All information contained in this email is confidential and not to be shared outside of the organization.
RWJUH COVID-19 Update
March 27, 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
Today’s Daily Briefing provides an updated summary along with another human interest story.

Situational Update
 
RWJUH is managing 43 COVID-19 inpatients and is holding another 24 patients who are awaiting test results. Since early March, RWJUH has now managed a total of 89 COVID-19 patients.

Globally, over a half million people have tested positive for COVID-19. Approximately 93,000 of those cases are in the United States, with the U.S. now surpassing Italy and China in total COVID-19 cases.  New York (44,635) and New Jersey (8,825) are ranked first and second in the number of statewide of COVID-19 cases.

COVID-19 Testing for Healthcare Workers and First Responders

Tomorrow, Saturday, March 28, 2020, the PNC Arts Center and the Bergen County Community College COVID-19 testing sites will only be testing symptomatic healthcare workers and first responders with valid ID credentials .  The sites have the capability to provide 500 tests and are expected to fill up early.  Beginning Saturday, April 4, 2020 and every following Saturday thereafter, tests will be offered for these groups at the PNC location only.  For more information, please visit www.nj.gov and click on “Testing Site Information.”

A Story for Sharing from BMSCH

Dawn Tortajada, a member of the Department of Pediatrics in Rutgers RWJMS, shared a personal story of teamwork. Dawn had concerns regarding a cystic fibrosis patient that was exposed to COVID-19 and experiencing symptoms.  

Dawn believed the patient would require admission to BMSCH and was very concerned about the safety of both the patient and the care team. With the guidance Dawn received from Dr. Amisha Malhotra and Dr. Dalya Chefitz, connection was made to the RWJUH Command Center and subsequently the COVID Team. Dawn shared all options for her patient with the team who thoroughly reviewed and discussed the case with the utmost dignity and compassion. The result was a successful and safe admission. 

Dawn requested that a special thank you go out to the following Team Members: BMSCH Transfer Center, The Command Center, COVID Team, Respiratory Therapy, Safety & Security, Pediatric Pulmonary and all of the amazing physicians, nurses and staff in the Pediatric Unit. In Dawn’s own words, “Difficult times bring out the best in the RWJ family.” I couldn’t agree more; teamwork makes it happen! 

In that spirit of teamwork, today’s #RWJUHStrong visual recognizes the BMSCH Neonatal Intensive Care Unit who provides care to our tiniest patients (Check out the biceps on Dr. Sorrentino in the back row!). 

On behalf of myself and the Leadership Team, THANK YOU for rising to the challenge and for continuing to deliver the highest quality, compassionate healthcare to our community.   

#RWJUHSTRONG
NICU

Send your #RWJUHSTRONG photos to [email protected] and we'll feature them in the daily emails and on the new screen in the Courtyard!
RWJUH COVID Situational Update
As of 12:00 PM, RWJUH had 43 COVID-positive patients in the hospital. Tests on additional patients and potential discharges of positive patients were pending. 22 patients were in ICU level of care.

RWJUH has had 89 COVID 19-positive tests to date.

SBMU , RCU and 4 West are cohorting COVID-positive med/surg patients (IMCs on 4 West).

MICU , CCU & the former SICU-CORE are cohorting COVID-positive ICU patients. (Non-COVID MICU patients have been reassigned to the former SICU-West space.)

Additional units are being prepared as part of the Surge Plan, to handle both med/surg and ICU patients.

As of 1:00 PM, the NJ Dept. of Health is reporting 8,825 COVID-positive patients in the state -- an increase of 1,982 from yesterday -- and 108 deaths . Of those, 640 positive patients are in Middlesex County, 634 are in Monmouth County, and 222 are in Somerset County.
Surgical Masks Available - East Tower Rotunda
The universal masking policy is in effect.

Clinicians may pick up a surgical mask in the
East Tower Rotunda from 7a-7p daily.

Please present your ID. On off-hours, masks can be signed out at the Information Desk in the Courtyard.

Masks can be used on non-COVID units for an entire day and discarded when you leave the hospital. If the mask becomes wet or soiled , please discard and request a new mask.

For COVID-cohorted units , please follow PPE protocols when seeing patients.

CLICK HERE for the full policy.
RWJUH Releases COVID-19 Treatment Protocols
The RWJUH Infectious Disease team has released treatment protocols for COVID-19 patients.

The protocols break down treatment plans for patients requiring ICU-level of care , requiring supplemental oxygen , and those with lower respiratory tract disease with risk factors for progression to severe disease.

Protocols will be updated and shared as evidence permits.

CLICK HERE to read the protocols.
A Message From RWJBH President & CEO Barry Ostrowsky
Everyone's hard work and dedication to protecting our patients, as well as colleagues and hospital staff, has not gone unnoticed.

CLICK HERE to watch a video message from RWJBarnabas Health President & CEO Barry H. Ostrowsky .

RWJBH System Medical Staff COVID Update

Dr. John Bonamo, RWJBH EVP and Chief Medical and Quality Officer , has released the latest system COVID update for members of the Medical Staffs. Topics covered include testing centers, PPE, staffing efforts and precautions.

CLICK HERE to read the full update.
Additional New Updates
  • We will no longer be isolating patients with cases of colonized MRSA or colonized VRE with no active infection. Patients with ACTIVE infections will continue to be placed on contact precautions. Nasal swabs for MRSA screening in critical care units will continue to be done.

  • Please note, under CDC guidelines, you should NOT cover your N95 mask with a procedural earloop or surgical mask. It is currently unknown how that affects the mask's HEPA filtration.

