June 29, 2020

Universal eye protection recommendation for physicians

Read the Physician Face Shield Memo

March 30, 2020

Surge Planning and Universal Masking

Dear Colleagues,

Confirmed COVID-19 cases continue to spread across the country, with cases now being reported in all 50 states. According to the Texas Department of State Health Services, as of this morning, there were approximately 926 confirmed cases across the North Texas region. While the “stay home” order seems to be mitigating some of the spread, we are monitoring the situation closely. We are preparing, and we are remaining vigilant. As we begin the week, here are some important things you should know:

Universal Masking and PPE Reprocessing

Our top priority is protecting our patients, clinicians, nurses, and colleagues so we can best serve our communities through the duration of this pandemic. In an abundance of caution, we are taking steps that go beyond current CDC recommendations to continue protecting staff and providers while maintaining proper PPE availability. These new guidelines apply to all areas of our patient care facilities, not just those where suspected COVID or COVID-positive patients are being treated.

  • Beginning Tuesday, March 31, all staff and providers in all patient care areas will wear masks. This will include all support staff who move in and through these areas.

For staff in non-patient care areas who can consistently maintain social distancing of at least 6 feet, masks will be optional.

We will deploy three types of masks, depending on the clinical role, the type of care the patient is receiving, and the level of suspicion for infection with COVID.

  • Level I “procedure” masks for all staff not needing higher levels of protection.
  • Level 3 masks for additional protection from fluids and droplets. These masks are for use by staff caring directly for suspected COVID or COVID-positive patients, except when performing aerosolized procedures.
  • N-95 respirators for staff caring for suspected COVID or COVID-positive patients. These  are the only masks that should be used during aerosolizing procedures, such as intubation, nebulization, bronchoscopy, or suctioning.

We are taking these steps now because social distancing is difficult to maintain in the busy patient care environment. We will continue to take steps to conserve PPE, including reuse and reprocessing of PPE where appropriate. These actions will help to ensure we have adequate supplies for as long as it takes to get through this crisis. Thank you for your focus and for your diligence to make this happen.

Projection of Virus Spread

There are a number of forecasting models that show we will see surges in our volumes that outpace our standard, routine capacity, specifically related to overall hospital beds, ICU beds and ventilators. While the models make a number of assumptions due to the novelty of the input data, we’re watching the models closely, and we’re working with HCA Healthcare to refine them based on data specific to our geographic region. We continue to update your facility leadership team with the latest data.

Surge Planning

As we prepare for various scenarios, every one of our hospitals has a surge plan specific to that facility. We review and revise those plans based on what is currently happening within our community, what is projected to happen, as well as what we’re already seeing in communities that have experienced large COVID-19 outbreaks. Our surge plans include using all available patient care space within our hospitals and in other settings across our healthcare system. This includes the conversion and/or retrofitting of certain functions in available space to accommodate this patient population. In addition to physical space, the plans address the equipment that will be needed, as well as the appropriate redeployment of our staff and physicians to ensure we are maximizing the use of our greatest resource, which is our people.

Workforce Redeployment Efforts

Our everyday lives and the way we provide care to our patients and community are drastically changing due to the spread of COVID-19. Much of our routine and elective business has declined dramatically, and the disruption to various service lines has left many of our colleagues without their usual case volume. At the same time, as the COVID-19 pandemic grows, we anticipate our hospital volumes to increase, and we want to be prepared to shift physicians to support the care of these patients when necessary. You will receive a survey this week requesting your availability and willingness to step in when the surge comes.  We strongly encourage you to join the workforce regardless of your specialty, as we could potentially use your services in unconventional ways in times of crisis. Thank you in advance for your response and willingness to serve.

For more Medical City Healthcare updates on how we are caring for consumers and caregivers during the COVID-19 pandemic, PSG providers can click here. Physicians on the medical staff at our facilities may visit our COVID-19 hub page for COVID-19 updates that affect your practice.

As this crisis evolves, Medical City Healthcare and HCA Healthcare will continue to evolve to meet the challenges. Responding in times of crisis is what we do. Every day, we are hearing remarkable stories of how our physicians and providers are going above and beyond to provide the best care possible and to support our community in this time of great need. In times like these, it makes us very proud to be a part of this team who truly cares like family. 

Every colleague and their family, every patient and their family matter. With a limited supply of PPE stock across the country, we must ensure – every one of us – that we have the right level of protection for our colleagues when they are faced with known risk. We currently have adequate supplies of PPE, and continue to source additional supply. Our utilization rate is increasing dramatically though, so we are taking immediate actions to help ensure we have what we need for our caregivers for the duration of the COVID-19 pandemic. Starting today we are implementing a PPE conservation and reprocessing initiative as recommended by the Centers for Disease Control to conserve PPE.

Specifically, the steps we are taking consistent with CDC guidelines include:

  • Appointing a PPE Task Force for each of our facilities. Led by a clinician, this task force will oversee accountability for PPE stewardship.
  • Allowing the use of both N95 masks and standard facemasks. The evidence base suggests that COVID-19 is spread by droplets, for which a standard face mask offers adequate protection. For aerosolizing procedures, the use of an N95 mask is recommended, when available. However even in this setting, evidence shows that a regular face mask offers protection from transmission to the healthcare worker.
  • Using supplies beyond the manufacturer’s recommended shelf life. As stated by the CDC: “Many models found in U.S. stockpiles and stockpiles of healthcare facilities have been found to continue to perform in accordance with NIOSH performance standards.”
  • Reuse of PPE. There are specific protocols that we are adopting, outlined by the CDC, to guide healthcare workers toward appropriately maintaining their PPE for reuse. HCA Healthcare has implemented a process for reuse of PPE based on this guidance.
  • Reprocessing of PPE. The Food and Drug Administration (FDA) is looking at standards for reprocessing of PPE and a decision is expected soon. To this end, we are now collecting goggles, face shields and N95 facemasks in our facilities.
  • Cohorting Respiratory Patients and use of Telemedicine. Patients with respiratory symptoms are cohorted from their first encounter in the ER or admission. Initial evaluation is conducted using telehealth technology to limit contact and conserve PPE.

Three recent published reports from respected journals have shown the efficacy of the recommended protocols. By wearing a surgical mask and appropriately cohorting patients – these case studies demonstrate that zero nosocomial transmissions can be achieved, even when exposure is significant.

We recognize the COVID-19 pandemic is creating unique challenges. We want you to know as we address them, we are following these three principles:

  • Ensure that our patients get the care they need, when and where they need it
  • Ensure that strategies for protecting our workforce are optimized, and designed to be sustainable over the long term.
  • Make decisions based on the known evidence and guidance from national authorities such as the CDC.

For more Medical City Healthcare updates on how we are caring for consumers and caregivers during the COVID-19 pandemic, PSG providers can click here. Physicians on the medical staff at our facilities may visit Medical City Doc for COVID-19 updates that affect your practice.

Please do not hesitate to reach out to your facility leadership team. We are all in this together and dedicated to protecting the health of our physicians, colleagues, patients and community.