President’s Message

President’s Message

Posted on Jan 4, 2022 in President's Message | 0 comments

Happy New Year!

Omicron is here.

I was hopeful that this winter would be safer, but COVID 19 is starting to feel like the unwanted guest that refuses to leave. Already, my plans for an extended family get-together were scrapped by a symptomatic positive among us (we are all vaccinated and boosted, but we took the extra precaution of testing before getting together).

This variant is highly infectious, with an R naught of 15-20, and it is likely that a good portion of us will possibly be infected by the time this thing is done. It is comforting to know that PPE works, however, constant vigilance is required – not just at work, but also in our personal lives. It would be advisable to avoid large gatherings, particularly amongst unvaccinated and vulnerable people. We also know that vaccination works even with this variant. Though not as effective in limiting infection, it does prevent serious disease and hospitalization. Spread the word to your patients, friends, family and make sure they get boosted.

Already, the emergency department is overwhelmed with high numbers of new daily cases, which limits our capacity to care for other patients. Thankfully, the number of admissions has remained steady and are smaller in comparison to last winter, but the next few weeks will be telling as to where our hospital resources are. No elective procedure cancellations are planned. Perhaps early reports indicating less severe disease with Omicron will ring true.

Please be safe out there. Our patients need us the most now, and first and foremost, we have to be present to help. We’ll get through this together!

Use this link to upload your booster info if you haven’t already done so.

https://app.smartsheet.com/b/form/00cd6043aaa64f2596f35534d8611336

This applies if you did not get your booster through a Sutter vaccine clinic.

Below are the guidelines for returning to work if you test positive.

SHEMS Return to Work Requirements for Employees – Changes Based on New CDC Guidelines

Symptomatic or asymptomatic employees may return to work when all of the following criteria are met:

·       If these criteria are met, there is no requirement to test negative prior to returning to work.

·       Employees who have moderate disease (shortness of breath, difficulty breathing) and are not severely immunocompromised may return to work after at  least 10 days have passed since the date of their first positive viral diagnostic test.

·       Employees who are identified as severely immunocompromised or were hospitalized for severe or critical COVID-19 may return to work after consultation and clearance with an infection control expert. In those situations, up to 20 days before clearance to return to work (RTW) is common and occasionally a test-based clearance approach is indicated.

·       Employee Health Services (EHS) will only manage the RTW process for employees who are diagnosed with or test positive for COVID-19.

Employees who test negative:

·       If a symptomatic employee tests negative for COVID-19, they may return to work once their symptoms resolve and they meet any standard affiliate policies and local health authority requirements. For example, affiliate policy may require a doctor’s note or other medical clearance if an employee has been off work for more than 3 days, and such requirements would apply.

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus

President’s Message

Posted on Dec 1, 2021 in President's Message | 0 comments

I hope everyone had a restful Thanksgiving. I was working most of the week through the holiday and weekend, so I sent my family down to LA to be with grandparents. I figured they would have more fun there rather than dealing with my usual work-related fatigue and grumbling.

The emergency department was humming with activity. Thanksgiving and the days before and after will bring an interesting mix of patients, those with nowhere else to be, those who have held out on acute issues to be with family and friends, only to have those problems escalate to the more serious, and those who have perhaps overindulged and are paying the price.

I had finished taking care of a patient, with an uncomplicated diagnosis and treatment plan, and she took the time to say to me, “thank you for all you do.” I felt heartened, thanked her for being such a nice patient, and in the spirit of things, catalogued some of the things that I should be thankful for.

I have a job – it’s not easy, but there a plenty of folks out there who are supremely dissatisfied with their jobs and have left the workforce altogether.

I have my family – they are all doing well, bar the occasional mishaps and whining (especially from the four-legged variety) and are mostly in good spirits.

I have my health – sure, my hair is getting gray, my midsection is flabbier, I think I’m shrinking in height, but all in all, not too many serious medical issues (that I’m aware of).

I have great friends and coworkers – doctors and nurses can be a tempestuous bunch, but I am continually impressed how hard everybody works to help each other and do the right thing for patients.

I have relative financial security –I still owe mortgage to the bank, but I am dutifully saving for retirement and my kids’ higher education. I live simply – aside from a sordid collection of bicycles. All the things I need (even if they are not all the things that I want) I can pay for.

