UCSF Division of Geriatrics Weekly Updates (5/29/2020) from Chief Dr. Louise Walter
We are now approaching the end of our eleventh week of sheltering-in-place and our eleventh Geriatrics Division Weekly Update. San Francisco has announced its reopening plan including phase 2B on June 15th, phase 2C on July 13th (hair salons/barbershops!), and phase 3 in mid-August. See link for activities allowed to reopen during each phase: https://sanfrancisco.cbslocal.com/2020/05/28/san-francisco-lphased-plan-reopen-more-businesses-outdoor-activities/. Below is a summary of the updates that have been shared with me this past week.
UPDATES ACROSS THE DIVISION
UCSF outpatient programs: No new updates as Care at Home continues to slowly ramp up in-person visits. We also continue to staff the San Francisco Campus for Jewish Living (SFCJL) COVID Respiratory Unit.
UCSF inpatient Programs: The ACE Unit on 15L has reopened to non-COVID-19 patients! Interdisciplinary rounds have restarted with social distancing guidelines. Data was presented during Inpatient Geriatrics Leader Rounds this week showing that the delirium rate on our ACE Unit decreased from 17% last year to 13% this year.
San Francisco VA: Our Home-Based Primary Care Program continues to enroll new veterans and make essential home visits. PPE orders have been placed to obtain the equipment required to support safely conducting home visits. Geriatrics Clinic will start seeing a small number of veterans in face-to-face visits starting next week. The VA community nursing homes continue to have a very low burden of patients with COVID-19 and are accepting admissions from hospitals. The VA Hospital is trying to stay below its mandated number of functional beds (post-surge volume is determined by the VISN) but clinical needs of our veterans and veterans coming from other parts of the country for postponed procedures are pushing hard against this cap. Our Community Living Center (CLC) is now rated as a 5-Star facility! The third round of CLC staff COVID testing is being completed this week. Thus far, everyone has tested negative. If all tests are negative then we will lengthen the time interval for testing to every three weeks. The CLC is no longer routinely testing asymptomatic CLC veterans for COVID-19. There are no cases of COVID-19 in the CLC currently. Here is an article about how CLC veterans are using donated iPads and tablets to maintain connections with their loved ones during this pandemic: https://www.sanfrancisco.va.gov/SANFRANCISCO/features/connecting_through_technology.asp
ZSFG: Anna Chodos, Edgar Pierliussi, Louise Aronson and Meredith Greene continue to be deployed as part of DPH COVID-19 response, with a focus on SNF response and RCFE and Board & Care response.
EDUCATION: The UCSF School of Medicine class of 2020 graduated in a beautiful first-ever virtual commencement ceremony last week, with well-wishes from special guests Mayor London Breed and Dr. Anthony Fauci. All education faculty are now looking ahead to the fall. Some instruction will continue to be conducted virtually, including lectures and anatomy lab. The National Board of Medical Examiners has announced that the USMLE Step 2 Clinical Skills Examination with standardized patients will be suspended for the next 12-18 months. This coincides with a recent decision (not related to the pandemic) that USMLE Step 1 will become pass/fail in two years. Leaders and educators at all medical schools and graduate medical education programs are working to understand the implications of these changes in national assessments.
RESEARCH: During Geriatrics Grand Rounds this week, Carla Perissinotto and Ashwin Kotwal presented preliminary results from their survey of older adults focused on how social distancing impacts well-being and unmet needs (see below for the recording of our 5/27 Geriatrics Grand Rounds).
GWEP: Our Geriatrics Workforce Enhancement Program (GWEP) received additional HRSA funding earlier this month and has decided to use the funding to develop a webinar series for educating health care providers about older adult care and the 4M’s (Mobility, Mentation, Medications and what Matters) in the context of telehealth/sheltering-in-place.
POLICY: Louise Aronson and Carla Perissinotto were featured speakers during the Department of Medicine Grand Rounds on 5/28/20, “Update on COVID-19: Testing, ICU Practices and Outcomes at ZSFG, and the Experience of Elders in the COVID-19 Pandemic.” Louise and Carla were discussants during the first part of DOM Grand Rounds and articulated important policy changes that need to happen to improve the lives of older persons. The recording can be viewed here.
STAFF: Our core administrative team has been busy while working from home, continuing to assist faculty, fellows & staff.
Paula has taken the lead in assisting with recruitment for the Research Analyst who will work with Carla and Ashwin. She is screening potential candidates resumes, conducting phone interviews, and scheduling several qualified candidates to interview with the PIs. We hope to fill that recruitment soon!
Caroline learned how to use REDCAP and is supporting Carla and Ashwin with their COVID-19 survey of older adults, while also continuing her day-to-day operations responsibilities, such as clinical scheduling, website updates, faculty recruitment, GeriNews, and more.
Elaine has been busy working with the fellowship directors to plan our Fellows Graduation celebration, onboarding 9 MSTAR students, and onboarding a new class of Fellows, including figuring out Fellows orientation/curricula/rotations within COVID-19 guidelines and preparing us all for her maternity leave.
Thomas worked with faculty to submit 4 grant applications, 3 financial reports, and assisted with setting up 3 new awards, all within the last month!
