Issuu

together healthy A Publication of

ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL SOMERSET

HEROES WORK HERE NOW YOUR DOCTOR IS JUST A

CLICK AWAY INSIDE THE

FRONT LINES

Somerset_Cover_COVID19_final.indd 1

COVID-19 SPECIAL ISSUE

WELCOME BACK! WEâ€™RE READY FOR YOU

6/2/20 8:37 AM

A MESSAGE FROM LEADERSHIP

Staying Healthy Together

or all of us who call New Jersey home, the COVID-19 pandemic has been a sobering reality. Every one of us has been affected in some way, and some have lost loved ones. To them, we extend our sincerest condolences. Throughout these extraordinary months, New Jerseyans have come together to encourage each other and the hospitals that care for their communities. At RWJBarnabas Health, we truly have been inspired by the support we’ve received, and offer our heartfelt thanks for every donation and card, and for the countless other gestures of caring. Most of all, of course, we wish to express our gratitude to our amazing staff— doctors and nurses caring for patients; hospital workers in the offices and on the floors; researchers seeking a cure and a vaccine; those charged with carrying out demanding new cleaning procedures; and those who have quickly adapted our facilities to care for COVID-19 patients. Now, it’s important to look ahead and begin caring for ourselves again. During the height of the pandemic, many people delayed getting healthcare—a choice that can have devastating consequences. Please rest assured that we’ve gone above and beyond all the measures recommended by the Centers for Disease Control and other national and regional experts to keep everyone in our facilities safe. Our team at Robert Wood Johnson University Hospital Somerset stands ready to schedule outpatient testing you may have been putting off, including your annual screening mammogram; to resume your physical, occupational or speech therapy in-person or via our new telehealth service; or to plan your elective surgery, including hip or knee replacement. Our Behavioral Health Services offers treatment for anxiety and depression, as well as specialized care for individuals with eating disorders. As always, our Emergency Department is here to handle any urgent medical issue, from broken bones to heart attacks and stroke. We look forward to supporting your good health in whatever way we can. Welcome back. Yours in good health,

HEALTH NEWS PROVIDING TOP QUALITY CARE Robert Wood Johnson University Hospital (RWJUH) Somerset, an RWJBarnabas Health facility, has earned an “A” Hospital Safety Score— the highest patient safety rating—from The Leapfrog Group, an independent hospital watchdog organization. It is the hospital’s fourth consecutive “A” rating and tenth overall. “RWJUH Somerset is committed to achieving the highest levels of quality in the care we deliver to our community, and this recognition from The Leapfrog Group is a testament to the work of a very talented and dedicated team and staff,” says Tony Cava, President and Chief Executive Officer, RWJUH Somerset.

MEDEMERGE JOINS RWJBARNABAS HEALTH

Medemerge, an urgent and primary care practice in Green Brook, recently joined the RWJBarnabas Health family. It offers walk-in medical appointments seven days a week. During the COVID-19 pandemic, the center provided drive-through testing.

ANTHONY CAVA

BARRY H. OSTROWSKY PRESIDENT AND CHIEF EXECUTIVE OFFICER RWJBARNABAS HEALTH

PRESIDENT AND CHIEF EXECUTIVE OFFICER ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL SOMERSET 110 Rehill Ave., Somerville, NJ 08876 | 908.685.2200

CONNECT WITH US ON @RWJSomerset @RWJSomerset RWJBarnabas Health RWJUH Somerset complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. For more information, see link on our home page at rwjbh.org/somerset. RWJUH Somerset cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. ATENCIÓN: Si usted habla español, servicios de asistencia lingüística, de forma gratuita, están disponibles para usted. Llame al 908.685.2200. RWJUH Somerset konfòm ak lwa sou dwa sivil Federal ki aplikab yo e li pa fè diskriminasyon sou baz ras, koulè, peyi orijin, laj, enfimite oswa sèks. ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 908.685.2200.

Healthy Together

| 2 |

Somerset_Memo_Covid19_REV1.indd 2

COVID-19 Special Issue

6/3/20 2:42 PM

together healthy contents COVID-19 SPECIAL ISSUE

6 2. WELCOME LETTER. A community update from our CEOs. 4. HEROES WORK HERE. We’re beyond grateful for the incredible work of our teams on the COVID-19 front lines.

