key: cord-0048024-3liz5p7s authors: Greenberg, Anya; Schwartz, Hope; Hooks, Nicholas; Lowell, Clifford; Roberts, John title: Emergency Blood Drives During the Covid-19 Pandemic: A New Model of Collaboration among UCSF Leadership, Medical Students, and a Community Partner date: 2020-05-06 journal: NEJM Catal Innov Care Deliv DOI: 10.1056/cat.20.0137 sha: ac07567f7121d7d463ed9833e3027edf36e9eb0e doc_id: 48024 cord_uid: 3liz5p7s In response to a potential blood shortage triggered by a shelter-in-place order in the San Francisco area, a multidisciplinary team at an academic medical center partnered with a major blood provider to create a safe and sustainable blood drive model during the Covid-19 pandemic. As part of a broad effort to disseminate this model, they describe the process in this case study. » A multidisciplinary collaboration between School of Medicine students, faculty, deans, UCSF Health leadership, facilities, operations, communications, and media is critical to overcoming the increased, complex, and evolving barriers to holding large events during the Covid-19 pandemic. » Medical students are well suited to lead and staff blood drives during the Covid-19 pandemic. » Aligning the interests of the medical center, blood provider, and community enabled us to have animmediate, tangible impact by accelerating the planning process (2 weeks vs. typical 8-12 weeks). » The updated blood drive model, which was established to address emergent needs, offers a long-term, sustainable approach for others to use during and beyond the Covid-19 pandemic. In response to the Covid-19 pandemic, San Francisco instituted a broad-reaching shelter-in-place policy on March 16, 2020, that immediately closed community spaces.1 Evolving nationwide limitations on public gatherings had led to the mass cancellation of blood drives, which are the primary source of blood products in hospitals.2 In mid-March, two major blood providers, Vitalant and American Red Cross, announced diminished blood supplies of as little as 2 days' worth. 3 The disruption of the standard model of community-based blood drives has put the health care system at risk for a critical blood shortage if a continuous pipeline of community donations is not reestablished.4 Rapidly developing a safe, sustainable model for collecting blood donations in community settings during the Covid-19 pandemic is a necessity given the short half-life of blood products2 and the need for continuous donations. Our goal was to quickly adapt standard blood drive procedures to comply with shelter-in-place and physical distancing requirements and execute a series of blood drives on UCSF's campus to: (1) develop a replicable blood drive model at our academic medical center with potential for adaptation by other health care and nonmedical institutions; (2) address the ongoing need for collecting blood products during the Covid-19 pandemic; (3) provide a safe opportunity for individuals to contribute to a critical public health need; and (4) inspire confidence in donors that safe blood donation is possible in the Covid-19 era. Central to this effort was a partnership between two senior UCSF faculty (the chair of Laboratory Medicine and a senior faculty member in the Department of Surgery) and two UCSF School of Medicine (SOM) students. Senior UCSF Health leadership including the Chief Clinical Officer, Chief Medical Officer, and SOM deans served as integral partners in addressing institutional and administrative hurdles. The Donor Recruitment Representative and Manager of Donor Recruitment from Vitalant represented the blood provider in operational aspects of drive organization. The SOM students served as project managers, planning and coordinating drive logistics, including working with UCSF Media Relations, UCSF Communications, UC Police Department (UCPD), facilities management, and parking management. Student volunteer coordinators recruited and managed health professions students to staff the drives. Vitalant contributed all equipment and personnel for collection of blood products. Blood donors from UCSF and the San Francisco community were recruited through internal UCSF messaging and local media coverage. In mid-March, a third-year UCSF medical student was approached by a senior faculty member interested in organizing a blood drive to address the impending blood shortage. Planning began the next day, March 18. Concurrently, under the guidance of the UCSF SOM deans and the UCSF Covid Student Aid initiative, a first-year UCSF medical student surveyed interest in volunteer activities, which yielded 200 students interested in donating blood. These UCSF SOM students became the UCSF Blood Drive project managers, with two senior faculty providing direct guidance and oversight. One faculty sponsor introduced the students to Vitalant to assess potential barriers to organizing multiday drives on UCSF's campuses. Once feasibility was confirmed, the project managers connected with UCSF Health and SOM leadership to form a multidisciplinary, virtual UCSF Blood Drive Working Group consisting of the team