UCSF Division of Geriatrics Weekly Updates (4/10/2020) from Chief Dr. Louise Walter
This is the fourth Geriatrics Division Weekly Update to keep everyone more informed about Division happenings as we reach the end of our fourth week of sheltering-in-place. The heartening news is that the rise of cases in the Bay Area is not logarithmic and none of our hospitals in San Francisco are overstretched. The number of COVID-19 cases in CA is now expected to peak ~ 4/13 (see link https://covid19.healthdata.org/projections). We are all cautiously optimistic that we will avoid a major surge of hospitalized COVID-19 patients in San Francisco if we continue social distancing. Below is a summary of the updates that have been shared with me this past week.
UPDATES ACROSS THE DIVISION
UCSF outpatient programs: Care at Home has transitioned to majority telemedicine visits as well as increasing access to mobile COVID-19 testing in the home and growing our clinical collaborations with UCSF Center for Geriatric Care (UCGC). Care at Home has become a resource for providers and families in the community for how to conduct medical care in the home given the majority of COVID+ people are not hospitalized, but in the community. Carla Perissinotto also continues to serve on task forces developing criteria for discharging hospitalized patients to SNF care and is conducting studies on loneliness and Grand Pad use among older people during this time of shelter-in-place.
UCSF inpatient Programs: Our inpatient workforce remains healthy. Mobile ACE continues to provide Geriatrics Consultations for all adults age 80 and older on all units of Moffitt-Long hospital. Inpatient faculty are working on an education campaign about the universal mask policy in UCSF clinical spaces as well as innovating with Voice-to-Text on iPads for patients to better hear/understand clinicians when they are wearing masks. Our faculty are also involved in crafting the compassionate visitor policy for hospitalized patients, so that patients with dementia, for example, can have a visitor. Carla Perissinotto and Stephanie Rogers are also part of the UCSF Ethics Committee and are glad to report that an upper age limit is not a criterion that disqualifies someone for a ventilator if they need it.
San Francisco VA: Our Outpatient Palliative Care team is collaborating with Primary Care and Medical Specialties to support their providers to discuss advance care planning, goals of care, and surrogate decision makers during their outreach calls to high risk patients. HBPC is doing primarily telephone and VVC visits and continues to provide essential face-to-face care for HBPC patients when needed. They also are ensuring high risk patients have their advance directives in place, surrogates designated and goals documented. IMPACT is collaborating with Primary Care to develop criteria and protocols for home visits for COVID+ or presumed + patients. The Inpatient Palliative Care team is contacting home hospice agencies to assess their capacity for caring for COVID+ veterans. The CLC continues to be COVID negative but is preparing for the day when the first veteran has a positive test. 3B Wing of the hospital building 203 has become a Respiratory Care Unit with a dedicated team of nurses and doctors committed to taking care of up to 38 patients with confirmed or suspected COVID-19.
ZSFG: ZSFG has the greatest number of hospitalized patients with COVID-19 (~30 patients with 16 in the ICU) but with careful surge planning and decreased surgery and medicine admissions the ZSFG inpatient teams are doing well and they have plenty of ventilator capacity. The ZSFG ACE unit is full as usual. There are no COVID-19 patients on the ACE unit as an early decision was to not put them on our unit with the most vulnerable patients.
EDUCATION: Fellows’ clinics continue via telemedicine and all our didactic learning continues on Zoom. There is a new DOM policy that divisions will reimburse fellows for rideshare costs to essential clinical duties if they neither have access to a car nor can readily use public or UCSF/VA shuttle service. UCSF students who are not able to do their clinical clerkships have been deployed across UCSF Health and the community to address COVID-19 needs.
RESEARCH: Mike Steinman is Co-Chairing a national task force focused on improving medication management in post-acute and long-term care, which also reduces unnecessary nurse contact. Mike Steinman, Carla Perissinotto and Laura Perry recently had a JAMA Internal Medicine viewpoint accepted. Rebecca Sudore has developed a COVID-19 planning guide for patients as well as a Simple ACP guide to start the ACP conversation that can be used by all healthcare professions and allied health professionals of any background across UCSF sites and nationally. She is working in tandem with Eric Widera to increase ACP, and for those who have time and training to provide COVID-19 goals of care information for high-risk patients. Carla and Ashwin have partnered with Anna Chodos to add ZSFG outpatients to their study of the impact on well-being and whether needs of elders in SF are being met during this time of social distancing.
