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GEDC Webinar "Transitions Between Nursing Homes and EDs in the Age of COVID-19" - Shared screen with speaker view
Ula Hwang
28:54
@theGEDC
Ula Hwang
30:29
New York, NY
maaret castren
30:33
Finland, ED
Cindy Zimmerman
30:36
Indianapolis, IN
Andrea Garcia
30:38
Grand Island NE VA Medical Center
DEBORAH DUNCAN
30:43
Louisvillle KY VA medical center outpatient clinic
Linda Taylor
30:44
Hi from Thunder Bay, LTC there are 5 of us. We would like to know how best to transfer residents in
Carlomagno G. Almonte
30:53
VA Northern California
Carla Lenton
31:00
Nursing home, Manitoba Canada - general information
Stacey Kitz
31:01
Brandon MB, ER chief and COVID lead
Joseph Barchak
31:02
Joplin, MO VA CBOC
Poonam Jain
31:06
Poonam Jain - Saint Louis VA Medical Center
Joanna Hill
31:09
port Colborne Ontario LTC
Brandy Stadnyk
31:12
Winnipeg, MB; long term care-hybrid health centre
Sethany Thomas
31:13
Home and Community with VA Medical Center in New Orleans,La.
Bruce McTurk
31:30
Barrie Ontario Nursing Home
Don Melady
38:19
Kathleen, Have there been challenges in getting a sufficient supply of PPE for all your staff? How did you navigate that?
Ula Hwang
38:27
atypical presentations for older adults with COVID
Ula Hwang
40:26
PPE considerations for use by NH staff, plans for testing of patients (entire wings and staff (don't forget housekeeping), for isolation and cohorting of covid+ NH patients
Ula Hwang
41:32
Best practice tip: Whenever having a LTC patient test positive, have a line open for NH staff to answer questions and answers to improve communication and allay anxieties
Adam Perry
42:53
https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e1.htm
Ula Hwang
43:33
Innovative patient monitoring ideas include using video monitors in NH patient rooms if they need to be placed in room requiring doors closed.
Andrea Garcia
43:37
Are you seeing nursing facilities asking for a negative COVID test prior to admission from a hospital, regardless of respiratory problems/COVID symptoms in their immediate health history?
Adam Perry
44:11
MMWR APRIL 3RD 2020 - 57% of + NH residents were presymptomatic at time of + test
Don Melady
44:15
If you’re posting in the Chat Box please ensure you have selected “All panelists AND attendees”
Mike Wasserman
44:32
one negative test has a 30% False negative rate, two negatives, 10%, abundance of caution needed
Ula Hwang
45:49
https://www.optimistic-care.org/probari/covid-19-resources for key information for NH facility staff about advanced care planning discussions during a crisis
Mike Wasserman
46:47
Long Term Care Quadruple Aim for COVID-19 Response, www.caltcm.org/covid-19
Bruce McTurk
46:54
when is a negative test not truly neg?
Chris Carpenter
46:57
Question: How should ED providers balance recommendations for Advanced Directives (and efforts to find/interpret them) with series of TRIAD studies demonstrating inability for multiple levels of emergency medicine providers to accurately and reliably interpret them (see http://pmid.us/17214023 + http://pmid.us/17976563 + http://pmid.us/19157750 + http://pmid.us/22100496 + http://pmid.us/25692502)?
Hugh Boyd
47:50
From Post-acute hospital & LTC - Guelph & Hamilton, Ontario.
Chris Carpenter
47:52
Question: What can ED’s within hospitals without any Palliative Care programs or interest do during COVID-19 to ease patient suffering? In other words, what feasible Palliative Care approaches for non-Palliative Care trained individuals exist?
Mike Wasserman
48:00
Long Term Care Quadruple Aim for COVID-19 Response, www.caltcm.org/covid-19
Bruce McTurk
48:54
does testing negative change management?
Eugene Ginchereau
48:59
Gene Ginchereau, Pittsburgh VA Health System
cathy leone
49:17
Our nursing home requires a negative COVID-19 result prior to transfer from any setting to our nursing home, due to pre-symptomatic conditions, no matter what their diagnoses. In our state a resident was transferred to the NH from a hospital for a fracture hip repair, and that nursing home now has 30+ positive cases, as well as staff, and many deaths. We will not take that chance.
Chris Carpenter
50:21
Question: The Journal of Geriatric Emergency Medicine review describing “Nursing Home Transfers” emphasizes the importance of shared decision making with LTCF patients and families prior to ED transfer. What prognostic models/instruments exist to guide shared decision-making discussions with family - preferably adjusted for health literacy levels and cognitive impairment. In other words, which patients are more likely to survive? Early reports from northern California indicate a 50% extubation rate for those (of all ages) who were intubated, whereas Italy (cited in the JGEM review) reported 80% never able to extubatne. Why the large difference?
