All information contained in this email is confidential and not to be shared outside of the organization.
RWJUH COVID-19 Update
March 30, 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 of our ongoing COVID-19 response efforts, as well as information about a change in access points to RWJUH.

Situational Update
 
RWJUH is managing 71 COVID-19 inpatients and is holding another 41 patients who are awaiting test results. Since early March, RWJUH has now managed a total of 134 COVID-19 patients. It is important to note that multiple COVID-19 patients have been transitioned off ventilators and continue to improve in recent weeks thanks to the hard work and exceptional care provided by the physicians, nurses, respiratory therapists and ancillary care team. Great work!

Globally, over 741,000 people have tested positive for COVID-19. More than 144,000 of those cases are in the United States. As of today, New York and New Jersey continue to rank first and second among all states in the number of COVID-19 cases.

Doctors’ Day
 
Happy Doctors’ Day to the dedicated members of the RWJUH Medical Staff!

Today’s #RWJUHSTRONG pic is a salute to all of our physician heroes. 

Shout Out to Our Laboratory

One of the most repeated quotes in business today is Wayne Gretzky’s, “I skate to where the puck is going to be, not where it has been”. Kim Joho, who oversees the Molecular Pathology/Emerging Pathogens Lab and her entire staff, definitely skated RWJUH to where the puck was going to be. Months ago, in the earliest stages of the COVID-19 pandemic, Kim took it upon herself to investigate the contents and validation of the CDC COVID-19 test kits. Kim determined that the CDC was using the same instrumentation that a vendor had provided to RWJUH for another study. Kim worked closely with the vendor and the CDC on a protocol that enabled RWJUH to use that instrumentation for onsite COVID-19 testing which significantly increased capacity and reduced wait times.  Kim and the entire Molecular Pathology Team have worked around the clock to ensure that test results went to everyone who needed them in a timely fashion. Thanks and kudos to Kim and Team Laboratory!!

Effective Tuesday, March 31, 2020 - Change in Access Points to RWJUH

We continually look at ways to maintain a safe environment of care for our team members and our patients. In that connection, we are considering daily temperature screening for all employees upon entering the hospital. Likewise, we are in the process of performing daily mask distribution out of four designated “safety stations” spread across our campus. 

Both of these best practices require that we limit the number of hospital access points so that we can direct incoming team members to one of the four designated Safety Stations for mask distribution and future temperature screenings. Those locations are shown below:   

  • Courtyard:  24 hours a day, 7 days a week
  • East Tower Bridge:  6 a.m. - 2 p.m.
  • French Street Entrance: 6 a.m. – 4 p.m.
  • Safari Café (off the BMSCH Lobby):  6 a.m. – 8 p.m.

If you require a mask outside of the designated hours, you can go to the Courtyard to receive a mask 24 hours a day, 7 days a week.
 
Ultraviolet (UV) Light Decontamination of Select Masks

A reminder that Ultraviolet (UV) light decontamination of two brands of N95 masks (3M and Kimberly Clarke Halyard Duckbill) is available 24 hours a day, seven days a week beginning at 2 p.m. on Monday, March 30.  RWJUH-NB Staff, House Staff, and Medical Staff can bring their mask in a paper bag to The Bristol Myers Squibb Children’s Hospital (BMSCH) first floor conference room which is right off the BMSCH lobby.

Your mask will undergo a visual check, cleaning of straps, UV decontamination by our Tru-D machine using company guidelines, and a final check of integrity before the mask is returned to you. The Tru-D process takes 11 minutes, but please allow about 10-20 minutes for processing You can wait in the area (please practice social distancing) or return in approximately 30 minutes to retrieve your mask.  Attached is an FAQ document for your reference. A big thank you goes to our Environmental Services team for their support of this program to keep our team safe. Please remember, that as patient volume increases, it is vitally important for all of us to remain vigilant and conserve masks and other PPE whenever possible.
 
NJDOH to Increase Bed Capacity
 
The New Jersey Department of Health (NJDOH) in partnership with the U.S. Department of Defense is planning to open a number of field hospitals throughout the state to supplement the anticipated shortage of acute care beds. Present plans for Central New Jersey (Somerset, Middlesex, Mercer, Ocean, and Monmouth counties) call for standing up a 250-bed field hospital at the Raritan Center in Edison within one month. Detailed logistics are in development. The NJDOH has asked RWJUH, as a Level I Trauma Center, to coordinate operations at this field hospital. I will share more information on this topic as it becomes available.

Closing Comments
 
Both State and Federal sources are projecting that Central NJ will experience a surge in COVID-19 patients over the coming weeks. I am highly confident that we have done everything in our control to ready ourselves for the upcoming challenges. My priorities remain the safety of our team members and our patients. Keep up the extraordinary effort.

CLICK HERE for the Daily RWJBH System Briefing.

#RWJUHSTRONG
In honor of Doctors' Day: Lena Merjanian, MD (OB/GYN); Kusum Punjabi, MD (Emergency Medicine); Vinette Coelho-D'Costa (Pulmonary/Critical Care); Bharati Deka, MD (Infectious Disease)

Send your #RWJUHSTRONG photos to chris.hoenig@rwjbh.org 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 71 COVID-positive patients in the hospital. Tests on additional patients and potential discharges of positive patients were pending. A total of 41 patients were in ICU level of care.

RWJUH has had 134 COVID 19-positive tests to date.

SBMU , RCU , 4 West and 2 Core are cohorting COVID-positive med/surg patients (IMCs on 4 West).

