RWJUH COVID-19 Update
March 20, 2020
TO: All Members of the RWJUH Family
FROM: John J. Gantner, President and CEO, Robert Wood Johnson University Hospital
RE: RWJUH COVID-19 Update

We have all heard that “one picture is worth a thousand words”. That being said, I decided that I would let our dedicated team members, provide the inspiration for today’s Daily Update. 
SBMU (First Dedicated COVID-19 Unit)
Pediatric ED
Hand Hygiene Team
CVICU
Reception Services
House APPs
Cardiac Surgery
Security
#RWJUHStrong

We are excited to launch #RWJUHStrong, recognizing the RWJUH Family which stands united in this time of crisis. Thanks to everyone who has sent us photos. Keep the pics coming and follow us on the new video board in the Courtyard, on The Bridge and on the Hospital’s social media pages.
 
Patient Volume Surge Plan

We have a surge plan in place in anticipation of the increased patient volume that we expect in the coming days and weeks. Our Leadership Team consistently monitors our patient volume and our current capacity to ensure the most effective and efficient use of space throughout the hospital.

Elective Outpatient Therapies

  • All testing/outpatient procedures/therapy modalities scheduled for the remainder of this week and the weeks ahead need to be assessed and clinically evaluated, and those cases deemed appropriate should be postponed.

  • Every elective outpatient testing modality/procedure could potentially spread coronavirus within the facility, use up protective gear and hamper the hospital workforce. We will thoughtfully and thoroughly review each scheduled elective testing and therapy modality, with a plan to minimize, postpone, or reschedule, until such time it is deemed safe and appropriate to resume normal activity.

  • Our patients will be best served by carefully evaluating and prioritizing gradients of “elective” care/testing/therapies, to ensure that the most time-sensitive, medically necessary care can be delivered. Some will be performed with appropriate screening of patients and when deemed clinically necessary.

  • Emergency and truly urgent outpatient testing and therapies will proceed as always.

  • The Executive Administration and the Medical Staff leadership are available to answer questions, help with the decision process and offer continued guidance.

I know that we continue to ask a lot from everyone as our COVID-19 preparation and response continues.  Your commitment to serving our patients and our community is inspirational. There is no doubt in my mind that our RWJUH Family will conquer this unprecedented challenge. 

CLICK HERE for the RWJBH Daily System Update.
RWJUH COVID Situational Update
As of 12:00 PM, RWJUH had 9 COVID-positive patients in the hospital. Tests on additional patients and potential discharges of positive patients were pending. At least eight COVID 19-positive inpatient have recovered and been discharged.

RWJUH has had 23 COVID 19-positive tests to date.

As of 1:00 PM, the NJ Dept. of Health is reporting 890 COVID-positive patients in the state -- an increase of 155 from yesterday. Of those, 76 positive patients are in Middlesex County, 53 are in Monmouth County, and 28 are in Somerset County. A total of 18 counties in NJ have at least 1 positive patient.

CLICK HERE for the NJ DOH's county-by-county tracking page.
New PPE Guidelines
As with many emerging pathogens, the science of COVID-19 is always evolving. The latest research has led to new guidelines from the CDC and WHO on PPE requirements , which have been adopted by RWJUH , RWJBarnabas Health , and many large hospital systems state- and nationwide.

For many situations, droplet precautions + eye protection are now the rule.

For assessment or routine treatment of all suspected or positive COVID-19 patients the following equipment should be :

  • Surgical/face mask

  • Face shield/goggles

  • Gown

  • Gloves

N95 Respirators/Masks should be used with the following :

  • During Intubation for presumptive or known cases of COVID-19. All other cases should be intubated utilizing a surgical/face mask.

  • During aerosol generating procedures (i.e.: sputum induction and open suctioning

  • When collecting oropharyngeal or nasopharyngeal specimens on suspected COVID-19 patients

  • When assessing patients in the outdoor tent treatment area

CLICK HERE for the full updated PPE/Isolation guidance.
Additional New Updates
  • An RWJBH employee/internal stakeholder hotline has been opened to answer all COVID-19 related questions. The hotline -- 1 (833) 579-0862 -- is manned 24/7 by clinical professionals. CLICK HERE for more details on that and more in the latest RWJBH System Update.

  • NJ's first drive-thru testing facility opened today in Bergen County, and quickly reached capacity. A drive-thru testing facility at the PNC Bank Arts Center in Monmouth County is currently scheduled to open on Monday.

  • As part of RWJUH's continuing efforts to support the Surge Plan, the Dept. of Pathology will not be performing elective, family-driven autopsies. Clinician-requested autopsies on non-COVID patients will still be considered. Any COVID-related deaths must be referred to the Office of the Medical Examiner. CLICK HERE for details.

  • Additionally, the IP team continues to assess guidance regarding quarantining during this time. The latest guidance/policy change keeps RWJBH employees at work after an exposure as long as there is no evidence of even mild symptoms. Exposed staff will wear a surgical mask for 14 days. As of now, a return to work may be allowed after 7 days of improving respiratory symptoms IF the COVID-positive patient is afebrile for 72 hours, without the need for medication. CLICK HERE to read the RWJBH Return to Work Policy.

  • The RWJUH Visitation Policy has been updated -- NO visitors are now allowed in the Emergency Department. CLICK HERE to read the updated policy.

  • The RWJUH OR has cancelled 330+ elective procedures to date. We are permitting only essential procedures to ensure the hospital has adequate resources for this COVID-19 outbreak. CMS and ACS both advise to cancel all elective procedures.

