COVID-19 Update From Dignity Health / St. Francis Memorial Hospital

March 20, 2020

COVID-19 test is now available in Cerner as a built-in test. Please choose nasopharyngeal swab from drop down menu. Lab add on order is no longer needed for COVID-19 test. The specimen needed is only a nasopharyngeal swab in viral transport media.

Please remove gown and gloves before exiting isolation room, and remove eye protection and mask after exiting isolation room, per CDC guidance. We recommend that intact masks be conserved by placing them in a personalized/labelled bag or container for use entering the same room. The goggles can be sani-wiped and are reusable.

Outpatient COVID-19 testing may be available at City Bay Urgent Care Clinic in Sunset and/or in an at home kit at Everywell. Please contact them for details. Neither entity is part of our organization and we cannot advise, comment or endorse their testing algorithms or accuracy.

ACE-Inhibitors and COVID-19

There has been some web based information circulating around the use of ACE-inhibitors and risks associated with COVID-19 that may concerning to some of your patients. Please see the attached memo and information sites. As always, we support control of blood pressure for hypertensive patients to decrease the risks of heart attack, stroke, and death.

Free Virtual Care Visits

Dignity Health is now offering free virtual care urgent care visits with a coupon code for patients experiencing mild to moderate symptoms of COVID-19. This service is also available to our employees and caregivers. We are encouraging anyone in our community who may need to visit a health care provider for any purpose to consider a virtual visit as an option.

To access a virtual care visit, go to www.dignityhealth.org/virtualcareanywhere, download the Virtual Care Anywhere app in the Apple App Store or Google Play Store, or call 855-356-8053 and use the coupon code COVID19.

NEW Resource

Our medical librarians across the organization have worked very hard to compile the most up-to-date resources in addition to linking our internal CommonSpirit Health Covid-19 documentation. This website is updated daily with evidence-based content from authoritative resources.

This URL is open-sourced – meaning it is available to our CHI providers, clinicians, and staff as long as they use the link below.

Dignity Health Libraries COVID-19 Portal

Infection Control Precautions (Updated): Use of Airborne Isolation for Select Scenarios

Evidence based guidelines demonstrate that SARS-CoV-2 is transmitted by droplets and that the droplets settle on surfaces. Therefore we recommend droplet and contact precautions with eye protection when seeing these patients and that you protect yourself with personal protective equipment (PPE). For COVID-19 precautions please use hand hygiene, gowns, gloves, a surgical mask and eye protection. For those present during aerosolizing procedures (eg intubations, bronchoscopies, aerosol treatments, etc.) please use an N-95 mask instead of a surgical mask and order/engage in these procedures only when in a negative pressure room. Note that not all COVID-19 confirmed or suspected COVID-19 patients need to be in a negative pressure room. They should all be in rooms with the door closed.

Note also that you may re-use your masks (surgical or N-95) when re-entering a patient room. Please put an intact mask in a lab specimen bag that is labelled with your name. Do not reuse masks room to room, from your pocket, or if damaged.

Elective Surgery Cases/Procedures

For cases that are emergent and cannot be safely delayed, remember to please email your Surgery review group: docvap@sbcglobal.net, robert.harveymd@gmail.com, cjkeys3421@gmail.com to review how and when best to proceed. Note that the city has now given us an Order to limit these surgeries and specified that on the occasion of a surgery requiring urgent scheduling we must:

  1. screen the patient for symptoms of COVID-19 on the phone prior to entry to the hospital, and
  2. we must proceed with a process that supports social distancing as much as possible.

N-95 Fit Testing for Airborne Precautions Masking

Please note that for COVID-19 isolation, the use of the standard surgical mask is part of the usual COVID-19 protection PPE, as above. However if you are performing aerosolizing procedures such as intubations, bronchoscopies, etc. you will need to use the N-95 masks for optimal protection. This would require that you meet with Employee Health for fit testing if you have not done so. You may call Joanna Torno, Employee Health Nurse, at 415-353-6472 to arrange. In addition if you recently failed N-95 fit testing Joanna has accessed a supply of alternatively sized N-95 masks and we ask that you represent to Joanna for repeat fit testing.

Telemedicine Options

Several MDs have inquired about telemedicine options. Remember that telemedicine is the use of any technology to support evaluation, diagnoses and treatment of patients and can be as simple as a telephone call, so some options are already in place. We are working with a few service lines on setting up iPad enabled consultations, prioritizing those services that would be needed for surge capacity and extending to other areas as able. If you have a specific need, please continue to advise the Medical Staff Office as we do anticipate opportunities to establish tele-options. CommonSpirit Health is anticipating nationwide access to a telemedicine option for outpatients seeking consultation in regards to COVID-19. We will provide specifics as it becomes available in the coming days. As you know, reimbursement for these services is ever changing.

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About Ahvie Herskowitz, MD

Dr. Herskowitz’s extensive training includes a medical degree from The Albert Einstein College of Medicine, residencies in Anatomic Pathology and Internal Medicine, and Fellowship training in Cardiology at The Johns Hopkins Medical Center. During his 12 years at Johns Hopkins, he became Associate Professor of Medicine and Immunology and Molecular Microbiology and led a research team in the study of molecular and immunological mechanisms of inflammation, autoimmunity, ischemia, heart transplantation rejection and congestive heart failure.

Dr. Herskowitz’s latest academic appointment was as Clinical Professor of Medicine at UC San Francisco. To learn more about Dr. Herskowitz, you can read it bio here.

      

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Any and all statements and opinions are provided for educational information and are not intended for medical diagnosis. As with all medical treatments and procedures, results may vary on an individual basis.

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Anatara Medicine & San Francisco Stem Cell Treatment Center  |  1700 California Street, Suite 520  |  San Francisco, CA 94109  |  P: 1 (888) 453-6825  |  F: (415) 345-0059