COVID-19 Information for Residency Programs - Week of November 27

First let me apologize for not providing more information earlier – however information has been changing within hours, including new directives from Middlesex London Health Unit late last night, and hours worth of meetings yesterday and today.

As of right now:

Outbreaks have been identified at University Hospital on 4IP, as well as 6th, 9th, 10th and the Multi-organ Transplant Unit.

New initiatives in place as of November 27 (today) include:

Schulich has removed all medical students from clinical learning at the University Hospital in all Clerkship Rotations and Clinical Electives as of 0600 hrs. on November 27, 2020.

Also, all students who are in Clerkship or Clinical Electives learning at St. Joseph's Health Care London, Victoria Hospital, Windsor Regional Hospital, Distributed Education hospitals or community clinics will be removed as well if they have been involved in patient clinical learning at University Hospital over the past three weeks. (Gary Tithecott, Vice Dean (Acting) UGME Nov 26/20)

University Hospital is diverting medicine patients from the Emergency Department at UH to admission at Victoria Hospital.

Only ‘life or limb’ referrals are being accepted (initiated evening of November 26th)

  • Surgery at University Hospital as of Friday, November 27 is limited to urgent/emergent cases, which means that there are approximately 4 operating rooms in use.

  • At this moment outpatient and clinics have not been impacted – but this may change over the weekend.

  • All inpatients at University Hospital are being tested for COVID-19 as of today, and any patients being admitted will be tested.

  • 4IP healthcare workers are confined to working on 4IP. They will have testing, and also be retested every 4 – 5 days. This includes residents. Call schedules are being adjusted to account for this. They are also being asked to ‘work-quarantine’. Residents affected and working on 4IP will have received specific information about this. All residents who were on medicine teams have been contacted by Learner Experience for support.

  • Consults – on 4IP – should be done with restricting the number of individuals involved (this is likely good practice for all consults – so please consider).

  • only KEY team member who directs care and makes clinical decisions for care of the patient attend to the bedside.
    • complete all possible tasks or care virtually when able.
    • only 1 team member complete the consult requested on 4IP in Droplet/Contact PPE and discuss with the team remotely.

  • Beginning today (Friday November 27th) the attempt is to try to restrict movement as much as possible between sites/hospitals. Recommendations are to:
    • Cohort physicians and residents to a site as much as possible.
    • If not working at UH presently, the request is to not return to work at UH unless absolutely necessary.
    • Cohort call as much as possible (recognizing that some services by definition must provide site cross coverage – for example neurosurgery, cardiac surgery, thoracics etc.).

  • Physicians and residents require COVID-19 testing if they provided inpatient care on outbreak units at any time from November 17th. Priority testing includes heathcare workers from: (note that this has not yet been finalized/approved so further information is likely). Also possible that all healthcare workers at UH will be asked to test.
    • Medicine
    • Multiorgan Transplant Unit
    • Cardiac Surgery
    • CNS
    • Hemodialysis

  • Testing sites:
    • Testing staff planned on site at UH through the weekend. Staff on 4IP can be tested on 4IP. The Medicine teams from 6, 9 and 10 will be tested on the 3rd floor behind Auditorium A.
    • The VH Testing Centre will be open today and Friday (closed this weekend) and team members can arrange a test there as well if this is more convenient for them. Book appointment here at the VH Testing Centre
    • Testing is also available at the Carling Assessment Centre 7 days a week and the team there has told me that they have capacity for same-day appointments if you request one. If the team members are tested at Carling Assessment Centre, they will need to provide confirmation to us that their testing has been completed so we can ensure our listing of who has been tested is complete. Book appointment here at the Carling Assessment Centre.

Answers to some questions:

  • Will residents be able to start block 7 (December 15th) if they are currently on rotation at University Hospital? Hopefully – but this is uncertain, however the measures being taken will hopefully be successful by that time.

  • My resident is anxious and worried, stressed, has children at home …. Please have your resident contact Learner Experience. Michelle Marlborough will provide support, and also has details about housing, as well as help with questions regarding medical leave etc.

  • My resident is not on 4IP – but do they still have to get tested? Yes if they were on medicine CTU from November 17 on.

  • What about call schedules? Call schedules should, as much as possible, restrict residents to a single site for coverage. This will not be possible for many services that are site specific and yet need to cross cover.

  • What about the number of beds – will they run out? Contingency plans are being developed – with St. Joseph’s/Parkwood, other community sites etc. if necessary in the future.

  • How long will ORs at UH be restricted to urgent/emergent? Not sure – infection experts are hoping this will be quite limited in time frame (as in days/week – not weeks/month) but of course…. No one knows.

  • Is there housing available? Residents were made aware of limited housing at Windermere Manor earlier in the week. Today the hospital has also provided information about additional housing available:
    Residence Inn Marriott London Downtown
    383 Colborne Street
    Front desk is 519-433-7222 and it is staffed 24 hours a day
    • For house staff who are required to isolate and not able to make other arrangements. Approval needs to be made with the person’s supervisor (program director) to ensure the stay is required.
    • The hospital will be able to cover the cost of a standard room and parking with breakfast included in the room package. All other incidentals are the responsibility of the employee. Please can you email Asha Rogers the details on anyone who is approved and the length of their stay.

Once again, thank you for all your work, and the support that you provide to our residents and fellows.

I will try to forward any new information as I receive it – and apologies if what I have provided here is wrong by tomorrow morning! It just might be, but I hope you will understand.

Please take care,