With New York State now having the most number of confirmed cases of coronavirus disease 2019 (COVID-19) on a global scale, physicians within the Department of Neurology at Columbia University Irving Medical Center and the New York Presbyterian Hospital published in Neurology a manuscript highlighting protocols implemented at their respective departments, and guidance for other institutions to consider, when preparing for the influx of patients with COVID-19.

The manuscript authors noted changes for routine meetings with key staff and leadership regarding inpatient and outpatient clinical care activities, human resource issues and public health guidelines helped to ease concerns. Mental health support, through the use of free private counseling services and hospital-wide tele-mental health support, was also a critical part of their efforts.

Training led by nursing leaders were provided for proper use of personal protective equipment (PPE), nasopharyngeal sampling technique, and protocols for screening patients for possible COVID-19 symptoms. A daily checklist was completed by nurses for all patients with possible symptoms and a daily nurse huddle occurs to share information on COVID-19 and to discuss possible and positive cases on the unit. A COVID-19 related binder was created to compile documents such as clinical guidelines, hospital protocols and policies.

Authors also noted that schedules were developed to scale down inpatient services to necessary staff including resident trainees. Further, all teams practiced social distancing and teaching occurred in workrooms, instead of at the bedside, to limit the number of team members entering patient rooms. The departments also cancelled all elective admissions for non-urgent purposes and closed their epilepsy monitoring units to patients and instead resorted to curbside consultations.

In-person visits to the resident clinic were converted to telemedicine visits. Any urgent admissions were screened for possible COVID-19 symptoms and rescreening for symptoms was conducted when a patient arrived from a different facility or was directly admitted to the inpatient unit. Patients who had tested positive for COVID-19 were centralized to designated hospitals and specialized teams for treatment.

The authors indicated that their respective neurocritical care units (NICUs) have been coordinating with the intensive care (ICU) to manage the significant number of patients with COVID-19 requiring transfer into the NICU. Faculty within the NICU provided routine education and preparation to staff and trainees regarding acute respiratory distress syndrome (ARDS) management, guidelines for non-invasive positive pressure ventilation, and high flow nasal cannula oxygen for suspected or confirmed patients with COVID-19.

Ambulatory staff members were also trained to screen patients, and those accompanying patients, for symptoms indicative of COVID-19 during tele-neurology visits. Moreover, to further support efforts to practice remotely, laptops and technical support was provided by departments for outpatient practitioners. Lastly, all medical student clerkships were suspended and all non-critical clinical and basic research was slowed. Departments set up a 96-hour ramp down policy to complete ongoing critical experiments, stopped noncritical experiments and all new experiments, and a virtual curriculum was created for medical students on rotation.

The importance of coordinated, multi-disciplinary efforts to prepare neurology departments for the COVID-19 outbreak is essential, manuscript authors noted. They add that We have worked cohesively within the department, the hospital, and university to implement strategies to minimize the risk of COVID-19 transmission and perform the best of care for our patients. The authors emphasized that this pandemic should be taken seriously and that despite challenges ahead, further necessary adjustments will continue to be of importance for neurology departments everywhere.

Reference

Waldman G, Mayeux R, Claassen J, et al. Preparing a neurology department for SARS-CoV-2 (COVID-19): Early experiences at Columbia University Irving Medical Center and the New York Presbyterian Hospital in New York City [published online April 6, 2020]. Neurology. doi:10.1212/WNL.0000000000009519

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Adapting to COVID-19: Protocols Implemented by Neurology Departments in New York Hospitals - Neurology Advisor