RWJUH Medical Staff
Weekly News Bulletin
March 10, 2020
Latest Update: Coronavirus
Newest Updates
COVID-19 COMMERCIAL TESTING

LabCorp and Quest Diagnostics have both prepared tests for COVID-19.

For both companies, swabs must be collected by physicians. Swabs will not be collected at Patient Service Centers, they will only be collected from physician offices. Proper collection requires isolation rooms and full PPE for all staff involved.

DO NOT SEND PATIENTS TO THE ED FOR THESE TESTS . Our EDs are still using the state laboratory for this test, which provides a quicker turnaround time but requires epidemiological questions to be answered before the test is approved.

LabCorp testing is available now. CLICK HERE for more details.
UPDATE: Quest Diagnostics testing has been limited to the West Coast until Monday, March 16th. CLICK HERE for more details.

PATIENT QUESTIONS

For all patients with COVID 19-related questions, we are advising all members of our Medical Staff to refer their patients to the NJ Dept. of Health COVID-19 Hotline: 1 (800) 222-1222.

The hotline is staffed 24 hours/day with trained medical professionals from the New Jersey Poison Information and Education System, a division of the Department of Emergency Medicine at Rutgers New Jersey Medical School. The team can accommodate callers in multiple languages.

CURTAILED ACTIVITIES:

As part of our efforts to keep our communities and each other safe while containing COVID-19, we ask that you:

  • Assess all non-essential internal and external events, as well as large-scale conferences and meetings. 
  • Curtail and/or cancel events as deemed appropriate.

Upcoming Medical Staff Events Cancelled/Postponed

  • CHOPeration: RWJUH (scheduled for Tuesday, 3/10) - POSTPONED (until Tuesday, September 15th)
  • Rutgers/RWJ Fearless Together (scheduled for Sunday, 3/22) - POSTPONED (date TBA)
  • RWJUH Doctors' Day Dinner/Quarterly Meeting (scheduled for Monday, 3/30) - POSTPONED (date TBA)
  • NJ Palliative Care Symposium (scheduled for Saturday, 5/2) - POSTPONED (date TBA)

RWJBH TRAVEL POLICY:

RWJBarnabas Health is instituting the following travel restrictions for employees and employed physicians, effective immediately. The restrictions will remain in place until May 1, 2020, or until further guidance is issued.

These guidelines are recommended for all credentialed members of the Medical Staff.

Work Travel

RWJBH is establishing a ban on all domestic and international work-related travel and business/academic attendance at meetings, conferences, etc.

Personal International Travel

If you have upcoming personal travel plans that include time in restricted travel countries, including – as of March 6 – China, South Korea, Iran and Italy, we strongly encourage you to reschedule plans that involve traveling to or transiting through these countries.

Before leaving for personal travel plans to these or any other countries not listed above, you must notify your facility’s Corporate Care/Employee Health Services before you leave and check in upon your return.

If you decide to travel to the restricted travel countries or will be transiting through them, you must be cleared before returning to work. You may be subject to a 14-day quarantine beginning the day after your last day in any of the countries listed above. Additional countries may be added to this list at any time, including during your travels.
 
Personal Domestic Travel

The CDC is not currently restricting travel to other states in the U.S., even those with higher numbers of confirmed cases. However, if you are traveling to one of the higher profile states, including Washington State, Oregon or California, you must notify your facility’s Corporate Care/Employee Health Services before you leave and check in upon your return.

Please note that these decisions regarding travel restrictions are subject to change as the outbreak evolves.

If you have travel planned and require documentation for insurance or other purposes, please email the Medical Staff Office.

CLICK HERE for more details on RWJBH's revised travel policy.

CONSUMER ACCESS TO TESTING:

Governor Phil Murphy has announced efforts to support consumer access to COVID-19 screening, testing, and testing-related services.

The Administration's efforts waive consumer cost sharing for all medically necessary COVID-19 testing, as well as services related to testing. This waiver includes emergency room, urgent care, and office visits related to COVID-19 testing for the state’s individual, small and large group markets; the State Health Benefits and School Employee Health Benefits Plans; NJ FamilyCare’s CHIP population; and the state's uninsured population, eligible for the Charity Care program. 

CLICK HERE for more details.
We're ALL In This Together
COMMUNICATION IS KEY

Caring for all of our patients, both in the hospital and in private settings, is a team effort -- not just among clinicians, but the entire healthcare team.