  • The triage tent outside of the ED is up and running. Nearly 40 patients were seen in the first day of use, and the tent has deferred traffic from the main ED. See pictures below -- and keep an eye out for a story about the tent on News 12 NJ!
  • Dr. Sheraz Siddiqui, Chief of Hospital Medicine, was a guest on ABC Radio on Wednesday (3/18). CLICK HERE to listen to his interview.
Are You Under Quarantine?
If you are presently under quarantine , please contact the Medical Staff Office at [email protected] or (732) 937-8767 .

Providers under quarantine should contact RWJUH Corporate Care/Employee Health for clearance to return to work. You may also need clearance from your employer.

Please provide documentation to the Medical Staff Office of your clearance to return to work.
Scientific Reviews
These links are provided solely for your consideration. The RWJUH Medical Staff Office is not providing these as recommendations for care of patients.








COVID-19 Testing Guidance
--Reminder: NEW Phone Number For COVID-19 Testing Approval--

RWJUH is continuing to conduct a LIMITED number of COVID-19 tests in-house.


ALL REQUESTS FOR COVID-19 TESTING MUST GO THROUGH INFECTION PREVENTION .


The NEW phone number for testing approval is 732-947-9620 . NOTE: This is a new phone number, opened Tuesday. PLEASE DO NOT SHARE THIS NUMBER WITH ANYONE OUTSIDE OF RWJUH.

DO NOT CALL THE COVID-19 HOSPITALIST TEAM SEEKING ASSISTANCE IN GETTING TESTING APPROVED . The Hospitalist team is focused on caring for these patients and does not influence testing decisions.

For Infection Prevention questions, please use extensions 2480 / 4482 / 7552 / 4474 during regular business hours. The public may call 1-800-222-1222 for any COVID-19 questions.

Guidance on COVID-19 Testing For Patients Not Requiring Admission--

At the current time, due to a shortage in swabs and viral transport medium, RWJUH is only taking swabs from patients who need to be admitted to the hospital .

Additionally, in the interest of conserving viral transport medium for patients requiring COVID-19 testing, please do not order any Respiratory Virus Panels (RVPs) until further notice .
We're All In This Together
The nursing and support staff at RWJUH are doing exceptional work under these trying circumstances. They are here to help, but they face the same worries and concerns that we all do.

These are extraordinary times. You are doing extraordinary work. Please keep doing so, as we all work towards the same basic goals: provide the best possible care for our patients, while trying to keep them -- and ourselves -- safe .
Do NOT Enter SBMU
In addition to being a closed service, SBMU is a closed unit for the protection of our patients and providers.

Please do not enter SBMU unless asked or consulted by the COVID-19 Hospitalist team.

This is both for your protection - limiting your risk of exposure to the virus - and in the interest of high quality patient care , keeping the patients treatment limited to teams that are trained and gaining expertise in COVID-19.
Daily Video Briefings
Every weekday morning, a video briefing by Dr. Jim Salwitz will be released, providing an update on COVID-19 activity at RWJUH and the implementation of the hospital's action plan.

BOOKMARK THIS PAGE and check daily for updates. New briefings will be posted at approximately 10:00 AM.

Have questions? Email [email protected] and please CC Chris Hoenig and we will try to ensure they are also included in our daily Video Briefings.
Blood Shortages
We have received notices from our blood suppliers regarding the tremendous strain COVID-19 has placed on blood supply . Recommendations from RWJBH’s Blood Management Program are as follows:

  • Strict adherence to the recommended transfusions triggers for RBCs:

  • 7g/dL for stable, non-bleeding patients (focus on entire clinical picture, symptoms not just a numbers)

  • 8g/dL for patient with cardiovascular disease

  • Single unit transfusion – RBCs and platelets (MUST reassess before ordering a second unit)

  • Surgical cases – anticipated blood loss ≥500cc implement cell saver with the requirement to spin down everything collected in reservoir and give back to the patient in order to reduce the need for banked blood

  • Minimize serial lab draws – focus on draws that are necessary (keep the blood in the patient)

  • ICU/CTICU and CCU – ensure utilization of VAMP (Venous Arterial blood Management Protection) systems to re-infuse excess blood not needed when drawing blood sample for testing

--Blood Donations Accepted-- 

Your help to encourage healthy people to donate blood and platelets is requested at this time. Our RWJUH Blood Services staff is working very hard to continue to provide services throughout this unprecedented time. Our goal is to maintain a safe and adequate supply for our patients in need!

Please have interested and potential donors access our appointment portal at rwjuhdonorclub.org or call 732-235-8100 x221 .

Starting next week, RWJUH is partnering with the Embrace Kids Foundation to turn their New Brunswick facility into a donation center. CLICK HERE for more details.
Additional Information
  • Please ensure your ID is visible at all times. RWJUH continues to evaluate campus entrance points to ensure the safety of our patients, clinicians and staff.

  • Leaders at Bristol-Myers Squibb Children's Hospital continue finalizing plans to cohort all pediatric patients with respiratory illness, including COVID 19-positive patients and PUIs;

  • There are no special laundry handling guidelines for COVID-19 -- standard washing and use of disinfectants on surfaces will kill the virus. While you may choose to not wear your white coat, standard precautions will help prevent the spread of the virus;

  • The new digital screen in the Courtyard is now live and includes information on COVID-19;

  • As we continue our efforts to restrict the number of people entering our facilities, a temporary ban is being put in place on flower deliveries to patients;

  • The Federal government announced today that CMS will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the country. Beneficiaries will be able to receive telehealth services in any healthcare facility, including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes. Medicare beneficiaries will be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings. CMS is waiving certain HIPAA requirements for telehealth services during this Public Health Emergency, allowing the use of platforms like Facetime on cellphones.
Additional Useful Resources