Angela Mills, MD, "COVID-19: Lessons learned from Columbia emergency medicine"

Dr. Mills presented on the COVID-19 experiences of four clinical ED sites associated with Columbia/NYP: Milstein, Morgan Stanley Children’s Hospital, Allen, Lawrence. The ED department across these four sites consists of 117 faculty, 38 physician assistants, 48 residents, and 12 fellows (shared with Cornell). In a typical year, they see 250,000 patients and 20% of those are admitted but during the pandemic, they have seen admission rates of up to 50% in a day. At the beginning/middle of March, the ED was already seeing high patient volume due to the flu and other viruses so they had to adapt to meet the increasing community demand: they partnered with primary care providers to staff tents to triage those that were less sick, they had stable young adults (up to age 35) transfer to MSCH ED, the peds ED provided additional telehealth visits to young adults and now all adults experiencing COVID-19 like symptoms, they partitioned the waiting room space to house those that were less sick, and they integrated palliative care in the ED. They started sending patients with mild symptoms home with a pulse oximeter and have found that sometimes they return to the ED when symptoms worsen or are being managed by their primary care provider. The Columbia/NYP ED has nightly calls with 9 other EDs throughout NYC and they have created standardized care pathways ranging from those with mild symptoms to those needing palliative care. The ED has tried to implement several measures to reduce healthcare worker stress and burnout—wellness mentoring from Psychiatry, food deliveries, hairdresser services, informational sessions with infectious disease doctors etc. Despite all of these measures, what remains to be seen are the downstream mental health effects on clinicians and staff since other countries are seeing that many individuals are not returning to health care work.

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