HENRY FORD COVID-19 UPDATES
Henry Ford Health System COVID-19 Information
IMPORTANT DOCUMENTS
HFH ICU COVID-19 Updates June 12 2020
Oxygen type and mask choice (COVID)_Final
COVID19 Response Team/Provider Team Resource Sheet
Employee Health COVID-19 Health Care Worker Policy Workflow
RESEARCH
As of 04/20/2020, HFH will begin enrolling in both the PREFACE and ACADEMiCC trials.
The attached documents outline inclusion and exclusion criteria.
Please contact the study research coordinators or Sara Hegab with any potential candidates.
Jackie Day 16-1254. After hours 734-673-5961
Sheri Renaud 16-1791. Cell: 519-984-2360
Roel Almario 16-3558 Cell: 586-383-3558
Sara Hegab 313-492-2210
Prevention of Respiratory Failure Addressing COVID (PREFACE trial)
Anti-Coagulation for ARDS Disruption Emerging in COVID-19 Care (ACADEMiCC Trial)
ICU/GPU MANAGEMENT DOCUMENTS
COVID Intubation & Airway Management Protocol
COVID Management Guideline Version 03.27.2020
Covid-19 ICU Patient End of Life FAQs Final
COVID-19 Guidelines – Maintaining and Discontinuing Isolation
COVID team checklists and tips
COVID Confirmed Case Management Workflow 3-24-20
N95 Respirator Guidelines for COVID patients
COVID-19 Oxygen Requirements at Henry Ford Hospital for patients and care units
COVID RESOURCE UTILIZATION DOCUMENTS
HFH COVID Resource Utilization Guidelines
Changing Code status talking points 4.3_
Covid Withdrawal of Mechanical Ventilation
Comfort Care Withdrawal at End of Life COVID 19
mSOFA for Patient Triage Inpatient Providers
Correlation of MSOFA Total Score and Hospital Mortality
Downtime Resp Distress Observation Scale document
PERSONAL EQUIPMENT (PPE)
PPE recommendations are Droplet Plus (surgical mask, eye protection, gown and gloves); however, N-95 masks should continue be worn for all aerosol-generating procedures including intubation, extubation, open airway suctioning, bronchoscopy, tracheostomy and trach care, chest physiotherapy and nebulizing therapy. Continue to wear N-95 masks for patients on BiPAP or high flow. Patients need to be in a room with a closed door.
- There is the introduction of New Blue Isolation Gowns on 4/9/2020
- Henry Ford Hospital Guidelines for the use of PPE
- Donning and doffing signage/instructions is posted in all PUI rooms. PPE video for COVID-19: https://youtu.be/bG6zISnenPg
- Cardiac arrest guidelines (adapted from IM) for ICU COVID positive patients are listed in a separate post.
MEDICATION GUIDELINES AND INFO
Henry Ford Hospital COVID 19 Treatment Drug Information Quick Sheet 3_31_2020
Hydroxychloroquine and Chloroquine FAQs
RESOURCES
Renal effects of COVID (this document has undergone peer review)
–Examples of subjects addressed include ACE-2, histopathology, filter clotting on RRT, initiation of RRT, and home dialysis.
http://www.nephjc.com/news/covidaki
Covid and RAAS (NEJM 2020-03-30)
LOCATION
Please refer to the COVID update document to see where patients are currently being ruled out/treated
- PH patients on vasoactive infusions will continue to be housed in MICU pod 3.
- Given positive COVID patients in several units, lung transplant patients are now being cohorted in MICU pod 5 (6N) to the extent there is private room bed availability.
- The State of Michigan has asked all facilities to keep patients where they all and Henry Ford Hospital is only accepting transfers that are true level of care situations for COVID patients. HFH is not accepting outside patients with COVID for ECMO. During this time of high patient capacity, we will continue to accept non-COVID outside transfers for level of care if we can add value. MICU fellows who receive a request for a transfer in which we likely can offer no value should discuss this with the ICU staff on call and the decision can be made to decline the transfer.
- The governor’s mandate limiting hospital visitors remains in effect and no visitors are allowed for ICU patients with the following exceptions: 1 visitor is allowed at the bedside of minors in the MICU and 4 visitors are allowed to be at the bedside of a hospice/comfort care patient or critical/actively dying patient. All visitors need to be screened for COVID 19.
PROCEDURES
There is an ICU Procedure team available to aid with usual ICU procedures. The protocol is here
Bronchoscopies, sputum induction and open suctioning should be avoided until COVID is ruled out.
If a bronchoscopy is needed for something life threatening, Interventional Pulmonary should be consulted and will discuss the indication with the attending staff.
Per Dr. Simoff, if you find yourself in a position that you must do a bronch and IP is not immediately available please follow the following recommendations on anyone on a vent:
- Paralyze patient first (adjust vent before if needed)
- FiO2 to 100%
- Place ventilator on standby while still connected to the system. Wait for exhalation to complete. Then and only then disconnect, this will greatly reduce the risk of exposure.
- Perform procedure, if needed, reconnect to give several breaths for oxygenation. Then repeat 3.
Intubations should be done with rapid sequence intubation (RSI) and therefore, COVID positive patients or COVID PUIs requiring intubation should all have intubation performed by anesthesia. RSI without bag-mask ventilation is recommended. During the apneic period, a bag-valve-mask with a PEEP valve can be passively held on the patient’s face to maintain positive pressure. The CDC recommends attaching a viral filter if available to the bag-valve mask before the procedure if available. Patients being ruled out for COVID or those positive for COVID who require intubation should NOT have routine chest x-rays done post intubation.
Tracheostomy: There is a Tier 1- Tracheostomy Guidelines During COVID-19 available
OTHER IMPORTANT FACTS
- Limit the number of number of HCP exposure by having the same resident/APP, fellow and staff in a given unit enter the room together on rounds. Remainder of resident or APP team should not enter the room. Medical students should not take care of these patients and should not enter the room.
- Healthcare workers who take care of a COVID-19 positive patient need to take and document their temperature twice daily.