PITTSBURGH (KDKA) — When there isn’t enough medicine to go around, who gets it?

“It’s not easy to have to tell your patients or your patient’s family that you might not have enough drug for them,” Erin McCreary, an infectious diseases clinical pharmacist at UPMC Presbyterian Hospital, said.

The state Department of Health initially sent 1,200 doses of Remdesivir, an antiviral drug, to 51 hospitals across Pennsylvania. Today, it sent 1,548 doses to 21 hospitals, with 6,390 doses expected to be distributed to 58 hospitals on Monday. The state Department of Health says it received the doses from the federal government.

The only one in our area to get it was UPMC Presbyterian.

“The amount of drug we initially got allocated was enough drug for three patients, for each patient to have a five day treatment course,” said McCreary. “There was a study of 10 days as well, but based on our allocation, we will be giving five day treatment courses for right now.”

“Figuring out a five-day course of it is equal to a 10 day course of it, potentially, extends a limited resource,” Dr. John T. Sullivan, chief medical officer at St. Clair Hospital, said.

Which three patients will get the IV medication? A committee of ethicists, patient representatives, health system leaders and supply chain teams will identify patients similar to the ones in Remdesivir studies, and place them in the lottery.

“Patients should receive the drug within 12 days of symptom onset. Based on the mechanism of action of the drug, it seems to work better if patients get it earlier in the disease,” said McCreary.

As for which hospitals in Pittsburgh would get the drug, the state health department put together a formula taking into account the number of in-patients and the number of patients on ventilators.

The hospitals that didn’t get it are okay with that.

“It’s going to where the active cases are, so that was not surprising at all to us at St. Clair,” says Dr. Sullivan.

“Are you fortunate that you don’t have enough patients that you might need this, right?” says Dr. Nikita Bhanot, of AHN Infectious Diseases.

Other options for getting Remdesivir include clinical studies, and compassionate use for children and pregnant women.

The drug has emergency use authorization from the FDA, but it is not FDA approved yet for COVID-19.

The standard treatment is supportive – meaning that doctors keep vital systems operating with the equipment, medicines and procedures they have.

Besides Remdesivir, patients can get other study drugs, or, if available, convalescent plasma, and drugs to treat overwhelming inflammation.

No one knows when more Remdesivir will be coming.

“In order to allocate resources fairly, something that is very important to understand is your patient burden, and to know when resources are coming in,” says McCreary.

“You anticipate more production will happen and drugs will be available to other centers, too,” Dr. Bhanot added.

“It takes six months to manufacture, mostly due to acquiring raw materials,” Dr. Sullivan says.

An issue affecting the whole country.

For resources that don’t go to everyone, would hospitals share?

“If there was a spirit of sharing, we’d reach out and help each other,” Dr. Sullivan said.

Dr. Sullivan says there’s been no better environment for collaboration in healthcare than this pandemic crisis.

Link:  https://pittsburgh.cbslocal.com/2020/05/15/upmc-presbyterian-hospital-coronavirus-treatment-remdesivir-doses/

PITTSBURGH (KDKA) — Across the world and in the United States, there’s a gender pattern with coronavirus.

“Men are more likely to be hospitalized, get very sick with it and die of it,” says St. Clair Hospital Chief Medical Officer Dr. John T. Sullivan.

In Wuhan, China, up to two-thirds of hospitalized patients are male.

In Italy, nearly 60 percent are male.

Among 6,000 people hospitalized in New York City, 60 percent are male, with two out of every three in intensive care are male.

And the death rate is higher for males in every age group over 20 years old.

Nobody knows why, but when it comes to gender differences, it’s usually related to one of a few things.

“Genetic, hormonal, sociologic differences can explain things,” says Dr. Sullivan.

While American culture may take some time getting used to seeing and wearing face masks while out in public, it’s becoming more and more commonplace as the country anxiously tries to outlast COVID-19. Sewing masks has become a way for many people to do something to help others when it’s hard to know what exactly to do.

And just as people will customize just about anything from license plates to cell phone cases, masks are one way to show individual style and spread some cheer with cool designs during an uncertain time.

Sheila Shepherd, a cook with Cura (a member of the Elior North America family of companies) at St. Clair Hospital in Pittsburgh, is from a long line of skilled seamstresses. Her mother, grandmother and great-grandmother sewed every Halloween costume and prom dress in the family, she says: “We always had one of a kind.”