10 9. STAYING STRONG WHILE SOCIAL DISTANCING. Simple steps can help you regain a feeling of control.

14. NEW WAYS TO LEAD IN CANCER TREATMENT. Collaboration and innovation are driving a new era in oncology. 15. ADVANCED OPTIONS FOR TREATING AUTISM. Telehealth services and intensive treatments offer new help.

6. DONORS ARE HEROES, TOO. A sampling of the valuable—and much appreciated— support we’ve received during the pandemic.

10. 6 QUESTIONS ABOUT TELEMEDICINE, ANSWERED. You don’t have to be a technology whiz to have a video visit with your doctor.

16. POWER PARTNERSHIPS. Working together to help make New Jersey healthier.

8. BACK TO LIFE. How a drug trial may have helped one man beat COVID-19.

12. CLINICAL TRIALS: WHAT EVERY CANCER PATIENT SHOULD KNOW. A trial offers patients a chance to benefit from the latest treatment.

17. YOUR SUPPORT SUSTAINS US. Communities have stepped up for their local hospitals—and you can still help.

Robert Wood Johnson University Hospital Somerset

Somerset_TOC_Covid19_final.indd 3

18. INSIDE THE FRONT LINES. Five healthcare providers share what their roles mean to them and to their patients. 20. SAFE AND SOUND IN THE E.D. Rigorous procedures ensure the safety of Emergency Department patients and staff. 22. WELCOME BACK! COVID-19 testing of staff and patients, extreme cleaning and many other measures make our facilities safe for care.

RWJBH.ORG/SOMERSET

| 3

6/2/20 8:58 AM

HEROES WORK HERE 4

eroes are everywhere at Robert Wood Johnson University Hospital Somersetâ€”from the bedside to all of the departments working behind the scenes. We salute everyone on our team for their roles in helping us care for patients with COVID-19.

Healthy Together

| 4 |

Somerset_Heroes_Covid19_final.indd 4

COVID-19 Special Issue

6/2/20 10:07 AM

1 MOBILE HEALTH SERVICES: This team stands ready to respond to any emergency. Members were literally on the front line of the COVID-19 pandemic as first responders. 2 PASTORAL CARE: During the COVID-19 pandemic, our pastoral care department connected patients and families in prayer through virtual visits via FaceTime or Skype.

3 PEER RECOVERY: Lay specialists in peer recovery from the RWJBarnabas Health Institute for Prevention and Recovery offer support to patients with addiction disorders. 4 LABORATORY: Our clinical laboratory professionals worked 24/7 to collect and process specimens from patients suspected of having COVID-19. Their efforts helped ensure accurate test results that doctors need to help diagnose and treat patients.

5 ENVIRONMENTAL SERVICES: This important team worked diligently to clean the hospital, keeping us all healthy and safe.

CENTRAL STERILE PROCESSING: Sterilizing hepa filters and ventilators used by COVID-19 patients is a critically important job. This group also sterilizes N95 masks worn by staff so they can be safely reused. 6

7 RESPIRATORY THERAPY: COVID-19 is a respiratory illness, so the role of our respiratory therapists is vital in managing their care. They check patients on ventilators every four hours and continuously monitor their oxygen levels.

8 LATINO COMMUNITY OUTREACH: Our Community Health department, our Diversity and Inclusion department, and the SALUD Business Resource Group worked with Bound Brook officials to distribute masks, hand sanitizer and information on the prevention of COVID-19. Community Health also made more than 4,100 phone calls to members of the Latino community.

PHARMACY: The Pharmacy team ensures that patients get the medications they need around the clock, including sedatives, painkillers and antibiotics that help manage the pain and comfort of COVID-19 patients on ventilators. The hospital also is part of a clinical study to evaluate the safety of an investigational antiviral drug, Remdesivir, in the treatment of COVID-19 patients. 9

10 RADIOLOGY: Conducting scans and X-rays that help doctors diagnose COVID-19 and understand the progression of the disease helps to ensure that patients receive the best treatment as their situation evolves. Â

