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VUMC builds a service line around care of COVID-19 patients

May. 4, 2020, 12:06 PM

 

by Paul Govern

Care of COVID-19 patients has led to swift establishment of a COVID service line at Vanderbilt University Medical Center, complete with the institutional infrastructure, planning and multi-disciplinary coordination implied by the service line designation.

“This has arisen as a natural consequence of our continued focus on a unified team approach to COVID-19 care across adult inpatient and outpatient settings,” said the leader for the new service line, Shubhada Jagasia, MD, MMHC, chief of staff, Adult Hospital and Clinics.

On March 12, Vanderbilt University Adult Hospital received its first COVID-19 patient. Through April 29, the hospital had admitted 132 COVID-19 patients, 99 of those admitted had subsequently been discharged, and nine patients had died.

“Watching this team put together plans for COVID patients across every care setting — outpatient, ED, inpatient and hopefully back to home — has been nothing short of spectacular,” said Shon Dwyer, MBA, RN, who arrived in early March as the new president of VUAH. “They have moved very quickly from high level concepts to nitty gritty, well implemented details. This has resulted in excellent quality of care with a focus on ensuring a high level of compassion for our patients and families.”

Concurrent with implementation of a COVID service line, VUMC has been preparing for a phased resumption of elective clinical services (consistent with Nashville Mayor John Cooper’s phased plan to reopen non-essential businesses in the city). According to Jagasia, VUMC developed a service line for COVID in large part to support safe care for non-COVID inpatients.

“As we resume normal operations in the adult hospital, we’ll continue to receive COVID-19 patients for some time to come,” Jagasia said. “With a focus on safety and infection prevention, we’ll continue to cohort the care of these patients, such that those clinicians and teams serving them will, as best as possible, not be interacting with patients served in other hospital areas. A service line structure helps support this level of cohorting.”

By March 20, a COVID-only unit had opened in MCE8, a 37-bed unit in Medical Center East that’s designed to accommodate patients from across the acuity spectrum, from stable to critically ill.

“Our hospitalists, ICU teams, and nurses deserve a huge amount of credit for supporting this work and providing exceptional, safe care to these patients,” said Bryan Harris, MD, MPH, co-medical director for the medicine patient care center and associate hospital epidemiologist. “Having dedicated teams allows them to develop true expertise in the clinical care of COVID-19, a disease about which we’re all still learning.”

With the arrival of COVID-19 in Middle Tennessee, VUMC implemented a coordinated strategy for managing patients isolated at home with the disease, involving Vanderbilt Medical Group clinicians and their teams, Population Health care coordinators, nurse practitioners from Vanderbilt Health OnCall and nurses from Vanderbilt Home Health.

All MCE8 patient rooms have been assigned tablet computers: inpatient telemedicine is helping teams preserve personal protective equipment and keep COVID inpatients and their families well informed.

Adult inpatients suspected of having COVID-19 and awaiting test results are admitted to a designated area of the hospital’s observation unit.

If MCE8 should fill up, a plan sets out which VUAH units would next receive COVID-19 patients.

“With our predictive modeling team, we’re constantly monitoring the number of new cases in the community and the number of patients requiring hospitalization. This will help the service line to be nimble and adapt to meet the demands of managing our patients,” Jagasia said.

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