The most important tool for helping each other during this time is communication. Support your fellow clinicians and staff by maintaining clear, open communications.

BED UTILIZATION

Now, as much as ever, bed utilization is important in managing Emergency Department volumes and any potential surge in patients. We ask all clinicians to evaluate their patients for:

  • Appropriateness for admission;
  • Appropriateness for discharge;
  • Care utilization.

To support optimal bed utilization, please ensure discharge orders are entered early (by 11:00 AM).

If you need assistance from Case Management, they can be reached at (732) 937-8702.
Clinician Guidance
IF YOU HAVE A PATIENT OUTSIDE THE HOSPITAL THAT MAY BE AT-RISK:


  • Ensure the patient meets surveillance criteria;

  • If the patient meets surveillance criteria, contact the local health department where the patient is located (contact information can be found at http://www.localhealth.nj.gov/)

For patients whose disposition does not require hospitalization (asymptomatic or mild symptoms):

  • Per CDC guidelines, make every effort to interview the Patient Under Investigation (PUI) by telephone, text monitoring system or video conference. AVOID HAVING THE PATIENT COME INTO YOUR OFFICE.

  • If a home visit is required, don and doff full personal protective equipment (PPE) outside of the house and ensure proper hand hygiene.

  • PATIENTS SHOULD NOT BE SENT TO THE EMERGENCY DEPARTMENT FOR ELECTIVE TESTING FOR COVID-19.

CLICK HERE for CDC guidance on implementing home care of people not requiring hospitalization for COVID-19.

For patients with symptoms severe enough to require hospitalization :

  • Notify the RWJUH Emergency Department by calling (732) 937-8700 before sending the patient to the ED;

  • Instruct the patient to immediately inform triage personnel that they are the Person Under Investigation that you had alerted.

IF YOU HAVE A PATIENT ALREADY ADMITTED TO THE HOSPITAL THAT MAY BE AT-RISK:

  • Call Pat Lafaro (RWJUH Director, Infection Prevention) on cellphone at (908) 399-0054 to assess the patient for testing criteria;

  • Communicate all orders and changes in plan of care with nursing staff on the floor, allowing all members of the team to take appropriate precautions and limit exposure.

FOR ALL OBSTETRICS PATIENTS BEING ADMITTED TO THE HOSPITAL:

RWJBarnabas Health has developed guidelines for Infection Prevention and Control of COVID-19 in Inpatient Obstetric Healthcare Settings.

CLICK HERE for details.

IF YOU MAY HAVE BEEN EXPOSED TO COVID-19:
(Including through patient care or personal travel to affected countries)

  • Call RWJUH Employee Health Services at (732) 937-8714 for assessment and screening BEFORE coming to the hospital. During off-hours, you may contact Dr. Salwitz directly for guidance at (732) 672-8388;

  • STAY HOME IF YOU ARE SICK

  • Questions? Call the New Jersey Dept. of Health COVID-19 Hotline at 1 (800) 222-1222, 24 hours/day.

  • Clinicians should seriously consider the risk of upcoming travel plans, even within the United States. Please see RWJBH Travel Policy above.
Current Situational Update
RWJUH VISITOR POLICY CHANGE:

Out of an abundance of caution, Robert Wood Johnson University Hospital (RWJUH) is putting temporary visitor restrictions in place, limiting guests to immediate family members ONLY, one visitor at a time. In addition, all visitors with recent international travel to CDC Level III countries, as well as cold/flu symptoms will be prohibited
For More Information
CLICK HERE for more information, including the latest RWJBH System Situation Update, additional Personal & Practice Preparedness, CDC Situational Update, and links for even more.
RWJUH Suspends Viral Cultures On Respiratory Samples
In accordance with recent CDC recommendations, the RWJUH Laboratory has suspended Viral cultures on respiratory samples. Most pathogens can be tested using respiratory panels available in laboratory; if a strong clinical indication for CMV testing is present, the sample can be sent-out for CMV PCR.

In addition, due to higher demand, we anticipate a possible shortage of respiratory viral panel kits; please order these tests judiciously.

CLICK HERE for more information
Hand Hygiene: As Important As Ever
February Hand Hygiene Shows Minimal Improvement
One of the easiest ways to prevent the spread of germs, viruses and infections? Washing your hands.

The goal is, has been, and will always continue to be 100% compliance with proper hand hygiene techniques.

