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Yale Department of Internal Medicine's Response to COVID-19

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Yale Department of Internal Medicine's Response to COVID-19 ONE TEAM Yale Department of Internal Medicine’s Response to COVID-19 Contents 4 Message from the Chair 6 Timeline 8 COVID by the Numbers 10 Clinical Care during COVID-19 32 Research 40 Education 52 Finance and Administration 53 Faculty Affairs 54 Other Programs 56 Philanthropy 60 Department Leadership 64 Afterword Front cover: (L-R) Onyema Ogbuagu, MBBCh; Lynn Tanoue, MD, MBA; Will Cushing, PA-C. Back cover: (L-R) Manisha Juthani, MD; Jonathan Siner, MD; Marcella Nunez-Smith, MD, MHS Message from the Chair “ Our department’s story is one of teamwork, collegiality, altruism, optimism, courage, and strength. ” — gary v. desir, md 4 annual report 2020 The challenges of the COVID-19 pandemic have tested the resolve of our clinicians, educators, researchers, trainees, and staff. Along with the many challenges, we shared stories of teamwork, collegiality, altruism, optimism, courage, and strength. We were inspired by the bravery of our clinicians and nursing partners who rushed into patients’ rooms to perform chest compressions without hesitation. We applauded the house staff and the hospitalists who showed tremendous flexibility as we reorganized care pathways. We mourned with family members who had lost loved ones. We rallied to collect personal protective equipment and donations of medications for at-risk patients; to meet new technological challenges; and to do what was best for our patients. Many of these tasks could not have been completed without the support of our nursing colleagues, housekeeping, environmental health and safety, engineering, information technology services, food services, and other partners across the Yale University, Yale New Haven Health, and the New Haven community. This report focuses on the Department of Internal Medicine’s response to the first wave of the COVID pandemic. It uses contemporaneous notes to provide a historical record of how the department reorganized its resources to care for its patients and its people; to educate; and to contribute to the understanding and treatment of a new disease. It also seeks to capture our emotions and the emergence of a deeper understanding of teamwork. In October, the second wave of the COVID-19 pandemic began, and again we are being tested. And we remain committed to our missions and core values. Sincerely, Gary V. Desir, MD Paul B. Beeson Professor of Medicine Vice Provost for Faculty Development and Diversity Chair, Internal Medicine, Yale School of Medicine Chief, Internal Medicine, Yale New Haven Hospital department of internal medicine 5 Department in-person Timeline: meetings and Medical Grand Rounds cancelled. Daily department survey A closer look at 2020 started. Department-wide meeting held to discuss coronavirus science, and Vital COVID Stats United States VACHS started epidemiology; trajectory First positive declared active screening of outbreaks in China, COVID-19 case public health at main hospital Europe, Seattle, and New reported at emergency. entrance. York; and Department Yale New Haven preparations for inevitable Hospital (YNHH). outbreak in CT. 5 31 8 913 1411 16 1918 20 21 23 24 25 26 30 JANUARY MIDFEBRUARYMARCH World Health Organization Daily department Human subject research announced the emergence leadership calls paused where possible. of pneumonia of unknown Department began. First palliative Virology Lab started cause in Wuhan, China. planning began. care guideline issued. in-house testing. More YNHH units became Yale New More than 34,000 Virtual Medical Grand COVID-19 restricted Haven Health outpatient telehealth Rounds held: “COVID-19 units. Bereavement program (YNHHS) visits conducted Clinical Management at launched for COVID-19- dashboard between YNHHS Yale: What We’ve Learned positive deaths. Decompression went live. physicians and patients. So Far.” 1375 participants huddles began for ICU staff. attended the call. PASSOVER 3 7 8 9 10 12 13 15 21 23 27 29 30 18 22 APRIL EASTER MAY Palliative Care and Geriatrics began Critical care triage consult triggers to policy for COVID-19- address goals Communications positive patients of care. Meals4Healers scripts and training and resuscitation project started. released to clinicians. policy distributed. Activation of daytime YNHH reached lowest Yale School of Medicine (YSM) YNHH Tele-ICU in Westerly and number of COVID-19 positive and YNHH announced the start officially Greenwich Hospitals. patients since pandemic of Phase 3 of the Pfizer vaccine terminated began, at 6 patients. trial. YSM announced the COVID Code D. Gap Funding initiative in support of junior investigators. 4 11 9 17 21 24 6 9 24 30 JUNE AUGUST SEPTEMBER OCTOBER NOVEMBER Virtual Medical Grand Rounds held: fourth annual “Stories of Yale Internal Medicine.” 