GWEP: We continue website updates to our COVID site. UCSF Patient Communications team has placed our COVID 19 Resources for Older Adults on their patient facing website and they forwarded our provider resources to add to the internal UCSF COVID site. We also continue to serve as a resource for our community partners about COVID-19 in older adults and ethical policies.
POLICY: Brie Williams is developing COVID-19 policies for prisons and jails, including helping lawyers know the difference between solitary confinement and medical isolation so they can advocate for the right things. She also helped get funding for a group of graduate students to provide hand sanitizer to prisons. Leah Rorvig developed a webinar about what correctional officers need to know about COVID-19 which is now required viewing for all correctional officers in Vacaville. See link to her webinar and other COVID-19 correctional health resources: https://amend.us/covid/.
STAFF: All Division staff continue working from home unless they are providing direct patient care. Sarah Ngo and UCSF Maker’s Lab are holding a Zoom seminar on Tips and Tricks for Making Your Own Fabric Mask today April 10, 2020 at 11:30am-12:00pm. Also, the 2020 UCSF employee engagement survey has been rescheduled to April 2021.
CLINICAL UPDATES FROM OUR HEALTH SYSTEMS
San Francisco VA: 1 hospitalized cases of COVID-19 at SFVAMC.
UCSF Health: 19 hospitalized cases at UCSF; https://coronavirus.ucsf.edu/
ZSFG: 30 hospitalized cases at ZSFG.
SF Chronicle COVID-19 Dashboard (CA, County and SF#s)
OPTIONAL WEEKLY GERIATRICS DIVISION CHECK-INS
We will continue our optional division-wide check-ins.
Next Check-In Meeting: Wednesday April 15th from 2:30-3:30pm on Zoom
Future meetings: April 22nd at same time.
Next Geriatrics Half-Day is April 29th.
MAXINE’S WEEKLY TIPS
UC Learning Center has updated resources for Resiliency During Challenging COVID-19 Times for both faculty and staff. Resources include re-establishing priorities and maintaining productivity, staying safe & healthy, work-life integration & change readiness, workstation & technology (including how to avoid “Zoom Bombing”). Visit their website to learn more.
SUPPORT OUR AWESOME UCSF STAFF
Nominate our UCSF Staff for an Achievement Award and/or SPOT Award. Nominations are due Friday April 17th. Submit your nominations through this website: https://starawards.ucsf.edu/or contact Maxine if you have any questions.
MORE GUIDANCE TO COME NEXT WEEK
- The University of California has instituted a hiring freeze through June 30, 2021 (see 4/7/20 email from Chancellor Hawgood). This is because of the dire financial situation resulting from the pandemic. The goal is to have a unified approach across the UC system that allows us to ride out this storm. There will be exceptions to the hiring freeze but the principles for implementing this freeze are still being worked out. We will have more guidance next week.
- If you are a UCSF clinician and want to help hard hit cities, like New York, through telemedicine please wait until UCSF has created a centralized telemedicine agreement and professional service agreement to guard against liability and allow you to legally provide care at another institution. I’m told this will happen next week.
HOME ERGONOMICS
I encourage everyone to look at these tips for setting up your ergonomics while working from home https://ucsf.app.box.com/s/d6l9rcbgc9j977ml5hx4ozv48rkagk96.
Or if you need to get up and move more, please join a Division Virtual Pilates Workout on Monday 4/13/20 5:00pm-5:45pm using the following link with password: 500377 https://ucsf.zoom.us/j/166373458?pwd=QTlYSUNPOGhwZU8yUmVXRjRMWU1XZz09
If you have other suggestions for maintaining our social connectedness during this time, please email me. Thanks for all you are doing!
Louise
PS: This video link was shared with me and at 11 minutes you can watch the original cast of Hamilton sing “Alexander Hamilton” over Zoom:
https://www.broadwayworld.com/videoplay/VIDEO-Original-HAMILTON-Cast-Reunites-to-Sing-Alexander-Hamilton-on-John-Krasinskis-SOME-GOOD-NEWS-20200406
Also, Sarah Ngo sent me the following link to virtual panoramic tours of some of the world’s greatest museums and historic sites which I really enjoyed while sheltering in place: https://artsandculture.google.com/project/streetviews