11 CRITICAL CARE: Our Critical Care nurses and intensivists cared for our sickest COVID-19 patients, many of whom were on ventilators. In addition, we had four patient care units dedicated exclusively to the care of COVID-19 patients. 12 REHAB SERVICES: COVID-19 patients need many services on their road to recovery. After a patient is removed from a ventilator, our speech pathologists evaluate their ability to begin eating solid food. Before patients go home, our physical and occupational therapists work with them to build up their strength. 13 SUPPLY CHAIN: Our supply chain team ensured that we had sufficient stock of personal protective equipment (PPE), hand sanitizer and cleaning supplies to prevent the spread of COVID-19. 14 BEHAVIORAL HEALTH: These experts help individuals who have difficulty coping during this challenging time. The department provides inpatient, partial hospitalization and intensive outpatient treatment for conditions such as anxiety disorders, depression, addiction and eating disorders. 15 SCREENERS: Employees from outpatient areas were redeployed to assist in other areas of the hospital, including serving as screeners in the main lobby and Steeplechase Cancer Center lobby. Everyone entering the hospital is screened for flu-like symptoms, has their temperature taken and is given a mask to wear throughout the hospital. 16 MAINTENANCE: Our Maintenance team helped retrofit our Critical Care rooms to move infusion pumps into the hallway, reducing the number of times nurses needed to enter the room of a COVID-19 patient to lessen potential exposure and conserve PPE.

To share your thanks or make a donation in support of our healthcare heroes, visit www.rwjbh.org/heroes.

Robert Wood Johnson University Hospital Somerset

Somerset_Heroes_Covid19_final.indd 5

RWJBH.ORG/SOMERSET

| 5

6/2/20 10:07 AM

HAPPY FEET 1-East nurses say “thank you” for a donation of comfortable Crocs.

DONORS ARE HEROES, TOO T

he outpouring of support from our community during the COVID-19 pandemic has been simply incredible. This support came to Somerset Health Care Foundation in many forms, including monetary gifts, donated meals, supplies, personal protective equipment (PPE), hand-sewn masks, mask extenders, shoes and Crocs, care packages, parades, and inspirational cards and signs. All of us at Robert Wood Johnson University Hospital Somerset are so appreciative of your generosity. It helped lift our spirits and renewed our strength. Thank you from the bottom of our hearts! Shawn Temple of the Front-Line Appreciation Group (FLAG) in Somerville (right) delivered meals to hospital staff. George Jonkoski, director, Food & Nutrition (second from left) managed meal distribution.

MEAL DONATIONS NOURISHED OUR BODIES AND SOULS It began with a few pizzas sent for our nursing staff. But soon it became a steady delivery of breakfasts, lunches and dinners, seven days a week for more than two months. In all, we received more than $350,000 in in-kind food donations, from Italian, Mexican, Thai, Chinese and Indian dinners to subs, sandwiches, salads, donuts, pastries and breakfast sandwiches. Many of the meal donations were coordinated by the Front-Line Appreciation Group (FLAG) in Somerville, led by Shawn Temple, which raised funds to purchase meals from local restaurants and delivered them to the hospital. One of our teen volunteers, Navleen Boparai, and her brother Raj, both students at Hillsborough High School, also started a “Meals for Heroes” initiative. The Hillsborough Junior Raiders, the Hardwood Club, Manville Pizza and countless other individuals, schools, businesses, local restaurants, first responders and Girl Scout and Boy Scout troops also donated meals for our staff. In addition, the Downtown Somerville Alliance donated individual gift cards from Somerville restauranteurs to be distributed to our front-line team.

You can still help our healthcare heroes! Visit www.rwjbh.org/give.

Healthy Together

| 6 |

PARADES OF THANKS The Somerville Elks coordinated a heartwarming “Heroes Procession of Thanks.” On April 3, 2020, a caravan of more than 250 cars drove around Robert Wood Johnson University Hospital Somerset with signs of support and thanks for our staff. They also presented our staff with more than $4,000 in gift cards and lottery tickets. Special thanks to the event organizers, Kayla Fraunheim, Pierce Fraunheim, Jim Daly, Brooke Rogers and Jim McGrady. In addition, many thanks to Paul Hubert, chairman, Somerset Health Care Foundation Board of Trustees, and John Ament, member, Somerset Health Care Foundation Board of Trustees, for their support. State Sen. Christopher “Kip” Bateman also participated in the caravan. In May, Laurel Circle retirement community in Bridgewater and the Manville Chapter of the Latin American Motorcycle Association showed their support while driving past the hospital.