Mike Wasserman
50:22
Cathy, you are correct. That’s why I’ll be speaking about COVID19 positive facilities
PRAVINSAGAR MEHTA
51:02
Nobody picks up phones
Michelle Moccia
51:23
Bravo for emphasizing the importance of knowing the type of facility and their capabilities. Create a directory of the facilities that use your ED as their 911 care provider and hyperlink their capabilities. Consider color code example: green "independent"; yellow "assisted living" and red "skilled" etc.
Ula Hwang
52:05
Awesome tip Michelle!
Don Melady
53:14
Lisa — please change your setting to ATTENDEES. That message came only to me!
Nicole Bolton
53:16
one thing we lack in our emergency room is the skilled nursing home facility or assisted living's staff calling the ER to give us report
Ula Hwang
53:18
Hi Lisa, add panelist and attendees to your chat
Lisa Kummer
53:56
Michelle great ideas, shared from Sioux Falls, South Dakota VA
Ula Hwang
54:22
Ideal best practices pre-COVID and during COVID is good two-way communication between NH and ED
Ula Hwang
55:04
https://www.vitaltalk.org
Michelle Moccia
55:27
Consider reaching out to the skilled and assisted living and discuss why the "warm handoff" is beneficial for their resident. Give them examples of a great and poor handoff. When they do call, make sure you acknowledge this win.
Ula Hwang
55:40
https://www.capc.org for good examples of communication dialogues around goals of care with COVID
Michelle Moccia
56:20
Vital talk tips is an app. Free! Check out the OOPS conversation tips. I think we have all had an OOPS
Conor Sullivan
56:48
Webinar Resources: Here is the URL for the Geriatric Emergency Department’s website https://gedcollaborative.com/ Check out COVID Resources on the GEDC website later today. https://gedcollaborative.com/resources/ where you will be able to find the presentation slides upon conclusion of today’s webinar.
Conor Sullivan
58:02
Dr. Perryhttps://emottawablog.com/2020/03/end-of-life-care-in-the-ed-related-to-covid-19/End-of-life care in the Emergency Department for the patient imminently dying of a highly transmissible acute respiratory infection (such as COVID-19). The EMOTTAWA link describes an excellent protocol.CAPChttps://www.capc.org/Dr. Unroehttps://www.optimistic-care.org/probari/covid-19-resources/Advance Care Planning During a Crisis – Key information for nursing facility staff
Andrea Garcia
59:35
Thank you for this discussion!
Lisa Kummer
01:00:17
Thank you, great information!
Conor Sullivan
01:00:39
Dear Colleagues, Thank you for participating in the Geriatric Emergency Department Collaborative’s webinar GEDC Webinar "Transitions Between Nursing Homes and EDs in the Age of COVID-19"Webinar Resources: Here is the URL for the Geriatric Emergency Department’s website https://gedcollaborative.com/ Check out COVID Resources on the GEDC website later today. https://gedcollaborative.com/resources/ where you will be able to find the presentation slides upon conclusion of today’s webinar.Dr. Aghahttps://www.westhealth.org/covid-19-resource-center/Outstanding resources at West Health’s Covid resource page with full implementation manual and toolkits for EDs and PALTCs.
Ula Hwang
01:00:41
Shoutout to Michelle Moccia at St. Mary's in Michigan for daily huddles on how to improve communication between ED and NH care. Scroll up for some innovative tips she has given
Chris Carpenter
01:01:05
Question: For large urban areas with 50 (or more) LTCF’s each with their own leadership and none of which coordinate or communicate with one another, which LTCF should Geriatric ED leaders target for communication recommended by Dr. Malady? We certainly cannot have dozens of conversations with different leaders generating different protocols, priorities, transfer forms, and procedures?
Kevin Biese
01:03:08
Good question Chris. In most cases, the SNFs have referral practice patterns - which means that a relatively limited number of SNFs send the ED the majority of patients that ED receives from SNFs. Ie - reach out to the ones that send you the most patients first.
Mike Wasserman
01:03:47
I would strongly urge connecting with your state’s AMDA (Society for Post Acute and Long Term Care Medicine) chapter
Mike Wasserman
01:04:04
Also, connect with your state’s QIN-QIO
Kathleen Unroe
01:04:09
Also trade organizations for nursing homes (AHCA and LeadingAge chapters) can be excellent vehicles to disseminate best practices/information across facilities.
Chris Carpenter
01:04:15
What is QIN-QIO?
Mike Wasserman
01:04:33
Quality Improvement Organization
Chris Carpenter
01:04:50
Have the national, regional or state AHCA and LeadingAge chapters disseminated the JGEM article and webinar?
