During a recent visit to VA Connecticut Healthcare System (VACHS), the Secretary of Veterans Affairs Colonel Robert Wilkie recognized the efforts of both Shaili Gupta, MBBS, and Christopher Ruser, MD, for their very successful leadership response to the first wave of COVID-19 by presenting them with coins of recognition. The contributions of Gupta were dedicated to inpatient efforts at the VACHS West Haven campus, a 100- bed hospital dedicated to veteran care. Ruser’s leadership focused on orchestrating an outpatient COVID response for the larger system of 55,000 veterans, eight primary care clinics, and 250 primary care staff. Collectively, the efforts of Gupta, Ruser and their teams succeeded, as evidenced by a low overall admission rate, low death rate, and low employee infection rate, as well as their innovative inpatient and outpatient work. In fact, the employee infection rate at VACHS was one of the lowest in the country.
Proactivity and a concentration on good clinical care and staff communication were the themes of Gupta’s actions as the COVID Response Coordinator/Director at VACHS. Specific highlights for which Gupta was recognized were:
- Hospital preparedness prior to arrival of the first COVID-19 patient, as described in Postgraduate Medicine.
- Daily informational huddles with house staff
- Designing and implementing standard operating procedures for house staff and faculty to ensure healthcare workers were protected from occupational exposures and followed the rapidly changing CDC guidelines in caring for their patients
- Liaison with nursing for cohesive efforts
- Weekly question and answer educational and informational sessions for all VA staff
- Leading VA COVID treatment group to design treatment algorithm
- Ensuring and providing first-hand clinical care to those patients admitted to the facility with COVID-19
- Monitoring and following each patient for clinical parameters to help inform management and triaging, which helped to institute early pronation policies, support ICU consult and triage, eliminate hydroxychloroquine well before other institutions did, and help to show that the requirement of supplemental oxygen in the first 24 hours of admittance to the hospital is a predictor of peak severity.
- This transition decreased foot-traffic in the facility; decreased clinic crowding; kept older, at-risk veterans away from potential COVID-infected other veterans or staff; and protected staff from possible infection, but still provided access to primary care and preventive services. VACHS is heading back in this direction during the second wave of the pandemic. At this time, healthcare workers are wearing face masks and shields; have access to improved screening; and clinic targets have been updated to 10% in person and 90% virtual. This model was detailed in the Journal of General Internal Medicine.
- Ruser’s efforts were also highlighted in “Ahead of the Curve: Ruser Helps VACT Respond to COVID-19 Crisis.”
- In addition, VACHS has largely had 24 hour or less turnaround of COVID-19 RT PCR tests, and has tested more than 10,000 veterans since the end of March. The team has participated in numerous clinical improvement efforts including 3-D printed swabs, different viral media/collection kits, and saliva testing to name a few.
For more about the impact of the innovative steps taken at the VA, review their PLOS One article comparing the use of different types of swabs for SARS-CoV2 (COVID-19) testing.
Ruser and his VACHS primary care leadership team were recognized for a broader outpatient response to COVID-19 which included:
- Conversion of all primary care appointment to virtual visits: Within the first six weeks of the first wave, VACHS matched their pre-COVID baseline weekly workload with virtual care, nearly 3,000 visits per week. Initially, many of these virtual consultations were by phone, but the use of VA Video Connect has increased.
- COVID Testing: Ruser communicated with Northeast Medical Group’s Karen Brown, MD, in the early days of the first wave to learn about their drive-thru testing plan. In collaboration with medical personnel Joe Battagliotti, LPN; Scott Beauregard, RN; Kim Roy, RN; Monte Wagner, APRN; David Rosenthal, MD; Gary Stack, MD, PhD, chief of lab medicine; and Wendy Strollo, lab director; and VA Assistant Chief of Police David Salthouse and Bryan Owens of VA Emergency Response to launch VACHS’s first drive-thru testing site at the U.S. Department of Veterans Affairs Health Care Center Annex / Errera Community Care Center in Orange, Conn. They later added a second site in Newington.
- Virtual respiratory clinics: Separate from efforts to virtualize regular primary care, VACHS built virtual respiratory clinics. These were two three-hour sessions daily, in the morning and evening. Sessions were expanded when demand was high. These clinics were staffed by volunteer providers. Run by Patricia Pitkin, APRN, the clinical contact center received a clinical call; had a nurse available to do a first-pass triage; and provided a warm handoff to a clinician staffing the virtual respiratory clinic. This provider would do a phone or video visit to determine if the veteran needed outpatient testing and follow-up or acute medical care. By providing this service, they streamlined assessment of veterans with possible COVID-19; kept them out of the crowded Emergency Department; and funneled them rapidly to get testing. For the second wave, VACHS improved the process by allowing registered nurses in the call center to order COVID PCR tests and schedule simultaneously with those providers staffing the virtual respiratory clinic.
- Drive-thru vaccination: VACHS leveraged their drive-thru testing sites to provide a safe alternative to traditional face-to-face vaccine administration. To date, they have given over 10,000 vaccinations in drive-thru, including both the influenza and shingles vaccines. This experience will be used to help in planning the COVID vaccine response.
- In June 2020, Rosenthal received a proclamation from New Haven’s Mayor Justin Elicker in recognition of his “commitment to the public health and well-being of our community,” for his work setting up a COVID-19 shelter for the homeless in New Haven. Watch Mayor Elicker’s virtual press conference from June 8, 2020 to learn more (start at 4:59).
- The initiative was also highlighted in ShoreLine Times.
With all these success stories, the diligence of Gupta and Ruser did not go unnoticed. In military tradition, as a token of affiliation, support, patronage, respect, loyalty, honor, and gratitude, VA Secretary Wilkie awarded them each with coins of recognition. Although traditionally given between military officials, these coveted coins are an honor also given to civilians for a job well done. While Gupta and Ruser were officially presented with the coins, they acknowledge the team effort, leadership, and guidance received by their VACHS colleagues