MICU , CCU & the former SICU-CORE are cohorting COVID-positive ICU patients. 3 Acute (Neuro ICU) is the next ICU planned for COVID-positive patients.

As of 1:00 PM, the NJ Dept. of Health is reporting 16,636 COVID-positive patients in the state -- an increase of 3,347 from yesterday -- and 198 deaths . Of those, 1,123 positive patients are in Middlesex County, 1,030 are in Monmouth County, and 349 are in Somerset County.
Reduced Access Points to RWJUH
For the health and safety of all RWJUH employees, Medical Staff, and patients , RWJUH will be reducing access points into the hospital, effective tomorrow (Tuesday, March 31st) .

Employees and Medical Staff will no longer have access to the hospital via the Emergency Department entrance, Administration Building entrance, hospital Loading Dock , and Main Lobby entrance.

Access is still permitted via the East Tower, BMSCH lobby, Plum St., French St. and CAB bridge.

Members of the Medical Staff are still requested to sign out surgical masks at the table in the East Tower rotunda, or in the Courtyard off-hours.

CLICK HERE for more details.
N95 Mask Decontamination
Ultraviolet (UV) light decontamination of two brands of N95 masks (3M and Kimberly Clarke Halyard duckbill) is available 24/7 , began TODAY (Monday, March 30th) .

RWJUH-NB staff, housestaff, and Medical Staff can bring their mask in a paper bag to the Bristol Myers Squibb Children’s Hospital (BMSCH) first floor conference room, in the BMSCH lobby area. The decontamination room is open 24/7 for the time being.

The mask will undergo a visual check, cleaning of straps, UV decontamination by our Tru-D machine using company guidelines, and a final check of integrity before the mask is returned to you. The Tru-D process takes 11 minutes , but please allow about 5-10 minutes before and after for processing your mask.

You can either wait in the area (please practice social distancing) or return approximately 30 minutes after you drop off your mask.

CLICK HERE for an FAQ on this process.

Thank you to our Environmental Services (EVS) team for their support of this program to keep our team safe.
RWJUH COVID-19 Treatment Protocols
The RWJUH Infectious Disease team has released updated treatment protocols for COVID-19 patients. Additionally, protocols for the management of respiratory failure in COVID-positive patients are now available.

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 treatment protocols.
CLICK HERE to read the respiratory failure protocols.

Clinical Trials

Additionally, RWJUH is participating in several clinical trials involving the treatment of COVID-positive patients. As we get additional information, we will provide it below:

Additional New Updates
  • As our inpatient COVID-19 population continues to increase, it is important that clinicians discharge any non-COVID inpatients that are able to leave the facility. As the COVID census increases, RWJUH will continue consolidating units to cohort COVID-positive patients.

  • RWJBarnabas Health is consolidating pediatric hospital care systemwide in order to increase capacity for adult care. All new inpatient pediatric admissions are being transferred to BMSCH at RWJUH, Children's Hospital of New Jersey at Newark Beth Israel, or Saint Barnabas Medical Center. Additionally, the maximum admission age for PICU patients at these three facilities is now 25. CLICK HERE for more details.

  • Times like these aren't easy, and we recognize that as providers, there is a lot of stress in navigating this pandemic. There are a lot of resources available to you to help deal with these stresses. CLICK HERE for more information.

  • We expect additional, faster COVID-19 testing capacity to come online this week. More details will be announced in the coming days and additional platforms are added.

  • Clinical IT is working on a special order set for COVID-positive patients. Details will be announced as the order set is finalized and brought into production.

  • Walgreens (in the Courtyard) continues to offer bedside delivery, including in the ED. For COVID-cohorted units and COVID-positive patients, prescriptions will be dropped off at the Nurses Station rather than at the patient bedside.

  • RWJBH is working with all system hospitals to offer ways to keep IV pumps outside of isolation rooms, reducing the risk of exposure for staff while ensuring safe care for patients. CLICK HERE for more details.

  • A team of Rutgers physicians, led by co-principal investigators Dr. Martin Blaser, Dr. Jeffrey Carson and Dr. Reynold Panettieri, is conducting a critical COVID-19 study involving the spread of the virus among front-line healthcare workers. As part of the study, 250 asymptomatic RWJUH-New Brunswick physicians and employees involved in direct patient care will be tested for COVID-19, and undergo bloodwork and swabs over the course of several months. CLICK HERE if you are interested in participating in this study.

  • RWJUH is evaluating access points into the hospital, and may reduce the number of entrances to help protect clinicians, staff and patients. This is consistent with many facilities throughout the region. Details will be announced as they are available.

  • NJ Governor Phil Murphy released a video message to healthcare workers statewide yesterday, via Twitter. CLICK HERE to view.
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.
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.











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.
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.

Tomorrow's guest will be Dr. Sheraz Siddiqui, Chief of Hospital Medicine.

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

Have questions? Email COVID-19@rwjbh.org and please CC Chris Hoenig and we will try to ensure they are also included in our daily Video Briefings.
Have You Tested Positive?
If you have tested positive for COVID-19 or are presently under quarantine , please contact the Medical Staff Office at RWJNBMA@rwjbh.org or (732) 937-8767 .

Providers having tested positive or 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
  • 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 do not go to the Command Center for supplies. N95 masks to use for FIT testing are available at the testing location.

  • The state has received a shipment of PPE from the Federal stockpile. State officials are centralizing the collection and distribution of PPE, including these supplies.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.
Additional Useful Resources