Kathleen Unroe
01:05:22
in addition to protocols, etc, warm hand off/phone calls are still needed for each patient, particularly now
Michelle Moccia
01:06:00
We are hosting daily huddles at 07:30 with the facilities who use us as their 911 care provider. 34+. We start the huddle with the update on our numbers of COVID-19 positive. We let them know the number of patients needing placement. We ask them to report out if their PPE is adequate, are they have challenges in staffing, their ability to take COVID-19 patients and any problem they are experiencing. We distribute supplies and/or we discuss with others who may help. We have one hour weekly calls with our ED Leadership and CMO, Infection Control Officers to help field questions, alleviate concerns, connect them with resoureces - powerful sharing. We have set up COVID-19 swab test kits too for them to use. We are working with a facility setting up a COVID-19 wing. We hosted our first Medical Director meeting :Sharing Care Strategies for the most vulnerable during the COVID-19 pandemic". Encourage the Med Dir. of facility to notify the ED physician prior to transfer "forward triage"
Kathleen Unroe
01:07:20
THANK YOU Michelle for providing real support to nursing facilities in your region - willingness to communicate and facilitate access to PPE, etc!
jane carmody
01:08:51
Michelle! wow. great info Also, in my health system days... looked at the discharge data ... started communicating with those facilities with highest numbers of the health system's patients
Alice Bonner
01:09:34
http://www.ihi.org/Topics/COVID-19/Pages/COVID-19-Care-of-Older-Adults.aspx This IHI webpage on COVID-19 and Older Adults is updated every 1-2 weeks. Age Friendly Health System work now includes a focus on COVID-19.
Carlomagno G. Almonte
01:10:04
https://www.voanews.com/silicon-valley-technology/us-military-government-workers-still-use-zoom-despite-fbi-warning
Mike Wasserman
01:10:08
Never too late!
Michelle Moccia
01:10:15
Most facilities want to work with their local ED and hospital. They are waiting for an invitation.
Lisa Kummer
01:10:58
thank you!
Kevin Biese
01:11:42
West Health tele health guide: www.westhealth.org/resource/telehealth-paltc-guide
terry fulmer
01:11:59
please check the JAHF website for our NH plans
Michelle Moccia
01:12:41
Thank you for the all the websites
Zia Agha
01:13:22
West Health Covid resources link
Kevin Biese
01:13:37
West Health SNF ED tele health implementation toolkits www.westhealth.org/covid-19-resource-center
Don Melady
01:14:08
Great point about maintaining the health of the staff — both for keeping them healthy AND for protecting the residents.
catherine eberle
01:14:20
JAHF is the John A Hartford Foundation
Zia Agha
01:14:33
https://www.westhealth.org/covid-19-resource-center/
Kathleen Unroe
01:15:23
NHs are required by CMS to have an "infection preventionist" on staff however the person with this responsibility may wear multiple hats; Dr. Wasserman advocating for these to be full time positions.
sarit gutmann
01:15:36
can you please share direct link to slides in this chat box. Thank you
Don Melady
01:15:43
Terry — could you copy and paste the JAHF URL into the chat — the best way for people to access it.
Andrea Garcia
01:15:50
Watching from a hot spot; nursing home staff and residents definitely starting to feel the stress.
Lisa Kummer
01:15:57
WE are just going through the curve now, Sioux Falls, South Dakota... this is very helpful.
Ula Hwang
01:16:12
Slides and a recording of this presentation will be available after the session is complete. Please check back on the GEDC website for these.
Lisa Kummer
01:16:23
Thank you Ula!
Don Melady
01:16:31
Marcus — please send that post to ALL ATTENDEES
Chris Carpenter
01:16:56
GEDC website is https://gedcollaborative.com/
Marcus Escobedo
01:17:26
Thanks Catherine. And here are two links for JAHF/The John A. Hartford Foundation on nursing homes that Dr. Fulmer referencedResources: https://www.johnahartford.org/dissemination-center/view/nursing-home-long-term-care-resources and Blog post: https://www.johnahartford.org/blog/view/nursing-homes-in-the-time-of-covid-19-we-need-urgent-action-now-and-a-long-term-strategy
Kevin Biese
01:17:58
Check out https://gedcollaborative.com for the slides and many other tools for ED clinicians caring for older adults during COVID
jane carmody
01:18:20
NHs are required by CMS to have an "infection preventionist" on staff however the person with this responsibility may wear multiple hats; Dr. Wasserman advocating for these to be full time positions. Great way for health systems to share their resources and expertise, infection preventionists
Lisa Kummer
01:21:00
thank you
Conor Sullivan
01:21:49
Dr. Steinberghttps://www.speakupontario.ca/http://www.goalsofcaremodule.com/Vital Talkhttps://www.vitaltalk.org/guides/covid-19-communication-skills/?referringSource=articleShareSerious Illness Conversation (SIC)https://bc-cpc.ca/cpc/category/sic/
Ula Hwang
01:21:57
For Mike Wasserman's NH Covid units, staffing includes:StaffingVolunteers<Age 65No diabetes/heart disease/or lung diseaseNo immunocompromising conditionsAntibody evidence of previous COVID-19 immunity (eventually)Willingness to stay in hotel (and willingness not work anywhere else for the duration of duties)
Michelle Moccia
01:22:34
Work also with your EMS to help you identify concerns they have when they go into a facility eg. lack of PPE; incorrectly using PPE. Not punitive but helpful so you can all work together to improve education and strategies to reduce the spread.