Karen is enjoying serving on the DOM Recruitment and Retention Committee, busily preparing for the launch of UCPath, and touching base with our staff regularly to make sure everyone is staying sane while sheltering-in-place.
Maxine has been thinking about what our core administrative operations might look like when UCSF gives us the green light for administrative staff to return to the office. Please reach out to her if you have any questions or concerns.
UCSF DIVISION OF GERIATRICS GRAND ROUNDS
This week we held our first virtual UCSF Division of Geriatrics Grand Rounds, “COVID-19 and Older Adults: What have we learned? How can we do better?” The focus was on three major gap areas underscored by the COVID-19 pandemic: Loneliness & Social Isolation, Long-Term Care and Goal-Concordant Care. Speakers included Carla Perissinotto, Ashwin Kotwal, Louise Aronson, Anna Chodos, Rebecca Sudore and Eric Widera.
There were over 250 attendees who watched our Grand Rounds live!
Here is the link to the recording of the Grand Rounds which has been posted to the Division YouTube channel and is in process of being posted to the DOM YouTube channel: https://www.youtube.com/watch?v=WnXPGZ4Ic9k
Please share the link widely.
NEXT UCSF DIVISION OF GERIATRICS HALF-DAY
DIVISION-WIDE MEETING on June 24th 3-4pm. **Everyone is encouraged to attend.
Topic: Faculty Diversity Champion presentation with a focus on unconscious bias and best practices for hiring.
The rest of our Geriatrics Half-Day schedule will be determined closer to the date.
MAXINE’S WEEKLY TIP
UCPath goes live on Monday, June 1st! This is a new UC-wide software solution for payroll, benefits, human resources and academic personnel. The first bi-weekly paycheck processed through UCPath will be on June 10th and pay statements will be available online through UCPath on June 8th. To answer all your questions related to UCPath, a new Bridge Center will open on Monday at 7am. Look for an email with more information on how to reach the Bridge Center. You can also ask Maxine if you have any questions or visit https://ucpath.ucsf.edu/.
Reminder: UCSF has created a program for UCSF faculty, staff and trainees to provide additional support to those who are experiencing anxiety, stress and distress related to the COVID-19 pandemic and its impact on their work and family life. You can learn more online at https://tiny.ucsf.edu/cope or text COPE to 83973.
MORE GUIDANCE TO COME
Unfortunately, we continue to receive difficult financial news. Talmadge King sent an e-mail on 5/22 that the following are effective now through 6/30/21 based on directives from the University of California Office of the President:
- Essential hiring only;
- Salary freeze for faculty and policy-covered (non-represented) staff; and
- Elimination of non-essential University-sponsored domestic and international travel and events
California also announced 10% budget cuts which means at least a 10% reduction in state funds to UCSF. Bob Wachter has informed division chiefs that every unit will likely need to cut their budget by 5-10%, but the guidance for what that means remains unclear (e.g., what is the denominator since we aren’t going to cut grants that we have received to send money back to funders, for example). Bob is seeking further clarification from the Dean and Chancellor and I will let everyone know as I learn more. There has not been any suggestion of salary cuts or furloughs at this point.
UCSF TOWNHALL SUMMARY
- SF DPH has loosened visitor restrictions: Therefore, UCSF is loosening visitor restrictions. All COVID negative/ non-PUI inpatients are now allowed one visit per day anytime during hospital visiting hours 11am-8pm. Exceptions to have additional visitors will be considered for patients at end-of-life (i.e., not expected to survive the hospital stay) and for patients with cognitive impairment, but these exceptions must be approved by the unit director. Security will have the list of approved visitors for each day and check that visitors are on the list before they can enter the hospital. All outpatients will also be allowed to have one visitor with them starting next week.
- The number of patients with COVID-19 hospitalized at our 4 UCSF hospitals remains at 14: Average length of stay for patients with COVID-19 is 13 days if they spent any time in the ICU and 11 days if they never went to the ICU. UCSF has conducted more than 13,000 COVID tests and positivity rate remains stable: 3% of those with symptoms test positive and 0.3% of those without symptoms test positive.
- COVID-19 Case Fatality Rate in the US. 1 in 5 people infected with COVID-19 die. NYC has 41% mortality rate among those requiring a ventilator. Greatest risk factors for mortality are chronic lung disease, cardiovascular disease and older age.
- UCSF Affiliate Hospitals’ Volumes are down: Affiliates (e.g., Marin General Hospital, John Muir) have experienced substantial loss in clinical revenue. Their volume is still down 47% in May while UCSF clinical volume is rebounding faster.
- PPE is changing at UCSF. Washable gowns are arriving in June as is new alcohol gel with higher alcohol content. There also is a pilot program to reprocess N95 masks which started on May 27th. Read these FAQs to learn more about the pilot.
We have the best Geriatrics Division in the country and we will get through this tough time together!
Thanks!
Louise
PS: Friends who perform in the Pacific Symphony sent me this original flute-trumpet duet played in my hometown of Fullerton, CA:
https://www.youtube.com/watch?v=wVhXBoPtEQY&feature=youtu.be&utm_source=wordfly&utm_medium=email&utm_campaign=Watch%2BListen20-05-18&utm_content=video5_version_A