Cleveland Clinic journal of medicine
-
Cleveland Clinic recognized the importance of mitigating community transmission of COVID-19 by keeping people at home. Patient-care activities quickly pivoted to remote touches, preserving continuity through a variety of digital and telephonic modalities. As the number of confirmed cases grew, standardizing home-based care became critical to managing high-risk patients, moderating the risk of exposure for healthcare workers, and reducing the amount of community spread through appropriate education on home-based care for exposed or infected individuals. This novel, team-based approach to caring for patients with COVID-19 incorporates a self-monitoring app for patient engagement, monitors symptoms for early intervention, and promotes a holistic view of care.
-
COVID-19 is extremely transmissible. Cardiopulmonary resuscitation (CPR) is associated with multiple aerosol-generating procedures including chest compression, positive pressure ventilation, and airway manipulation. ⋯ CPR in patients with suspected or proven COVID-19 must be performed without compromising the safety of healthcare providers. An overview of special considerations.
-
Moral distress is the psychological distress that is experienced in relation to a morally challenging situation or event. Although it was first observed within nursing, caregivers across all disciplines-including physicians, respiratory therapists, social workers and chaplains-experience moral distress. In this consult, we discuss 5 types of moral distress using examples of changes to clinical practice that have occurred due to COVID-19. We also provide suggestions for responding to moral distress and outline the resources available at Cleveland Clinic.
-
Hospital-to-hospital transportation of patients in the COVID-19 era presents unique challenges to ensuring the safety of both patients and health care providers. Crucial factors to address include having adequate supplies of protective equipment and ensuring their appropriate use, defining patient care procedures during transport, and decontamination post-transport. Transport vehicles need to have adequate physical space, an isolated driver compartment, NS HEPA filtration of air. Having a standardized intake process can help identify patients who would benefit from transport to another facility.
-
Resuming procedural sedation services for elective procedures during the COVID-19 pandemic requires unique considerations to ensure safety for patients and providers. Guidelines for resuming these procedures, including timing, screening and testing, use of personal protective equipment, and case planning are discussed. ⋯ Decreasing the need for oxygen supplement can be accomplished by opioid and sedative sparing strategies, including the use of multimodal analgesia and non-pharmacologic analgesic and anxiolytic interventions. Recommendations are made for patients who are COVID-19 positive and require procedural sedation.