These are a few of things that I am thankful for, and I encourage you to think along these lines during the holidays. Many of our patients are not so lucky.

Omicron is coming.  This particular variant is notable for having multiple mutations within the spike protein that may evade our current vaccines. Already, Pfizer, Johnson and Johnson, Moderna are signaling that they will likely be developing new vaccines to address the latest variant.  Last month, I was hopeful that we were through the worst of it, that we would soon be in the endemic phase of this COVID nightmare, but perhaps that was too wishful. Europe is going through its fourth major wave of infections, lockdowns are once again being imposed. Global vaccine equity is the key here – while most developed countries have vaccinated 50-70% of their population, the African continent has only vaccinated 7% of the population. Complacency in adequately vaccinating developing countries has fostered an environment rich for mutation.

With that somber note, I wish you all a peaceful winter holiday. Take stock of everything that you are thankful for, and spread some gratitude to your colleagues and patients.

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus

President’s Message

Posted on Nov 1, 2021 in President's Message | 0 comments

I recently watched an interview with Dr. Robert Wachter, chair of Medicine at UCSF, regarding his view of the trajectory of the COVID pandemic. He indicated that we have likely switched from a pandemic phase to an endemic one, where COVID will always be present to some degree. It got me thinking a lot about my own behaviors in the current state.

We have seen our internal numbers of cases going down, as well as those across the Sutter system. But they are not gone. Small blips here and there, with no great surges, the numbers of inpatients appeared to have stabilized, at least in the Bay region.

I have been living a pandemic lifestyle for the past year and a half. No dining in restaurants, no movies, no gym, no airplane flights. Of course, these have been personal choices based on the particular risk profile I live in – of constant exposure through work, of having school age children with no vaccine options (soon to change this coming week!), and of having parents with age and comorbidities being risk factors for serious illness or death.

But as the world learned from the influenza pandemic of 1918, life must go on. It took nearly two years for society to get back to some sense of normal, but it was one in which flu became common and seasonally came back to cause illness and death. This required, when it became available, a yearly flu shot to mitigate its effects. This is where I see us within the context of COVID.

Recently, my wife and I got our boosters, and we feel safer already. I have begun to loosen the reins a bit, making my first journey into the climbing gym (where one must show proof of vaccination to enter, and masks are required regardless) since this whole thing started. Just as in medicine, there is always a calculus of risk that goes into decision making, and some things I have withheld for too long.

The pandemic has accelerated certain technical innovations in healthcare such as telemedicine, which used the restrictions on in person interactions as a catalyst for growth and maturation. It will likely continue to grow. Virtual meetings are the standard now, and more people work remotely as part of their daily ritual. Just how much of what we once knew is going to come back, and do we even want to go back there? Perhaps the pandemic has made some things better? I know many others who are even less tolerant of risk than I am, and they keep waiting for the pandemic to be over, but… the coronavirus is unfortunately here to stay.  It’s endemic now. Over time, our collective immunity should strengthen, and we can only hope for the day when coronavirus is just a common cold again.

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus

President’s Message

Posted on Oct 1, 2021 in President's Message | 0 comments

First of all, I want to say thank you. The past few months have been pretty rough, with short staffing at ABSMC coinciding with the recent surge in COVID cases. Thanks for complying with the California healthcare worker vaccine mandate: to keep ourselves, our families, and our patients safe. And lastly, thanks for participating in the most recent physician engagement survey. Your responses are critical to making a better working environment at Summit.

A bit of good news: COVID cases across the system are finally on the decline. The graph below illustrates the daily case count over time within the Sutter geographic footprint.

Flu cases during the pandemic have been thankfully sparse, but as we are approaching the winter months, it is vital that we also get vaccinated for influenza to help avoid a twindemic of COVID and flu. Below is the schedule for the flu/TB clinics for the East Bay.

The CDC is currently also recommending a COVID booster (for those who received the Pfizer series) for age greater than 65 and those who work or live in high risk settings. That would include most of us, but it has not yet been yet determined that a booster is necessary for those that received the Moderna or J&J vaccine.  The news came unfortunately a bit late to incorporate Pfizer boosters to the flu/TB clinic schedule, so I encourage you to get your shot through your primary physician or your local pharmacy, or through https://myturn.ca.gov/

We continue to highlight the importance of wellness and mental health during these difficult times. Please see below for a list of resources.

