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Hello please ask your questions
Thank you for inviting UCSD to the meeting.
Thank you for your comments. What is the hospital’s current capacity for testing?
Based on internal medicine grand rounds, it is currently 300 per day, they anticipate reaching 1000 tests per day by mid next week
Thank you Dr. Jackler for inviting UCLA. As a resident, I am interested in what our sister institutions have implemented for their trainees, keeping in mind the high risk of infection for otolaryngologists and the need for maintaining adequate patient care. 1. Have residents been scaled back to “skeleton crews” to triage urgent visits/surgeries only? 2. What contingency plans for coverage are in place if a resident becomes ill/quarantined? 3. What alternative didactics/remote learning are being implemented? I would appreciate hearing what your institutions are doing.
Hi Brooke, I will comment as Program Director a little later in the presentation.
it has been found in stool
link to Hopkins map is here: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
How long are we planning on doing urgent patients only (at least for now)? It would be helpful to know so we can plan ahead.
Peter Santa Maria
re: billing for video visits. Usually there are criteria for various levels of billing that rely on number of systems examined. Is there a guidance for billing video visits?
Yes, I have clarified with Jeff from compliance and Lena from telehealth. Due to the new changes, the billing is the same. However, if we decide to do an endoscopy after, then that is a separate procdure visit only. If you decide that you spent significant time discussing a change in plan, then you would bill the second visit based on time.
I have a face mask in the lab for UV that I could provide
@UMegwalu Minimum 30 days, but you may opt for longer if you wish. I have cleared my own schedule through end of April
Video visits can be billed either by E/M (obviously you can really only account for history and MDM, which is ok for revisit patients since you only need 2/3) or by time.
urgent patients only: how long will depend on data—it is likely to be 2-4 mo
there are 3 telephone visit cpt codes, based on time
Video visits are billed based on time spent and complexity.
Video visits use the same E&M codes as regular visit. Telephone visits use different codes 9944x
Sorry, I meant one Face Screen in the lab for UV that I could provide
telephone visits may be appropriate rather than video, and are not billable
telephone visit may become billable soon
Thank you Nico. I think we need to figure out if that will definitely kill the virus and also allow the masks to keep working. If we can figure that out, your lab equipment may very well be vital to our department during the surge.
I have mannequins to train people if Rob wants to be trained!
Sorry Zara, what I mean is a Plastic Face Screen that we use to protect ourselves from UVs when we look at DNA gel closely. I looks just like one I saw for the clinic
@PHwang: thanks for the input. I think we would benefit on having a department-wide consensus on how long the initial period of urgent-only appointments should be. It seem right now individual divisions/providers are doing their own thing.
@UMegwalu: agree, but probably not possible to develop projections for another 2 weeks. I'm certain it will be an ongoing dialog.
Perhaps we can agree as a department the minimum we would continue urgent only in clinic so that the staff can be prepared then choose a reassess time. Certainly if a provider wants to do longer, that's their choice but a minimum collective decision would be helpful for operations.
Wearing scrubs outside of the hospital will undermine public confidence in the rigor of our infection control.
In mod to severe ARDS, ventilation with pt in prone position is a/w reduced mortality and is recommended (Thompson BT et al NEJM 2017). Are we doing this for intubated/ventilated pts? Or even for nonintubated pts that are hyperemic/dyspneic?
Shouldn't ALL intubations/extuibations done by the Anesthesia team be considered high risk to that service, and the nursing staff present at that time? Even if the Cardiac or Urologic PROCEDURE is not aerodigestive, how are we as an institution accounting for the safety of the anesthesiologists and CRNAs whose procedure always involves in the airways?
Many times the connector tubing becomes disconnected, and also the patients cough after extubation, leading to droplets. Unless patients are known to be COVID-test-negative, when a surgeon team feels that an urgent surgery needs to go, it seems risky and unclear how our Anesthesia teams can feel safe given their exposure to the airway. I don't think the testing capacity is available yet to screen asymptomatic, but urgent, non-ENT, patients, so just asking how this is being considered?
Anesthesiologists and respiratory therapists are indeed at weighted risk. We are adopting universal precautions (N95). In time, as testing band width increases, knowing COVID status before any procedures.
As we, in ENT, have significantly adjusted what we have considered to be 'urgent' surgeries, it seems the leadership may need to confirm what other surgery services consider to be 'urgent' and whether each procedure justifies the risks to our trusted/dedicated Anesthesiology MDs and staff. Thanks
For those interested, the notes from my introductory review of COVID-19 in OHNS can be downloaded at: https://stanfordmedicine.box.com/s/tsbo38z0mr3d4co87v1x2ecx3wolc6n5
Below is the link to a recording of a very interesting lecture by Dr. Schooley at UCSD (on our faculty, former Chief of ID) on SARS-cov-2 (COVID-19). It is 1 hour in length.Distribute as you feel appropriate.Link: http://neurostream.ucsd.edu/fullscreen-player.php?path=domgr_vd&source=MGR-03-18-20_zoom.mp4
Any documentation or experience of possible viral load within the middle ear and mastoid from around the world?
Is there a plan for new patients who do not have COVID symptoms to be able to do video visits? For example for semi-urgent visits that ideally shouldn’t be put off for 2 months, but do not need to be in person.
Yes. SHC stated they would make sure patient's are not billed if urgent during the emergency state. It's not 100% clear based on their statements. I think because they don't know either.
Masters P, Perlman S. Fields Virology. In: Knipe D, Howley P, eds. 6th ed: Lippincott Williams & Wilkins; 2013:825-858
The last two Dept. of Medicine weekly Grand Rounds at Stanford covered COVID-19. Both 1 hour sessions were very useful and are viewable online. This website also has listed the 1 hour pediatric COVID-19 Grand Rounds. https://medicine.stanford.edu/education/medicine-grand-rounds.html.
Does anyone know the rate of immunity? Meaning if you had Covid 19 what is the rate you would get it again? Friend asking...
I have been told by the ID team that convalescent antibodies studies are now just getting underway. Clearly, it will be important to know who is immune - a condition hopefully which will contribute to herd vulnerability.
Laurie - how have you managed the airway or trauma emergencies that tend to come through SCVMC? Has the situation arisen since March 13?
@JenniferAlyono, we can do video visits for anyone and now can bill NPVs in addition to RPVs. As someone mentioned, billing is by time. One restriction is that the patient should be a California resident.
re: immunity. data from SARS is usually 2-3 yrs of immunity. IgG and IgM being studied re: Covid-19. there are a few reports of 2nd infection: may or may not be accurate but possibly so.
insofar as there is a declared Nat’l emergency the requirement that the patient must be a resident of CA should be re-evaluated
Thank you for your thorough response Dr. Sung.
We have the best staff in the world!
Can we proactive for our African partners to guide them to deal with the crisis they likely going to face too, not with the same means?
Does anyone have reliable data regarding false positives and false negatives for the RT-PCR test?
How can we access this recording?