Now, she’s sewing one-of-a-kind protective face masks during a time when all the high school proms have been canceled. So far, she’s sewn more than 350 masks and counting for dining team members, hospital staff, family and friends. She charges $1.50, the cost of material, and donates her time. Her sister and nieces help with the project.

One of the toughest issues hospitals have faced during the COVID-19 pandemic is where to place patients — whether they’re COVID-19-positive or not — when they’re ready to leave the hospital but not ready to head home.

Most of the skilled nursing facilities where patients — most, but not all of them seniors — normally could be admitted would not take patients who were either COVID-19-positive or recovering from COVID-19 for fear of infecting their existing, vulnerable patients. They wouldn’t even take a non-COVID-19 patient unless the person had tested negative for the coronavirus twice in two days.

To try to address that and other issues related to post-acute care, case management leaders from the seven southwestern Pennsylvania health systems and hospitals organized a task force in late March to talk weekly and share best practices and common problems — a model based on one that the region’s hospitals’ chief medical officers had already formed early in March.

PITTSBURGH (KDKA) — There are new protocols in place if you are going to the hospital for surgery amid the coronavirus pandemic.

Larry Wirick needs a new heart valve. His operation was supposed to be in mid-March.

“Two days prior to my surgery, I got a call saying, ‘Canceled,’” Wirick said.

He wondered when, if ever, he’d have the procedure. Then the doctor’s office called back.

“It was going to be May 13. I felt relieved,” Wirick said.

So on May 7, a week out from surgery, he had preoperative bloodwork, a check-up and testing for coronavirus, in that order.

He also had to quarantine after being tested.

“We have to have a test close enough to the operation that they don’t get infected between the test and the date of the operation. But also, not so close to it that we don’t have the results,” says St. Clair Hospital Chief of Cardiac Surgery Dr. Andy Kiser. “I think it’s important for our patients to be tested because they’re at such high risk of having problems if they have the virus. And if they did, we could still take care of them, but at a higher level of caution. We are not just protecting the patient. We are protecting the people that take care of the patient. And there can be nine people in the heart room.”

Wirick lives with his wife and 21-year-old son and does not expect to test positive.

“We are not concerned because we know who he’s with. My wife and I, we are not around people. I wish we could go tomorrow for the surgery,” Wirick said.

Whether he tests positive or negative, Dr. Kaiser will still proceed with the surgery. He and his team will take precautions either way.

Link:  https://pittsburgh.cbslocal.com/2020/05/07/new-procedures-for-routine-surgeries/

In her more than 11 years as a registered nurse, Mary McFarland has never seen anything quite like what she and her nursing colleagues have to do to care for Covid-19 patients.

McFarland is a senior clinician at UPMC Presbyterian’s intensive care unit, usually an administrative job that oversees the ICU. But the unprecedented nature of Covid-19 has led to dramatic changes for McFarland and other nurses in the Pittsburgh region.

Changes to age-old nursing routines begin immediately upon entering a hospital, where every employee is screened for the early symptoms of the silent virus. At UPMC Presbyterian, an entire ICU has been set aside to treat the critically ill with Covid-19. And when in that ICU, where patients have struggled daily to breathe and to live, even the smallest move can be a matter of life and death for the caregivers themselves.

“It is a completely new set of skills,” said McFarland, who helps coordinate the nursing care and has worked directly with Covid-19 patients.

The importance of every step in the process has been amplified, from cleaning and hygiene regimens to the careful process of putting on and taking off the head-to-toe personal protective equipment that helps protect care providers from catching Covid-19. It impacts interactions with the patient, as well. There are specific steps that must be taken, all the time, to make sure everyone remains safe. UPMC has instituted a nurse-observer system, where specialists carefully monitor the donning and doffing of PPE.

“If only one step is forgotten or done out of order, it could put the nurse at risk for exposure, so it gives a level of extra comfort for the nurse observers to watch everyone who goes in and out of the room to keep everyone safe,” McFarland said.

‘Whole health care dynamic has changed’

McFarland and many other nurses are on the front lines of the war against Covid-19. And unlike the wars against infectious diseases of the past, this one has changed so many things about how nurses do their jobs.