6 annual report 2020 Vital COVID Stats First positive NP-15 emptied with Residency New rounding practices Blood drives National Doctors’ Day. COVID-19 case its patients moved to Match Day announced. Firm started in Task force created to reported at EP 6-5. All noncritical First COVID-19 restructuring began. conjunction address burnout. Yale New Haven research suspended. positive patient YSM released first with the Hospital (YNHH). was admitted list of COVID-19 American onto NP-15. research projects. Red Cross. 5 31 8 9 141113 16 1918 20 21 23 24 25 26 30 JANUARY MIDFEBRUARYMARCH Staff began to work from home. Conversion of patient appointments to telehealth began. YNHH leaders declared One-year term extension Global Health webinar a Code D (disaster) NP-12 and announced for assistant First patient held: “COVID-19 and activated the Hospital NP-14 moved and associate professors in died from COVID- Update: Caring While Incident Command to SRC. specific tracks. related causes. Keeping Safe.” Structure (HICS). Virtual Medical Grand YNHHS discharged YNHHS discharges 2,500th COVID-19 SCU moved Rounds held: “COVID-19 1,500th COVID-19 patient from Greenwich Hospital. YNHHS to NP-12. Clinical Management at patient from Yale announces its laboratories performed Yale: What We’ve Learned New Haven Hospital. almost 15,000 COVID tests with 95% So Far.” 1375 participants being resulted within 24 hours. attended the call. 3 7 8 9 10 12 13 15 21 23 27 29 30 18 22 APRIL MAY Critical care triage policy for COVID-19- YNHH COVID-19 positive positive patients inpatients peaked at 450. Medical Grand Rounds and resuscitation YNHHS COVID-19 positive Supportive Care Unit held virtually: “Critical Care policy distributed. inpatients peaked at 638. (SCU) set up on NP-4. in COVID-19 Patients.” YNHH YNHHS moved into YSM clinicians, researchers, and educators officially mitigation phase. sent an open letter to Connecticut Governor terminated Ned Lamont explaining the impact that the Code D. current COVID surge had on health care systems in the state, and urging the governor to enact more restrictive measures. 4 11 9 17 21 24 6 9 24 30 JUNE AUGUST SEPTEMBER OCTOBER NOVEMBER Marcella Nunez-Smith, MD, MHS, Department physicians was named as co-chair of President- met with Governor Lamont elect Joe Biden’s COVID-19 and Department of Public Second wave Transition Advisory Board. YNHH Health Commissioner Deidre of pandemic began. returned to Code D status. Gifford, MD, MPH. department of internal medicine 7 COVID-19 Number of volunteers from across by the Numbers YaleNumber School of volunteersof Medicine from (residents, across fellows, faculty) Yale School of Medicine (residents, fellows, faculty) + 177Residents+ + Fellows 1Physicians00 Yale New Haven Hospital: 177Residents + Fellows 1Physicians00 Yale NewCumulative Haven COVID Hospital: admission (since 31420123120) Cumulative COVID admission 4,1064,106(since 31420123120) * 439 72,154* Total Deaths 72,154 439 Number of Number of phone and video visits Total Deaths Numbersta of working Number of phone and video visits 3,570Total Discharges sta workingfrom home 3,570Total Discharges from home * 300* + 300+ * Does not include Medical Oncology and Hematology * Does not include Medical Oncology and Hematology Yale New Haven Health: Yale NewCumulative Haven COVID Health: admission Cumulative(since COVID 31420123120) admission 8,0178,017(since 31420123120) 70++ Number70 of emergency credentials Amount of research funding Number of emergencyissued for Medicine credentials service Amount of dedicatedresearch funding to COVID19 836 issued for Medicine service dedicated to COVID19 836Total Deaths Total Deaths 6,939Total Discharges + 6,939Total Discharges $10M$10M+ These numbers do not reflect those who remain hospitalized as of 123120. These numbers do not reflect those who remain hospitalized as of 123120. 8 annual report 2020 Department Statistics Number of volunteers from across Yale School of Medicine (residents, fellows, faculty) + 177Residents + Fellows 1Physicians00 Yale New Haven Hospital: Cumulative COVID admission 4,106 (since 31420123120) * 439 72,154 Total Deaths Number of Number of phone and video visits sta working 3,570Total Discharges from home 300+* * Does not include Medical Oncology and Hematology Yale New Haven Health: Cumulative COVID admission 8,017 (since 31420123120) 70+ Number of emergency credentials Amount of research funding 836 issued for Medicine service dedicated to COVID19 Total Deaths 6,939Total Discharges $10M+ These numbers do not reflect those who remain hospitalized as of 123120. department of internal medicine 9 CLINICAL CARE DURING COVID-19 In February 2020, Department Chair Gary V. Desir, MD, and Vice Chair of Clinical Affairs Lynn Tanoue, MD, MBA, began hearing from colleagues at the University of Washington in Seattle
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