members listed above. The group decided to open the drives to the community rather than limiting them to UCSF affiliates only. UCSF-only drives would limit additional foot traffic of non-UCSF personnel on campus; however, it was important to our leadership to ensure that the effort was an inclusive community partnership, consistent with our mission as a public institution. We held the drives at campus sites that were set apart from clinical areas in order to minimize traffic in areas dedicated to patient care. Project managers met with Vitalant staff for an in-person walk-through of potential spaces. Requirements included >1,500 square feet (for optimal physical distancing), adequate electrical supply, ramp accessibility, nearby parking, and separation from clinical areas. We identified ideal spaces at two UCSF campuses: an indoor gymnasium at Parnassus Heights and a banquet hall at Mission Bay. We relied on our Working Group to facilitate use of this space; similar spaces had been converted to meet evolving Covid-19 pandemic needs. We worked with UCSF facilities to ensure appropriate tables and chairs were available. UCPD was brought on board to ensure that community members could enter UCSF's campus. UCSF parking secured space for Vitalant vehicles, including a box truck and minivan, blocking metered spaces and loading areas in front of the donation sites for the duration of drives. The UCSF Communications team created standardized signage to direct donors and minimize unnecessary traffic ( Figure 1 ). In collaboration with Vitalant, UCSF Communications, and our faculty partners, we developed a standardized communication outlining the need for blood donation and addressing potential questions and concerns (Figure 2a, Figure 2b ). Key points included: (1) blood donation is an essential activity under San Francisco's shelter-inplace regulations; (2) risk of transmission of Covid-19 through blood products is minimal5; and (3) appropriate measures would be taken to ensure physical distancing. Our communication strategy included campus-wide outreach to UCSF students and employees; listings on the UCSF Covid-19 webpage and UCSF calendar; an online and print newspaper story; and a social media blast from UCSF students and the UCSF Health official social media pages. All 185 appointment slots were filled within <24 hours of beginning our outreach using Vitalant's online donor recruitment system, with additional individuals added to an alternate list. To support blood drive operations given the adapted workflow, we recruited UCSF student volunteer coordinators, who managed drive staffing and worked with the SOM administration to approve volunteer tasks (Figure 3) . We drew from a large pool of UCSF students, who currently have flexibility given suspended clinical clerkships and remote classroom activities. Although medical schools filled the volunteer roles at our drive, these roles don't require any medical knowledge and could be filled by a diverse set of individuals in drives outside of health care organizations. We collaborated with Vitalant staff and the UCSF Chief Medical Officer to ensure set-up and procedures were adjusted to minimize the likelihood of Covid-19 transmission according to the following protocol ( Figure 4 ): Prior to entering the donation area, all staff, volunteers, and donors received UCSF's standard Covid-19 verbal screen and a temperature check. All check-in and screening stations, waiting area chairs, blood donation tables, and canteen stations were set-up greater than 6 feet apart, and appointments were scheduled every 15 minutes to minimize crowding. We prohibited visitors who were not donating blood and required walk-in donors to leave the area and wait for a phone call rather than waiting in the donor area, as they would in a standard drive. Post-donation canteen snacks were handed out individually. When donation was complete, donors exited from a separate door to maintain forward flow through the space. To comply with Centers for Disease Control and Prevention (CDC) guidelines around universal use of face coverings released on April 3, all Vitalant staff and student volunteers wore surgical masks and gloves during our second drive. Donors were asked to come with an appropriate face covering, and donors without coverings were provided surgical masks. Given the Covid-19-related considerations, fewer appointments than typical for a blood drive were scheduled to maintain physical distancing. Thus, we recognized the necessity of filling every appointment to maximize donations with fewer opportunities. To address donor cancellations more than 24 hours before their appointment, we drew from an alternate list of UCSF students or staff who were employed at each campus. We maximized attendance by sending personalized reminder emails to scheduled donors the night before the drive (in addition to automated reminders from Vitalant's online scheduling system). In any blood drive, Vitalant expects some no-shows, deferrals who do not meet eligibility requirements, and screen-outs. Although we discouraged walk-ins