Tales of a department: how the COVID-19 pandemic transformed Detroit’s Henry Ford Hospital, Department of Neurology—part I: the surge

Ramadan, Ahmad Riad; Alsrouji, Owais; Cerghet, Mirela; Chopp, Michael; Danoun, Omar A.; Grover, Kavita; Ismail, Mohammed; Katramados, Angelos; Mohamed, Ghada A; Mehta, Chandan; Newman, Daniel S.; Osman, Gamaleldin; Reuther, Jackie; Sallowm, Yamin; Zaman, Iram; Barkley, Gregory L.

doi:10.1136/bmjno-2020-000070

Cited by 6 publications

(5 citation statements)

References 2 publications

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“…During the COVID-19 pandemic, Detroit city and Southeast Michigan were among the early epicenters in the United States [4] . We initiated a collaboration of large medical centers and academic institutions in the region to better characterize EEG findings, assess the prevalence of seizures and status epilepticus in patients with COVID-19 and the functional outcomes grouped as recovered, recovered with disability or deceased.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of seizures, status epilepticus, and EEG findings in critically ill patient with COVID-19

Danoun

Zillgitt

Hill

et al. 2021

Epilepsy & Behavior

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Objective Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a myriad of neurological manifestations and its effects on the nervous system are increasingly recognized. Seizures and status epilepticus (SE) are reported in the novel coronavirus disease (COVID-19), both new onset and worsening of existing epilepsy, however the exact prevalence is still unknown. The primary aim of this study was to correlate the presence of seizures, status epilepticus, and specific critical care EEG patterns with patient functional outcomes in those with COVID-19. Methods This is a retrospective, multicenter cohort of COVID-19 positive patients in Southeast Michigan who underwent electroencephalography (EEG) from March 12 th through May 15 th , 2020. All patients had confirmed nasopharyngeal PCR for COVID-19. EEG patterns were characterized per 2012 ACNS critical care EEG terminology. Clinical and demographic variables were collected by medical chart review. Outcomes were divided into recovered, recovered with disability, or deceased. Results Out of the total of 4100 patients hospitalized with COVID-19, 110 patients (2.68%) had EEG during their hospitalization; 64% were male, 67% were African American with mean age of 63 years (range 20-87). The majority (70%) had severe COVID-19 were intubated or had multiorgan failure. The median length of hospitalization was 26.5 days (IQR=15 to 44 days). During hospitalization, of the patients who had EEG, 21.8% had new onset seizure including 7% with status epilepticus, majority (87.5%) with no prior epilepsy. Forty-nine (45%) patients died in the hospital, 46 (42%) recovered but maintained a disability and 15 (14%) recovered without a disability. The EEG findings associated with outcomes were background slowing/attenuation (recovered 60% vs recovered/disabled 96% vs died 96%, p<0.001) and normal (recovered 27% vs recovered/disabled 0% vs died 1%, p<0.001). However, these findings were no longer significant after adjusting for severity of COVID-19. Conclusion In this large multi-center study from Southeast Michigan, one of the early COVID-19 epicenters in the US, none of the EEG findings were significantly correlated with outcomes in critically ill COVID-19 patients. Although seizures and status epilepticus could be encountered in COVID-19, the occurrence did not correlate with the patients’ functional outcome.

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Section: Introductionmentioning

confidence: 99%

Outcomes of seizures, status epilepticus, and EEG findings in critically ill patient with COVID-19

Danoun

Zillgitt

Hill

et al. 2021

Epilepsy & Behavior

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“…Most of our inpatient services, with the exception of the neurointensive care unit, were converted to isolation units to accommodate a rising number of patients with COVID-19 while hospitalisations for neurological diagnoses experienced a sharp decline, as reported by ourselves and others. 4 5 Eighteen of the 24 neurology residents and 3 of the 7 fellows were redeployed to cover COVID-19 services. The residency programme director and chief residents together determined which residents were to be redeployed based on the residents’ rotation schedules.…”

