Occupational Health, effective 5/13/2020. Please review when considering taking vacations this summer and timelines for new faculty arriving and quarantine.
Your COVID-19 Questions & Answers
Response from Tom Belhorn

Q: I am confused whether we are supposed to put a mask on some young children for COVID precautions. It seems risky for some. Can you clarify the guideline?
 
A: There is agreement with the guidelines by AAP, CDC, and our own UNC policy – no mask should be used (COVID-related) on a child less than age 2 years. And several pediatric societies have come out strongly against the companies producing a “baby mask” – these very small masks produced for young infants are considered a hazard and should not be used.
 
And FYI, there will soon be further guidance on healthcare provider PPE changes with the roll out of the Universal Pandemic Precautions. Further information to come…
UNC ENT Video - Proper Swabbing Procedure
Millions of Americans have been tested for COVID-19 and an alarming 30% of the tests are false negatives. The experts here at UNC Otolaryngology are here to explain how to properly swab the nasopharynx.
Familes4FamiliesCH Event at UNC Children’s at Raleigh
From Pediatric Pulmonology
Our newest partner, Families4FamiliesCH, is a group of volunteers from Chapel Hill who came together after recognizing that many of their neighbors were facing a critical food emergency during the COVID-19 pandemic.

F4F volunteers represent families who help by purchasing and delivering groceries to the doorsteps of those in need in Chapel Hill. When the Founder, Caroline Jones, learned of fifteen families struggling in the Raleigh area, she agreed to expand their geographic boundaries.

On May 12th Caroline and her team distributed food to fifteen families in the parking lot of UNC Children’s Specialty Services at Raleigh. During this event, Caroline learned more about the financial burdens associated with CF, the specific nutrition needs, and that 1/3 of our CF population struggles with food insecurity.

Since that day, Caroline has reached out to supporters across the state to help more than 40 of our patients and families.
I hope each of you have an enjoyable long weekend!
Thank you for all that you do for the children and families cared for at UNC Children’s.
 
Gratefully,
919-417-3130 (cell)