  • Additionally, latest guidance from the CDC has changed masking requirements for treating COVID-positive patients. A surgical mask and face shield are adequate for non-aerosolizing treatments and assessments, with the patient wearing an earloop mask while you're in the room. N95 masks should still be work for patients undergoing aersolizing procedures and on high-flow oxygen.

  • A 24/7 Palliative Care COVID hotline has been established for network providers to call for support and guidance from MDs and APNs. The phone number is (973) 282-7233.

  • The RWJUH Emergency Department has received a device known as the AeroBox, which is designed to limit the risk of exposure to clinicians while intubating COVID-positive patients and PUIs. The acrylic box was designed by a Taiwanese physician, who shared the plans online. The Rutgers Biomedical Engineering Team used those plans to construct these boxes.
  • The ACGME has established guidelines for reassigning residents/fellows in a pandemic, and Rutgers RWJMS has the flexibility to do so (i.e. reassign an endocrine fellow to general medicine service). Processes are in place to activate this plan if/when needed. CLICK HERE for more from the ACGME.

  • RWJUH is eliminating the ventilation portion for all Nuclear Medicine Lung scans for the foreseeable future. This is to protect our patients and staff alike, because of possible room contamination during the aerosol administration. If you believe your patient needs a lung scan, please obtain a Chest X-ray, PA and Lateral preferably, since aerosol ventilation is not being performed. Perfusion imaging alone, will often be diagnostic at ruling in or ruling out pulmonary embolism, particularly with a normal or near normal Chest X-ray. 

  • Additionally, due to a shortage in swabs and viral transport medium, RWJUH is only taking swabs from patients who are previously approved to be tested. Additionally, in the interest of conserving swabs and viral transport medium for patients requiring COVID-19 testing, please do not order any Respiratory Virus Panels (RVPs) until further notice.

  • RWJUH, along with the entire RWJBarnabas Health system, continue to manage our supplies, including PPE, medications, and equipment like ventilators. At this time, RWJUH continues to maintain an adequate stock of PPE. While our material team continues to source additional supplies and we are accepting donations, we are meeting staff needs at this time.
How Can I Help?
As our hospital and Medical Staff continue working hard to provide the best care possible to our community, many are asking what they can do to help .

From PPE to food, and from technology to money, every little bit helps.

RWJUH and the RWJBarnabas Health system are streamlining the processes to vet, collection and distribute donations.

CLICK HERE for a link that you can share that includes ways the public can help, and contact information to connect them with those who can help.

Volunteering
As the number of COVID-positive patients (and clinicians) increases, we are working on plans to maintain our clinical staff to provide great care for our patients.

IF YOU WOULD BE INTERESTED IN VOLUNTEERING TO ROUND AND TAKE CALLS AT RWJUH (for COVID and/or non-COVID patients), please fill out the form below .
Additionally, RWJUH may look to clinicians to help set patients on ventilators should the surge in intubated patients outpace our Respiratory Therapy capacity. Clinicians may volunteer to assist with ventilating patients.

CLICK HERE for a brief overview on how to operate the models of ventilator used at RWJUH.

NOTE: We have not yet reached the level where we are calling on volunteers to begin rounding. This process is to allow us to build our contact lists, if the need to activate volunteers.
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.












REMINDER: Call For IP Approval BEFORE
Ordering COVID-19 Testing
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.
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.
Do NOT Send Patients To ED Unless
They Require Hospitalization
Please do NOT send patients to the RWJUH Emergency Department for COVID-19 testing unless they require hospitalization .

Due to a shortage of swabs and viral transport medium , RWJUH is currently unable to test everyone who comes into the Emergency Department.

As noted above, all tests require the approval of RWJUH Infection Prevention.

Outpatient testing facilities are now open in several NJ counties.
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.
Additional Information
  • The triage tent outside the Emergency Department continues to work really well. ED leadership is evaluating expanding hours in the tent.

  • Updated guidance is available on the cleaning and reuse of goggles and face shields. CLICK HERE for details.

  • If you are concerned you may have been exposed to a COVID-19 positive patient, either in the community or in the hospital, please self-monitor your symptoms, including checking your temperature twice a day. Report any symptoms/temperature over 100.0 to RWJUH Corporate Care/Employee Health.

  • Blood donations continue to be needed. CLICK HERE to schedule an appointment with the RWJUH Blood Services team.

  • The Courtyard doors right beside Starbucks, leading to/from the East Tower, are being closed and made swipe-access only. The doors nearest the East Tower elevators will no longer require a swipe.

  • New guidelines are in place for the handling of COVID-positive decedents. All expirations of COVID-positive patients must be reported to the Medical Examiner's office and the NJ DOH Communicable Disease alert statement must be included, with COVID-19 written in as the infectious agent. CLICK HERE for the full guidelines.

  • ALL transfers into RWJUH must be reviewed and approved by the Service Chief. Any patients that have tested positive for, or suspected of having COVID-19 must be approved by the Chief Medical Officer or his designee.

  • ALL coordination with government officials must be handled through hospital leadership. If you have questions or suggestions for state leaders, please email Dr. Salwitz and he will coordinate with RWJUH leadership.

  • Additionally, all members of the Medical Staff are expected to protect confidential information, including the information contained in this email. DO NOT SHARE with the press or on social media. Given the volatility of the current environment, especially on social media, you should always use caution in what you post. If you are approached by the media for interviews, please reach out to the RWJUH Medical Staff Office to aid in clearing with the hospital Public Affairs team any hospital information that can be shared.

  • 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.

  • 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.
Additional Useful Resources