The Pittsburgh region, with its relatively light level of Covid-19 patients, has thus far been spared the unimaginable crush of victims that marked New York City, New Orleans and Detroit, among others. But in the early days of the crisis, no one knew that would happen, and the hospitals couldn’t take the chance. And this has remade, at least temporarily, what it means to be a nurse.

“Over the past two months, the whole health care dynamic has changed,” said Diane L. Puccetti, chief nursing officer of St. Clair Hospital.

It’s not just having to don extra gear and being supercautious. Nurses, even those not directly dealing with Covid-19 patients, also are now navigating health care systems that have radically changed their operations.

Nonemergency procedures and surgeries were eliminated, taking with them a large bulk of the patients and the work (elective surgeries were just permitted by the state to resume last week). Visitors are banned in all but a handful of circumstances. Entrances are closed. Employees have to be screened and their temperatures taken before they are allowed to go to work. And some health care workers have been sent home for either exposure to or confirmed cases of Covid-19.

One of the major consequences has been a redeployment of nursing staff. With most operating rooms and other parts of the hospital temporarily paused, health systems and hospitals moved nurses to pressure points in the Covid-19 era: Working the entrances to screen employees, serving as roving nurses on floors they don’t usually work and filling in for ICU and step-down unit nurses who either take a meal or other break.

St. Clair Hospital this week resumed elective testing and diagnostic procedures for patients at its main campus and its Village Square Outpatient Center in Bethel Park. Elective surgeries will resume May 11.

The resumption of all medically necessary care follows guidance, issued by the Pennsylvania Secretary of Health April 27, that hospitals across the state can resume the performance of elective care while considering a “roadmap” issued by American Hospital Association in conjunction with several medical and nursing professional associations.

In a communication sent May 6, St. Clair recommended to its patients that essential medical care not be further delayed and outlined numerous actions the hospital is taking to keep its patients safe. Key among the actions is the use of screening and testing protocols developed by its clinical experts with guidance from the U.S. Centers for Disease Control and Prevention, as well as St. Clair’s clinical partner, Mayo Clinic.

Other key actions address steps to maintain a clean and safe environment, continued restrictions on visitors, promotion of social distancing and the use of masks and other personal protection equipment to safeguard patients and staff.

Also, as of May 4, St. Clair’s affiliated multispecialty group, St. Clair Medical Services, resumed providing routine in-office care, along with its continued use of telemedicine. St. Clair Medical Services has more than 130 physicians in the group, practicing at more than 35 sites across the South Hills. The offices likewise will have enhanced protections for returning patients.

By Harry Funk – Reporter, The Almanac

Link:  https://thealmanac.net/news/st-clair-hospital-resumes-elective-testing-procedures/article_8737096c-8fc8-11ea-a3d7-f7c73c55796f.html

There has been one unexpected bit of good news coming out of the Covid-19 crisis: Some of the health leaders at competing local health systems have been drawn closer together and are meeting more regularly to share ideas and talk about common issues.

That has happened with the chief medical officers, who have come together in the past two months as the Pittsburgh Area Regional Covid-19 Health Care Collaboration. And it’s also happening with the hospitals’ chief nursing officers, too.

The chief nursing officers are emailing constantly with one another and getting on calls once a week to work through issues that have arisen as the Covid-19 global pandemic swept into greater Pittsburgh.

The group that has arisen stemmed from the somewhat regular meetings of CNOs of the members of Bridges Health Partners, a Warrendale-based organization that includes Butler Health System, Excela Health, St. Clair Hospital and Washington Health System. Those meetings happened four times a year and usually included topics of interest, but they’ve become in recent months focused on how to deal with the nursing challenges surrounding Covid-19, said Mary Lou Murt, SVP and chief nursing officer of Monongahela Valley Hospital.

Now the top nursing executives of Allegheny Health Network and UPMC, who are not Bridges members, are taking part as well. The conversations began in the early days of the Covid-19 crisis as the lead nurses discussed how each hospital was screening employees, how they were staffing, how they were using and finding PPE and how they were ramping up for an expected surge. While the surge of Covid-19 patients hasn’t happened, the nurses have found plenty of other things to talk about: A recent call found the nursing officers talking about how their hospitals and health systems were preparing for the resumption of the surgeries and procedures that were postponed in the runup to Covid-19.

“We’ve really been able to share some ideas about how to best take care of patients and employees, and learn from each other’s successes and failures,” said Diane L. Puccetti, chief nursing officer of St. Clair Hospital in Mt. Lebanon.