Caring for patients during the COVID-19 pandemic poses unprecedented challenges. While patients continue to require care—both COVID- and non-COVID-related—the need to support social distancing and ensure patient safety is critical.

In recent months, University of Wisconsin–Madison Department of Medicine faculty have worked closely with UW Health and partners to develop innovative solutions for delivering patient care safely and effectively during this crisis.

The emerging role of telehealth

Telehealth has quickly emerged as an effective way to meet patients’ acute and chronic health needs without them visiting the clinic in person.

Across UW Health—in primary care, geriatrics and specialty care—staffing and system capacity has been rapidly reconfigured to meet the new demand for socially-distanced encounters. Now, patients can have video clinic visits and share images via their electronic heath record.

Mark Micek, MD, MPH, clinical associate professor, General Internal Medicine, pictured below, notes that providers are working to determine which future visits could be offered via telehealth. Patients can always opt for an in-person visit, he explains, but telehealth offers an opportunity for them to make that choice in partnership with their doctor.

Above, a video visit with Dr. Mark Micek.

Kathryn Miller, MD, assistant professor (CHS), General Internal Medicine, pictured on right, notes that providers have been pleasantly surprised by how much can be accomplished through telehealth—and especially video visits.

Through video visits, providers can quickly gather a lot of information about a patient’s health, well-being, pain or distress. They can spot symptoms like labored breathing, jaundice or tremors, and remarkably, even talk patients through some of the components of a physical exam.

“The eye contact in a video visit also helps foster the trust needed between a patient and provider, which in turn leads to better health conversations and decision making,” reflects Dr. Micek.

“Even after life gets more back to normal, telehealth and video visits will still be a part of how we do things,” Dr. Miller adds. “It’s really a transformative time.”

Drive-up injection therapy

At the UW Health Endocrinology clinics, patients who receive injection therapy for osteoporosis—many of whom are older and at higher risk for severe illness from COVID-19—now have the option of drive-up service. This way, they can continue treatment to reduce their risk of fracture without having to enter the clinic building in person.

To accomplish this, clinic staff, under the leadership of Vanessa Rein, MD, clinical associate professor, Endocrinology, Diabetes and Metabolism, pictured below on left; Neil Binkley, MD, professor, Geriatrics, pictured below in center; and Vincent Cryns, MD, professor and division head, Endocrinology, Diabetes and Metabolism, pictured below on right, began by consolidating the injection schedule to two days per week. 

A nurse then contacts each patient before their appointment, assesses for COVID-19 symptoms, reviews medications and allergies, and if appropriate, offers the drive-up option. When the patient arrives, they receive the injection right in their car, without having to park and enter the building.

Above, a patient receives a drive-up osteoporosis injection at UW Health West Clinic.

 “Patients have been extremely appreciative of this option and many stated they would have cancelled their injection otherwise, even with the increased risk for fracture,” explained clinic manager Holly Senz RN, MSN. “We have had a very positive response from our patients and our injection nurses. These drive-up injections decrease the exposure risk for both.”

Similar efforts are underway at UW Health Rheumatology clinics for patients who require injections to stop or slow disease progression.

Supporting dialysis patients

COVID-19 also presents unique challenges for patients with kidney failure.

In the inpatient setting, it’s estimated that 10 to 30 percent of patients in COVID-19 intensive care units have acute kidney injury severe enough to require dialysis.

To minimize nurses’ exposure to those patients, and preserve personal protective equipment, teams at UW Health are training ICU nurses to administer dialysis, recruiting nurses with previous dialysis experience, and deploying different types of dialysis when appropriate, says Tripti Singh, MD, assistant professor (CHS), Nephrology, and medical director for University Hospital’s acute inpatient dialysis unit, pictured below on left.

Creative system changes to meet that need also include extending tubing on dialysis machines and moving them outside patients’ rooms, she added.

In the outpatient setting, the layout of dialysis clinics makes it challenging to maintain social distancing, especially for patients needing a four-hour treatment several times per week.

To address this issue, Roy Jhagroo, MD, associate professor (CHS), Nephrology, and medical director for UW Health partner Fresenius Kidney Care, pictured above on right, explains that in addition to requiring masks for all dialysis patients and staff, the team has partnered with another dialysis clinic in the area.

Patients are assigned to one of the two locations, thus reducing the number of people in the clinic at any one time, and ensuring greater physical distance during treatment.

Leadership at all levels

As internal medicine physicians, Department of Medicine faculty across all subspecialties are playing a critical role in the front-line care of patients with COVID-19.

Many also participate in special task forces within their division, in the Department of Medicine, at UW Health and at partner organizations.

For example, a familiar face in the news is Nasia Safdar, MD, PhD, professor, infectious disease, and UW Health’s medical director for infection control and prevention.

Dr. Safdar’s many media appearances include a profile in the Wisconsin State Journal, quotes on Wisconsin Public Radio and interviews on local and national television, among others.

She was also the inaugural guest on the Wisconsin Foundation and Alumni Association’s The UW Now virtual livestream. Over 2200 viewers nationwide watched as she discussed how COVID-19 is transmitted, shared how the health system and the university are responding to the pandemic, and answered audience questions.

Above, Dr. Nasia Safdar was the inaugural guest on The UW Now virtual livestream.

In addition, Peter Newcomer, MD, MMM, clinical professor, General Internal Medicine, is UW Health’s chief clinical officer and has served among the rotating group of medical branch directors for COVID-19 response. Through regular video updates, he keeps all UW Health staff informed during this rapidly-changing situation.

Dr. Newcomer was also a recent guest on The UW Now virtual livestream, along with University of Wisconsin School of Medicine and Public Health (SMPH) Dean Robert N. Golden, MD. He discussed how UW Health mobilized in response to the pandemic, including postponing treatments, expanding virtual care, redeploying staff and reorganizing space.

Above, Dr. Peter Newcomer and UW SMPH Dean Dr. Robert N. Golden also joined The UW Now virtual livestream to discuss steps the health system and school are taking to fight coronavirus.

Together, all of our faculty are working together to provide the best possible care for patients during these unprecedented times. We thank them for their unparalleled dedication and leadership.

Banner: Samantha Murray-Bainer, MD, assistant professor (CHS), Hospital Medicine, at University Hospital. Credit: Clint Thayer/Department of Medicine.