Don Melady
01:23:12
Speak Up Ontario website
Don Melady
01:23:53
https://www.speakupontario.ca
Ken Boockvar
01:24:44
Helpful guide for NHs to simplify medication regimens to reduce staff exposure to COVID and time administering medicines from Lamy center and US Deprescribing Research Network: https://www.pharmacy.umaryland.edu/PALTC-COVID19-MedOpt
Adam Perry
01:25:15
An initial step in collaboration is to let referring facilities know that the ED prioritizes communication with NH providers by assigning a single point of contact, such as a phone line to an ED provider or transition coordinator.
Ula Hwang
01:26:43
SDM - Shared Decision Maker
Ula Hwang
01:26:57
Surrogate Decision Maker
Michelle Moccia
01:27:36
Great tip Adam!
Conor Sullivan
01:28:12
Dr. Steinberghttps://www.speakupontario.ca/http://www.goalsofcaremodule.com/
Todd James
01:28:24
Thank you everyone!
Kevin Biese
01:28:29
What a great webinar - thank you all!!
Chris Carpenter
01:28:34
Excellent job by all of the speakers! Thank you - thank you - thank you!
Conor Sullivan
01:28:41
Dear Colleagues, Thank you for participating in the Geriatric Emergency Department Collaborative’s Webinar, "Transitions Between Nursing Homes and EDs in the Age of COVID-19"Some Post-webinar Resources: Here is the URL for the Geriatric Emergency Department’s website https://gedcollaborative.com/ Check out COVID Resources on the GEDC website later today. https://gedcollaborative.com/resources/ where you will be able to find the presentation and slides upon conclusion of today’s webinar.Dr. Agha - West Healthhttps://www.westhealth.org/covid-19-resource-center/Outstanding resources at West Health’s COVID resource page with full implementation manual and toolkits for EDs and PALTCs.Dr. Perryhttps://emottawablog.com/2020/03/end-of-life-care-in-the-ed-related-to-covid-19/End-of-life care in the Emergency Department for the patient imminently dying of a highly transmissible acute respiratory infection (such as COVID-19).CAPChttps://www.capc.org/Dr. Unroehttps://www.optimistic-care.org/probari/covi
Carlomagno G. Almonte
01:28:51
How do we get the CEU?
Libby Hoy
01:29:24
Thank you!
Conor Sullivan
01:29:29
Dr. Steinberghttps://www.speakupontario.ca/http://www.goalsofcaremodule.com/Vital Talkhttps://www.vitaltalk.org/guides/covid-19-communication-skills/?referringSource=articleShareSerious Illness Conversation (SIC)https://bc-cpc.ca/cpc/category/sic/
Ula Hwang
01:29:30
May 11 3p EST next webinar
Jennifer Porth
01:29:34
Great presentation! Thanks!
John Schumacher
01:29:35
Thanks. Great information
Charles Graffeo
01:29:45
Thanks!
Ula Hwang
01:29:45
Thank you speakers!!
Andrea Garcia
01:29:48
Thank you all, great information!
Sethany Thomas
01:29:52
From Sethany Johnson RN at VA Medical Center in New Orleans, La. Very informative!!!
Conor Sullivan
01:29:55
More COVID/GED related resources:SCCM Surviving Sepsis Campaign COVID-19 Guidelines.https://www.sccm.org/disasterBMJ Best Practice.https://bestpractice.bmj.com/topics/en-us/3000168#important-updateCOVID at LTACHhttps://www.nejm.org/doi/full/10.1056/NEJMoa2005412?query=featured_coronavirusAMA Journal of Ethics“March 2020 - Ethics Talk Podcast: COVID-19 Pandemic Response”https://journalofethics.ama-assn.org/covid-19-ethics-resource-centerMarch 27 - The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19) https://jamanetwork.com/journals/jama/fullarticle/2763952March 27 - Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington https://www.nejm.org/doi/full/10.1056/NEJMoa2005412?query=featured_coronavirusMarch 20 – Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)https://sccm.org/getattachment/Disaster/SSC-COVID19