EPIC refuel is coming soon – November 6. This is a major revision to EPIC that will bring the EHR more to a native state and make future upgrades less time consuming.

The Best of Epic:

Upgrades and Enhancements coming November 6th!

Secure Chat: fully integrated text messaging

  • Securely share patient information and images
  • Expanded to ALL Epic users on the desktop
  • Bonus: Physicians and Advanced Practice Clinicians can also use their mobile devices!
  • Facilitate team communications

Care Everywhere Image Exchange

  • Send and receive images with other Epic health systems
  • Phase 1: Outgoing images include clinical photographs, consents, POLST forms, and other items in the media tab
  • Incoming images include all of the above PLUS reference quality radiographs and ECG’s from other organizations that choose to send them

Efficiency and Usability Tools Including…

  • Personalization: Customizable SmartSets, Consolidated My Tools menu, modifiable Chart Review reports and Navigators
  • Efficiency: Improved patient search across the system, exempting orders from reconciliation, note template speed buttons, enhanced pre-charting
  • Enhanced Communications management function

As we approach the release date we will send out additional details about the new tools, but wanted to give you a sneak peek at what’s coming

Lastly, I wanted to share a letter from Barbara Kivowitz, a patient family advisor. Her words and thoughts capture a lot of the emotions we have been feeling recently.

President’s Message

Posted on Sep 2, 2021 in President's Message | 0 comments

I felt a pit in my stomach that weighed a ton. I had just gotten out of a code, a cardiac arrest that had sadly not survived. He was a relatively young man, and had a sudden and dramatic collapse, with not too many comorbidities. In short, his demise was quite unexpected. We had done everything possible, but that day was just not meant to be.

A short while later, my charge nurse notified me that his family had arrived and were waiting to hear news. Of course, I was encumbered, mired in the details of my other patients, but I knew that talking to the family was going to be the most important thing I did that day.

I had Stevie, the chaplain, as backup for some emotional support – not just for the family, but for me as well. When delivering bad news, you can never know how a family will react. Most of the time, it’s just sadness, but sometimes, it’s anger that can be misdirected at physicians and nurses.

As I walked toward a private room where the family was waiting, my brain had to switch gears. While working, I tend to be pretty analytic, almost a bit too calculating and cold in allowing logic to dominate my decision making. Though cognitive neuroscientists have dispelled the myth of a strict right/left brain divide, there are some useful distinctions between the two halves that interact. Take for example Broca’s area, the portion on the parietal lobe that encodes speech/language: the left side typically analyzes the content of the language, while the right side interprets the prosody and emotional content of speech.

I sat down with the deceased patient’s wife and his brother. Behind masks, our eyes met, and I could see that she was still hopeful. As I delivered the bad news, I could tell that she needed to hold my hand. She grasped very tightly on my every word. And as I tried to be analytical, I knew that that was not what she needed. She needed more, that human connection of grief. I hugged her as she sobbed. She thanked me for all I had done.

When I left that room, the pit I had in my stomach was gone. Perhaps it was a sense of relief on my part that the ominous task was complete, but I think that it was actually that I was able to help a family get some closure.

These are the challenges we face everyday, as we get lost in the minutiae of medical data. Our patients expect a translation of data into something more relatable, more personal. This is not only in times of bad news, but with equivocal and good news as well.  

On the business side of things, I hope you all have read the emails from the system, the medical staff, and our chief medical executive, Dr. Boynton.

Below is additional information to help us be compliant with the public health order recently instituted.

Vaccinated (at a Sutter hospital Dec 2020 – Mar 2021)

We should have your vaccination records. No further action is required.

