key: cord-0859388-wtqqze2d
authors: Codispoti, Christopher D.; Bandi, Sindhura; Moy, James; Mahdavinia, Mahboobeh
title: Running a virtual allergy division and training program in the time of COVID-19 pandemic
date: 2020-03-31
journal: J Allergy Clin Immunol
DOI: 10.1016/j.jaci.2020.03.018
sha: 823306ecad430ec8592b97151e8821c0666f1e3f
doc_id: 859388
cord_uid: wtqqze2d

nan

The COVID-19 pandemic has expanded rapidly in the US and around the globe, much faster than 24 anticipated. Hundreds of thousands are infected and unfortunately plenty of patients have died. As an 25 academic allergy and Immunology division in a large city, our clinical, educational, research and 26 community responsibilities have been tremendously impacted. Patients needed us more than ever, but 27 mitigation efforts prevented us from seeing them routinely in person. Three weeks ago, as the first 28 severe case of COVID-19 in Chicago was diagnosed and admitted to our ICU, we understood we needed 29 immediate plans. The change happened in multiple categories; clinical operation, training programs and 30 research (table 1) . While in the past decade we have witnessed a tremendously rapid progress in 31 communication technology, these changes pale in comparison to the speed of change within the last 3 32 weeks. It was the time to harness this technology to be used for educational activities and patient care. 33

Here, we report on the changes to our clinical and educational activities in response to the COVID-19 34 pandemic. 35

With the exception of urgent visits and biologic medication administration, outpatient clinical 37 operations were transitioned to telemedicine. All faculty and fellows were trained emergently to 38 perform virtual medicine through video and phone visits. Our inpatient consult service changed shape as 39 well; the requested consults ran through an algorithm based on the need for physical examination, and 40 the risk to COVID-19. Faculty volunteered in COVID-19 telemedicine clinics , which provided a unique 41 opportunity to augment our typical curriculum evolving COVID-19 guidelines. The insight gained was 42 tremendously helpful, not only for referring potential COVID-19 cases, but also for understanding the 43 impact of this infection on allergic conditions. The changes and strategies implemented by our division 44 are summarized in table 1. 45

The training program was faced with difficult decisions on how to maintain clinical training. Previous 48 reviews have found that supervision using telehealth can be an effective method of clinical training. [2] . 49

Both faculty and fellows were trained and provided with adequate information technology support. 50

Faculty, who had previous experience with telemedicine visits, supervised the fellow's telehealth 51 training. Fellows were instructed via university-provided web-based sessions, through both pre-52 recorded and live interactive sessions, on virtual visits. After these tutorials, fellows were directed to use 53 the virtual hospital desktop. The virtual desktop can be accessed remotely by their office or home 54 computer, in conjunction with a smartphone or tablet-based video-conferencing application to perform 55 visits. After web-based tutorial training was completed, the fellow's first virtual visit occurred in a 56 cleaned patient room while the patient was at home. These ad-hoc offices improved social distancing 57 for the fellows. After the review, the supervising attending allergist joined the patient and fellow in a 58 concluding group virtual visit. The first virtual visits allowed the supervising Allergist to help the fellow 59 navigate the EMR, trouble shoot, and fix any problem in person. Once the fellow was comfortable, we 60 allowed fellows to work from home. We also identified a need for future emergency planning, given the likelihood of the crisis worsening. 106

There would be more difficulties, such as COVID-19 infection among faculty, fellows and support staff, 107 and increased inpatient responsibilities for all physicians including allergists. Contingency plans and 108 schedules were placed for both inpatient and outpatient responsibilities with two lines of backup for 109 faculty, fellows and other staff. Furthermore, we shared detailed information on the available resources 110 by university for stress management, employee and family health and contingency child care . 111 the WAO, the AAAAI and the ACAAI in these difficult times to share experiences and knowledge to 120 overcome present and future difficulties. 121 122 123 • Faculty volunteered to screen concerned patients for COVID-19 • Nurses volunteers in various COVID-19 testing areas • All providers were added to hospital surge lists for COVID-19

ACGME Guidance Statement on Coronavirus (COVID-19) and Resident/Fellow

Education and Training Considerations

Coronavirus-COVID-19-and-Resident-Fellow-Education-and-Training-Considerations

A systematic review of the factors that influence the 130 quality and effectiveness of telesupervision for health professionals

Special Article: 133 COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic

Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 in H.R.6074 -135 116th Congress