In February, hospital-wide hand hygiene compliance ticked up very slightly to 80.7%, from 80.3% in January.

Among physicians, compliance climbed to 83.2%, an improvement over January's 77.0%.
High-Performing Units
Pediatric Recovery (100%)
Same Day Surgery (100%)
2 West Nursery (100%)
4 North - Bone Marrow Transplant Unit (100%)
Pediatric Heme/Onc (100%)
3 Core CVICU (97.8%)
3 North CCU (95.7%)
SBMU (95.5%)
Units With Opportunities For Improvement
3 Tower Postpartum
5 North
6 North
Labor & Delivery
CLICK HERE for a full unit-by-unit breakdown.
CLICK HERE for a video on proper hand hygiene.
IVIG Rates Updated To mL/hr In SCM
Change Matches Rate Used In IV Pumps; Previously mL/minute
IVIG (Immune globulin 10% Intravenous Inj) rates in SCM are now set for mL/hour, matching the IV pump rates.

Rates were previously in mL/minute, causing confusion with pump programming.

Sample conversion (multiply by 60 min/1 hr):
Screenshot:
RWJUH Leadership Announcement
Congratulations to Kate Managarelli, BSN, RN-BC, who has been appointed as the Nursing Director of 9 Tower and 2 East Orthopedics.

Kate joined RWJUH in 2005, and has been the Assistant Nursing Director in the Emergency Department since 2014.

CLICK HERE for more details.
FREE CME: OK To Proceed
Chapter 16: Breaches in Infection Control
Efforts to reduce morbidity and mortality from breaches in infection control date back to the 1800s, when scientists such as Joseph Lister and Ignaz Semmelweis showed that handwashing could reduce the risk of infection. The introduction of antibiotics in the 1930s led to a decline in infections from staphylococcus and streptococcus. However, antibiotic-resistant Staphylococcus aureus began to emerge by the 1950s and triggered the development of formal infection control programs.
 
Completion of the evaluation associated with each chapter qualifies providers for 0.5 AMA PRA Category I CME credits, totaling 26 CME credits for the year.
 
CLICK HERE to read Chapter 16 and complete the CME evaluation.

NOTE: Access to Chapter 16 expires on Friday, April 3, 2019.
From The NJ Dept. of Health
Weekly Flu Report
The New Jersey Department of Health is continuing its Weekly Respiratory Virus Surveillance Report, tracking the flu season across the state.

The CDC estimates this year's flu shot is approximately 45% effective.

Statewide flu activity remains high, with all regions of the state reporting widespread activity.

Surprisingly, the predominant strain so far this season continues to be B, which is unusual for this late in the flu season. In another unusual twist, the CDC reports a surge in H1N1 cases nationwide, representing the second-straight year that a second strain of flu has seen a spike.

CLICK HERE for this week's full Flu Report.
Quick Links
Upcoming CME Events
*Please monitor individual events for potential postponement or cancellation.*

Clinicians Leading Safety Together - RWJBH High Reliability Organization Training (*2.0 CME Available) - Online
CLICK HERE to access (video password is safetytogether ).

Babs Siperstein Humanities & Medicine Seminar Series (*1.0 CME Available) - Monday, March 23rd
Details to come.

7th Annual Digestive Diseases: New Advances (*14.25 CME Available) - Saturday, March 28th
CLICK HERE for details.

Babs Siperstein Humanities & Medicine Seminar Series (*1.0 CME Available) - Monday, April 20th
Details to come.

Global Neurosurgery: Ask Not For Whom The Bell Tolls (*14.5 CME Available) - Thursday, April 30th-Friday, May 1st
CLICK HERE for details.

2nd Annual Mid-Atlantic Gastrointestinal Interventional Course (MAGIC) (*14.0 CME Available) - Thursday, June 4th-Friday, June 5th
CLICK HERE for details.
Other Upcoming RWJUH Events
32nd Annual RWJUH Golf Classic Invitational  -  Tuesday, June 16th
CLICK HERE for details.

Diabetes Support Group & Educational Series  -  Second Tuesday of Every Month
CLICK HERE  for details.

Bariatric Surgery Morning Support Group  -  Third Tuesday of Every Month (8:00 AM)
CLICK HERE  for details.

Walking Group  -  Every Thursday (12:00 PM)
CLICK HERE  for details.
As always, your feedback is always welcomed and appreciated. Please do not hesitate to contact Dr. Salwitz with any questions or concerns.