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1/10 Finished 1 week as @UCLAHealth COVID-19 ward (non-ICU) attending. Here is a brief summary of what I learned with help from an outstanding team @SaumitraThakur Jayasree Sundaram, Wen-Ching Tran, Michelle Chong, Faisal Saab
2/10 Clinically, timing is everything: As we know, days 7-10 from symptom onset is typically when patients can deteriorate, so discharge on day 12 is generally safer than on day 6 ( https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext)
3/10 Don’t anchor on COVID-19, e.g., procalcitonin can help assess for concomitant bacterial infection, but beware of false elevations in severe inflammation, some fungal infections, ESRD, etc. ( https://www.ncbi.nlm.nih.gov/pubmed/25228701 )
4/10 Consistent with the literature, we saw deteriorations most often in middle-aged to older men>women with ≥1 comorbidity and beware of speed (e.g., 1 L NC to 6 L NC within hours) https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
5/10 Surprise: Overall service has plenty of movement, and home oxygen (DME) and home pulse oximetry can greatly shorten length of stay, making room for sicker COVID-19 patients
6/10 Personal protective equipment: PRACTICE, PRACTICE, PRACTICE, do dry runs, have your teammates watch you, GO SLOW, sanitize hands in-between every step of doffing to minimize self-contamination
7/10 Actively think about how to minimize exposure for all staff (Daily dosing >> TID dosing, take all subjective history via phone, ask patient to wear mask, afternoon phone rounds on more active patients, drips outside the room, AVOID unnecessary tests/procedures, etc.)
8/10 Hot zone is a must zone: create a designated area in your home entryway (if no garage) where you remove everything you brought to the hospital, throw clothes in the wash, shower, sanitize everything in the hot zone (e.g., keys, cell phone), and wash hands
9/10 A note on patients' families: try to preemptively call daily, it really helps all parties. They are worried sick being out of the loop, unable to visit their loved ones. Patients and families are scared, so it goes a long way to invite family into rounds on speaker phone
10/10 Ultimately, it helps morale when vast majority of hospitalized (non-ICU) patients survive to discharge, but please do not let up aggressive social/physical distancing cc @uclaimchiefs @UCLA_GIMHSR @boback @DrKerbel @rgbMDPhD
