key: cord-0854404-yuzwii3y
authors: Lucchinetti, Claudia F.; von Bormann, Alexander G.; Nagel, Jill J.; Jones, Amie E.; O’Horo, John C.; Callstrom, Matthew R.; Amrami, Kimberly K.; Barth, Jean E.; Breeher, Laura E.; Dowdy, Sean C.; Evers, Theresa S.; Hucke, Dawn L.; Hurt, Ryan T.; Otte, Kimberly K.; Pringnitz, Rachel L.; Prunty, Maureen E.; Ravikumar, Prajnashree; Rushlow, David R.; Sanchez, William; Swift, Melanie D.; Tommaso, Christopher P.; Wehde, Mark B.
title: Mayo Clinic Strategies for COVID-19 Engaging and Empowering the Front Lines During the COVID-19 Outpatient Practice Reactivation
date: 2020-06-30
journal: Mayo Clin Proc
DOI: 10.1016/j.mayocp.2020.06.040
sha: 6a3f4cf64dc5148c6fcfc6c3a31eca9f9007905d
doc_id: 854404
cord_uid: yuzwii3y

nan

The integrated operational and communication network between department/division chairs, SMaRT champions, the SMaRT executive group, and institutional practice leadership not only helps educate and empower the front line of the practice, but it also enables rapid scaling and dissemination of best safety practices across the campuses. SMaRT champions have access to a continually updated toolkit that includes the latest IPAC guidelines, diagnostic testing and screening protocols, environmental assessment tools, COVID-19-specific educational material, and appropriate PPE utilization and stewardship requirements.

Health care workers are acutely aware of regional and international differences in PPE guidance and practice. Staff feel safer about PPE when they have accurate information, and PPE guidance reflects their understanding of risk. IPAC is responsible for creating evidence-based guidelines for proper PPE usage. SMaRT then shares strategies for staff to use the appropriate PPE given the exposure risk, while ensuring ongoing availability of supply.

To manage and mitigate the risk of COVID-19 transmission in the outpatient practice, SMaRT created subsets of teams to oversee 5 prioritized work streams:

1. SMaRT Facilities partners with practice areas to promote physical distancing on campus. Implementing safe-spacing measures requires a combination of data modeling of patient volume, creative use of existing spaces, modified patient flows, and leveraging telemedicine and remote work. coordinated input for preparing a unified recommendation. The recommendation was shared with the ENT champion, along with educational recommendations for staff, areas of opportunity for innovation, and future considerations for mitigating risk. Using the SMaRT network to escalate this concern allowed clear communication to ENT practitioners of what was expected to provide safe care and eliminated contradictions that may have undermined confidence in safety measures.

In early stages of practice reactivation, maintaining physical distancing in patient and staff areas quickly emerged as a leading safety barrier. In response, SMaRT formed a rapid response team to assess and quickly implement physical distancing strategies for prime bottleneck areas, including elevators and patient lobbies. With close facilities collaboration, the first safety procedures were in place within 48 hours. In elevators, floor markings, appropriate signage, and sanitizing stations were added.

Chairs in outpatient lobbies were positioned strategically to preserve maximum seating and attain needed distancing, and a physical distancing toolkit was developed for SMaRT champions. By applying both centralized and decentralized physical distancing strategies as part of a rapid response effort, SMaRT was able to promote safe distancing.

The Centers for Disease Control and Prevention guidance for time required to remove 99.9% of air contaminants based on air changes/hour caused risk concern for aerosol-generating procedures in the practice and also caused inefficient room turnover.

As a result, the SMaRT group initiated a collaborative effort among engineering, facilities, and the practice to improve aerosol clearance. This workgroup measured aerosol clearance rates and found that clearance was 2 times faster in laminar flow rooms than predicted, providing both staff confidence and improved efficiency for the practice.

With countless variables and evolving science, eliminating risk from COVID-19 is unlikely anytime soon. However, in partnership with the clinical practice, SMaRT has created a robust network of safety professionals that ensures Mayo Clinic achieves unparalleled and uncompromising confidence and trust among patients and staff. At Mayo Clinic, a culture of teamwork, mutual respect, and professionalism sets the tone for the practice. In a recent opinion piece, Atul Gawande, 2 a surgeon and public health researcher, wrote about culture as an important element of success in health care's response to COVID-19: "It's one thing to know what we should be doing; it's another to do it, rigorously and thoroughly… [and feel] you can comfortably call one another out when you see a standard slipping." For over 150 years, Mayo Clinic has adhered to the highest safety standards and will continue to do so during the COVID-19 era.

Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic

Amid the coronavirus crisis. A regimen for reentry. The New

Members of the SMaRT Executive Committee: Kimberly K. Amrami, MD; Jean E.