in official communications, we were able to accept a limited number as replacements for no-shows and dropouts or when staff had extra capacity. Through this multipronged approach, the drives ran at 90% of total donation capacity and exceeded Vitalant's red blood cell unit goal for the drive series by 20%. Seventy-three percent of total donors were first-time donors, which is significantly higher than usual and indicates a large, motivated, previously untapped pool of potential blood donors. After publicizing UCSF's blood drives, we were approached by medical students, health professionals, and employees of private organizations across the country interested in holding blood drives at their institutions. We have individually addressed as many questions as possible and hope this case study helps others looking to replicate our model. Overcoming concerns about the appropriateness of blood drives during shelter-in-place: Established that blood drives are essential health care activities as a foundation for this effort. Identifying spaces large enough to allow for physical distancing: Tapped UCSF Health and SOM leadership to rearrange use of space at the hospital administration level. Setting up events to prevent transmission of Covid-19: Implemented universal Covid-19 screening prior to entry. Did not advertise walk-in availability to prevent crowding. Prohibited nondonor visitors. Followed CDC guidelines for personal protective equipment use. Ensured greater than 6 feet physical distance between all stations. Addressing donor concerns about the safety of donating blood during the Covid-19 pandemic: Shared up-to-date evidence affirming that the virus is not a blood-borne pathogen.6 Clearly communicated steps being taken to prevent transmission. Ensuring personal protective equipment (PPE) availability in accordance with CDC guidelines: Required Vitalant to provide PPE for their staff to meet the CDC guidelines. Worked with Covid-19 Command Center to procure masks from the UCSF supply for student volunteers and any donors who required a mask. Operationalizing the blood drive quickly in light of the impending blood shortage: Cleared a wide range of administrative hurdles efficiently through an agile core group aligned with advisory multidisciplinary stakeholders. While typical blood drives take 8-12 weeks to plan, our planning phase spanned 2 weeks, from March 18 to March 31. Adapting to emerging needs during the drive: Ensured that the evolving UCSF Covid-19 screening tool was current. Adapted to new CDC PPE guidelines by requiring masks for all Vitalant staff, providing masks to student volunteers, and sending email reminders about face coverings to donors after the new CDC guidance was released. Our five primary metrics assessed: 1. Compressed start-to-execute time to meet urgent need. Achieved: 2 weeks rather than typical 8-12 weeks. 2. Effective publicity of drives. Achieved: Publicity sufficient to address Covid-19-related concerns and ensure turnout sufficient to meet collection goals, with 100% of appointment slots filled prior to start of drives. • Identify motivated project managers and senior sponsors within the health system. • Engage senior leadership and establish multidisciplinary working group for rapid approval process. • Approach blood provider partner in local community with track record of coming on-site for blood drives. • Establish protocols for preventing Covid-19 transmission in conjunction with blood provider and hospital leadership. • Work with SOM leadership to approve student involvement in managing the project, volunteering for drives, and serving as donors. • Identify point-person on each team for logistical coordination (e.g., facilities, parking, UCPD, printing, communications, student volunteer coordinators, etc.). • Share learnings with other groups interested in holding blood drives under this adjusted model. Health Officer of the City and County of San Francisco. Order of the Health Officer No. C19-07. Department of Public Health. City and County of San Francisco Verge of Serious Shortage': Bay Area Blood Centers Feeling Impact of Coronavirus Outbreak. ABC7 News San Francisco The essential role of patient blood management in a pandemic: a call for action Detection of SARS-CoV-2 in different types of clinical specimens Clinical presentation and virological assessment of hospitalized cases of coronavirus disease 2019 in a travel-associated transmission cluster Special acknowledgements go to UCSF medical students Gio Gemelga, Karly Hampshire, Brian McSteen, and Cameron Niven for their time investment in blood drive operations and volunteer coordination; Andrea Casson from Vitalant for coordinating key logistical aspects of the partnership described here; and the UCSF facilities team for their generosity in donating space for the blood drives.Disclosures: Anya Greenberg and Hope Schwartz have nothing to disclose. Nicholas Hooks is an employee of Vitalant. Dr. Clifford Lowell serves on the Board of Trustees at Vitalant. Dr. John Roberts receives funding from Merck & Co. for unrelated research.