Section: Discussionmentioning

confidence: 99%

“…5 We have previously Open access described our experience and challenges as a Neurology Department at the beginning of the pandemic. 4 In this study, we surveyed our own neurology trainees and teaching faculty using two anonymous and voluntary webbased questionnaires to assess their viewpoints on the impacts the pandemic had on our trainees' well-being, performance, education and clinical experience. To our knowledge, this is the first study to analyse and compare perceptions through surveying both neurology faculty and trainees at a teaching institution serving an area hit hard by the early COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, we described the organised response of our HFHS Department of Neurology response to the pandemic which included putting a moratorium on all ‘non-essential’ rotations, redeploying residents to provide care for patients in overwhelmed COVID-19 units, implementing teleneurology outpatient visits, and shifting to online learning modules and lectures. 4 In this study, we conducted two anonymous surveys: one distributed to our neurology trainees (residents and fellows) and one given to our neurology faculty, to assess and compare their perceptions of trainees’ medical education, clinical experience and well-being during the pandemic. To our knowledge, this is the first study to objectively report both neurology trainee and teaching faculty perspectives on the challenges faced in education and work conditions during the early COVID-19 response.…”

Section: Introductionmentioning

confidence: 99%

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Single-centre study surveying neurology trainees’ and faculty’s perceptions of the impact of the COVID-19 pandemic on residents’ medical education

et al. 2021

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ObjectiveTo assess perceptions of our neurology residents and faculty regarding training experience and medical education during the early COVID-19 pandemic.MethodsWe distributed two online, voluntary and anonymous surveys to trainees and teaching faculty of our Neurology Department at Henry Ford Hospital. Surveys inquired about trainees’ stress, well-being, clinical experience and satisfaction with medical education and available support resources during the first wave of the COVID-19 pandemic in Michigan (mid-March to June 2020).ResultsA total of 17/31 trainees and 25/42 faculty responded to the surveys. Eight (47%) trainees reported high stress levels. Nine (57%) were redeployed to cover COVID-19 units. Compared with non-redeployed trainees, redeployed residents reported augmented medical knowledge (89% vs 38%, p=0.05). There was no difference in the two groups regarding overall satisfaction with residency experience, stress levels and didactics attendance. Twenty-one (84%) faculty felt that the redeployment interfered with trainees education but was appropriate, while 10 (59%) trainees described a positive experience overall. Both trainees and faculty believed the pandemic positively impacted trainees’ experience by increasing maturity level, teamwork, empathy, and medical knowledge, while both agreed that increased stress and anxiety levels were negative outcomes of the pandemic. Twelve (70%) trainees and 13 (52%) faculty were interested in pursuing more virtual didactics in the future.ConclusionOur findings provide an objective assessment of residents' experience during the COVID-19 pandemic and can guide teaching programmes in their medical education response in the face of future global crises.

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“…The COVID‐19 pandemic created a dualistic problem for health systems–while ED and inpatient volumes rose, outpatient visits declined. 8 , 9 , 10 , 11 The surgery department, in particular, had many procedure postponements as the pandemic grew and the stay‐at‐home mandate was issued. By mid‐March, ambulatory surgery centres were completely closed, with only time‐sensitive procedures allowed.…”

Section: Health Care Infrastructure and Processmentioning

confidence: 99%

COVID‐19 in the hotspot of Metropolitan Detroit: A multi‐faceted health system experience

Gifford

Johnson

Haque

et al. 2021

Health Planning & Management

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Health systems were abruptly plunged into a crisis as SARS-CoV-2 exploded into a pandemic in spring 2020. In March-April 2020, Metropolitan Detroit was a US "hotspot. " As a large health system with five hospitals and two behavioural health inpatient facilities, a health insurance company, a medical group and physician network, and 41 ambulatory clinics normally hosting over 10,000 daily patient encounters, the Henry Ford Health System deployed numerous strategies in the management of this upheaval. As hospitals and Emergency Departments were inundated with COV-ID-19 patients, other services and activities needed to shut down as state-mandated policies were promulgated, new internal and external communication networks established, and management of employees and resources such as ventilators, ICU beds, personal protective equipment, and laboratory supplies became critical challenges. We describe herein the system-wide strategies implemented and lessons learned in the operation of a health system in the initial throes of a global pandemic.

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Tales of a department: how the COVID-19 pandemic transformed Detroit’s Henry Ford Hospital, Department of Neurology—part I: the surge

Cited by 6 publications

References 2 publications

Outcomes of seizures, status epilepticus, and EEG findings in critically ill patient with COVID-19

Outcomes of seizures, status epilepticus, and EEG findings in critically ill patient with COVID-19

Single-centre study surveying neurology trainees’ and faculty’s perceptions of the impact of the COVID-19 pandemic on residents’ medical education

COVID‐19 in the hotspot of Metropolitan Detroit: A multi‐faceted health system experience

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