Vaccinated (not at a Sutter hospital via myEHS)

If you are already fully vaccinated but did so in an outpatient setting or a non-Sutter hospital you should have received an email requesting you to submit your information. If you have not already done so, please use the following link to provide your vaccination information:  http://covid19.sutterhealth.org/VaccinationProof/external

Not vaccinated

If you are not yet vaccinated, then by Sept 30, 2021 you will need to submit either/or:

  1. Valid proof of vaccination: http://covid19.sutterhealth.org/VaccinationProof/external
  2. Valid religious or medical exemption via the following links:

http://covid19.sutterhealth.org/ReligiousExemption/external

http://covid19.sutterhealth.org/MedicalExemption/external

In addition, you will need to provide negative test results semi-weekly starting August 23, 2021 in order to continue treating patients in the hospital setting. Please use this link to submit your test results: http://covid19testresult.sutterhealth.org/external

  • Recommendations on testing frequency and timing can be found in CDPH guidance for acute care hospitals and all other clinical environments.
  • Clinicians do not need to submit proof of their test results. The state only requires they report the result of the test. However, it is recommended they retain proof of each test.

If you plan to be fully vaccinated, you will be exempt from the bi-weekly testing requirement two weeks after receiving either a single-dose COVID vaccine or the second dose of a two-dose vaccine and no further action will be required.

Please contact Leanna Hudson (Manager, ABSMC Medical Staff Services) if you have any questions or need assistance with your submission.

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus

President’s Message

Posted on Aug 5, 2021 in President's Message | 0 comments

I was enjoying a blissfully peaceful day at the San Diego Zoo with the family. The sun was out, there was a nice breeze, and I had no mask on. Sure, we were outdoors, and the CDC had relaxed mask recommendations for the vaccinated indoors. But this was still a new thing to me, to be in public without a mask on. In fact, this was the first time that I had strayed from the Bay Area since the start of the pandemic, and it was liberating.  Vaccination rates in the state, while not approaching the magic 70-75% hurdle, were quite good in most counties. Overall disease incidence was still quite low.

Abroad however, reports came from Indonesia of a massive surge. Israel was reporting breakthrough infections among the vaccinated. The UK was in the midst of another wave.  News of the highly infectious delta variant became widespread, and I was cautiously hopeful that we would be able to resist this locally.  But as a global pandemic is indeed global, so were we to soon feel its effects.

Upon my return to work, I came to know that we were not going to be spared the latest COVID surge. CDC reports indicated that the delta variant, a more highly infectious strain, and one that seemingly caused more severe disease, was responsible for 80% of new infections in the US. We were once again wearing full PPE, N95’s and eye protection all day, PAPR’s were whirring constantly, and the arsenal of weapons we had to combat the virus were once again deployed. Moreover, as more data came out, we learned that even the fully vaccinated were not exempt from falling ill, though the severity of disease was lessened, the risk of hospitalization and death was substantially mitigated.

In some ways, we are better prepared for this. We know much more about COVID than at the outset, and we have better data on the efficacy of treatment regimens. Dexamethasone, remdesivir, casirivimab/imdevimab, tocilizumab, baricitinib: These tongue twisting names had become part of our daily lexicon and were dutifully employed on the sickest of patients.  But to hear a patient asking for the vaccine when they have already contracted the disease and to have to respond with “we can’t give it to you now, but when (or if) you get better, you should get it in a few months,” – is heart-rending.

In some ways, we are in a worse state. Our hospital is struggling financially, morale is low, there are constant staffing shortages (the causes of which are multifactorial) and patient volume is high. Most recently we are hearing about nationwide shortages of tocilizumab and baricitinib.

I am so thankful of the time that I had to see my dad in San Diego and have some (mostly) carefree moments, but I realize that now is not the time to let our guard down, for the enemy at the gates has returned with increased vigor and strength.

We will get through this, and the vigilance at work has to be met with equal seriousness outside of work. We know that even while fully immunized, we can be infected and transmit disease to others.  There are still vulnerable populations that either have not been vaccinated or cannot receive the vaccine. My kids, about to start school in person in two weeks, are not eligible for the vaccine yet.  So we are not out of the woods yet. Please, mask up when indoors and around large groups of others outdoors.

I can understand the frustration of taking care of patients who have not been vaccinated, but we have the golden opportunity to make a difference. Your patients trust your medical advice, and they are far more likely to be influenced by your counsel than a celebrity or a PSA. Take the time to understand the barriers and the causes of reluctance and address those with an open mind. Vaccination is not the only path forward, but the alternative is going to result in far more deaths, and far more difficult end of life decisions.

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus