Becker's Hospital Review

65 FINANCE CMO / CARE DELIVERY We were looking to the governor of Nebraska to give us the go-ahead on opening up elective surgeries and we received that May 4. One con- cept is to have a phased-in approach of limiting the number of cases you do per day to make sure you have enough PPE. is will be diffi- cult once the "floodgates" are open. We will keep a continuous count of PPE to make sure we have enough to meet the demand. e hospitals of the county meet daily with the county health depart- ment to plan for the patient surge as well as PPE inventory. We also worked together to plan when to shut down elective surgeries. Hope- fully, we will work together to plan the opening of elective surgeries. Tony Slonim, President and CEO, Renown Health (Reno, Nev.) As we transition from a public health model, where the public health infrastructure has jurisdiction, back to a medical model where the doctor-patient relationship has jurisdiction, we are relying on our phy- sicians to help us establish guidelines for prioritizing which patients get scheduled first and how to tier the other patients whose care might have been postponed because of concerns related to COVID-19. We believe that in the context of a state and national emergency, the public health infrastructure has jurisdiction with managing the event. We look to and follow guidance from the CDC, state department of health and local health district. As contributors to the dialogue, we are active participants in the emerging recommendations and challenge them, in a collegial way, if we do not agree, so that the work product can be improved. Matt Walker, PharmD, CEO, William Bee Ririe Hospital (Ely, Nev.) We have begun rescheduling the week of April 20 by reaching out to patients, explaining the risk/benefit and allowing the patient to decide. We are doing registration over the phone to allow less time and con- tact within the facility, and we will now bring the patient directly back to the pre-op/post-op area to reduce exposure and time in the facility. We had canceled orthopedic cases, cath-lab cases, urology, etc. We are starting with the more urgent cases and allowing more time for the case so the potential for getting behind and making patients wait in the facility is reduced. We have shared our plan with the local [emergency operations cen- ter] and health officer. Everyone is in agreement that the steps taken are prudent, and given the limited cases here, it seems low-risk. We also have a contingency plan to stop all cases if we see an increase in cases locally or have admissions that increase risk for patients coming through the facility. n Some COVID-19 patients only show digestive symptoms, study finds By Anuja Vaidya A subgroup of COVID-19 patients may show symptoms of digestive issues, such as diarrhea, a study found. Researchers in China examined 206 patients with mild cases of COVID-19. Forty-eight of the patients only showed a digestive symp- tom; 69 showed both digestive and respira- tory symptoms; and 89 showed only respira- tory symptoms. They followed patients until the patients tested negative for COVID-19 at least twice, more than 24 hours apart. Among the patients with digestive symp- toms, 67 had diarrhea lasting one to 14 days. About 62 percent of patients with a digestive symptom had a fever at the same time. Researchers also found that COVID-19 pa- tients with digestive symptoms sought care later than those with only respiratory symp- toms. They also were more likely to test pos- itive for COVID-19 in their stool. The study was accepted for publication by the American Journal of Gastroenterology. It was made available before appearing in the journal, however, to offer early visibility to the study's results. It will undergo further review and copy editing. n Photos of bodies piled up at DMC hospital prompt state probe By Anuja Vaidya M ichigan state regulators are investigating reports of bodies being stored in vacant rooms at DMC Sinai-Grace Hospital in Detroit, Gov. Gretchen Whitmer said April 17, according to The Detroit Times. On April 14, CNN published photos from the hospital that were being shared among emergency room staff that show bodies of dead patients being stored in vacant rooms and being piled up in refrigerated holding units in the parking lot of the hospital. An ER worker shared the photos with CNN, and two other ER workers confirmed that these pictures were real and show how the hospital was storing bodies in early April, during a particularly grueling 12-hour shift, the workers said. Additionally, a prior Detroit Times report found that workers at DMC Si- nai-Grace Hospital were scrambling to find body bags for the patients who died and places to put the bodies. Officials from the State Department of Licensing and Regulatory Af- fairs visited the hospital in mid-April, a department spokesperson said, according to the report. At a press conference April 17, Ms. Whitmer said: "It's just incredibly, incredibly sad. There's been a lot of tough days in the last six weeks. I'm making decisions that I never could have imagined we'd be confronting as a state." The state is working to coordinate its cold storage capacity, she said. A DMC spokesperson said that the hospital was using mobile refriger- ation units to manage the capacity issues springing up at morgues and funeral homes in the area due to the COVID-19 pandemic, according to The Detroit Times. "Patients who pass away at our hospital are treated with respect and dignity, remaining on-site until they can be appropriately released," the spokesperson told The Detroit Times. n

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