COVID-19 Special Issue

Somerset_Donations_Covid19_final.indd 6

6/2/20 9:37 AM

Marc Milano, MD, medical director of Robert Wood Johnson University Hospital Somerset’s Emergency Department, fourth from right, with Emergency Department staff on Crazy Pants Day.

DONATION OF CRAZY PANTS LIFTED SPIRITS

CHILDREN’S SPECIALIZED HOSPITAL (CSH) The Long Term Care team of CSH in Mountainside thanks the Front Line Appreciation Group (FLAG) for a donation of breakfast sandwiches.

A donation of colorful yoga pants by Gwen Stanton, LuLaRoe Fashion Retailer with Gwen’s Amethyst Boutique, sparked a #pantsthevirus movement at Robert Wood Johnson University Hospital Somerset. Marc Milano, MD, medical director of the Emergency Department, took a few of the pants with crazy patterns and began wearing them to the hospital each day. After seeing how the pants brought smiles to everyone’s faces, he continued to wear “crazy pants” every day throughout the COVID-19 pandemic to boost employee morale. Staff throughout the hospital joined him in wearing crazy pants on Spirit Day.

From left to right, Somerset County Freeholder Brian Gallagher, Tony Cava, president and CEO of Robert Wood Johnson University Hospital Somerset, State Sen. Christopher “Kip” Bateman and Tim Hionis of Hionis Greenhouses.

SPRING FLOWERS BRIGHTENED OUR DAYS Hionis Greenhouses in Readington Township donated more than 2,000 spring flowers that were distributed to Robert Wood Johnson University Hospital Somerset employees Easter weekend. The donation was facilitated by State Sen. Christopher “Kip” Bateman.

Angela Lee (front, left), patient navigator for the hospital’s Chinese Medical Program, with a donation of 3,000 masks from the Buddhist Light International Association N.J. Chapter, whose president, Paul Tong, is standing on the right.

SUPPLY DONATIONS FILLED CRITICAL NEEDS Donations of supplies, including masks, face shields, hand sanitizer and ventilators, helped us safely care for our patients with COVID-19 and prevent the spread of the virus. We’re grateful to the many individuals, businesses and partners in the Indian and Chinese communities who generously donated more than $50,000 in critical supplies. In addition, we received supplies from medical staff members, including Charles Accurso, MD, Michael Rodricks, MD, and Rachana Kulkarni, MD.

THANK-YOU CARDS BROUGHT SMILES We received hundreds of thankyou cards and signs from schools, Girl Scout and Boy Scout troops and individuals throughout our community, which we displayed all around the hospital.

Robert Wood Johnson University Hospital Somerset

Somerset_Donations_Covid19_final.indd 7

RWJBH.ORG/SOMERSET

| 7

6/2/20 9:38 AM

Jessee Kotch with his children, Evan and Erin, on the new floor he finished laying just before he became critically ill with COVID-19.

A PROMISING DRUG TRIAL

BACK TO LIFE HOW A DRUG TRIAL MAY HAVE HELPED ONE MAN BEAT COVID-19.

ne weekend in the middle of March, 52-year-old Jessee Kotch was busy laying a new floor in his family room. Finishing up on Sunday, he noticed he didn’t feel well. He had chills, but no fever. A manager for UPS, Jessee went to work as usual on Monday, but came home early and went straight to bed. “He slept for 14 hours,” says Lisa Church, Jessee’s RONALD G. NAHASS, MD fiancé. Healthy Together

| 8 |

The rest of the week was a blur for Jessee. “I missed days of work that I wasn’t aware of,” he says. “But I had no cough or shortness of breath. It never entered my mind that I had COVID-19.” On Saturday, March 28, Jessee got out of bed to have dinner with Lisa, his mother, Jo Anne, and his children— Evan, age 4, and Erin, age 3. Later that evening, Jessee was shocked to notice his fingernails were blue. “I Googled it,” says Lisa, “and found that it means you aren’t getting enough oxygen.” Soon after, she drove Jessee to the Emergency Department (ED) at Robert Wood Johnson University Hospital Somerset.

As fate would have it, the hospital is one of three RWJBarnabas Health (RWJBH) facilities that are part of a national clinical trial testing the antiviral drug Remdesivir for treatment of COVID-19. Jessee learned that he met the criteria for the study and decided to enroll. “I met Jessee in the ED,” says Ronald G. Nahass, MD, MHCM, an infectious disease specialist and principal investigator for the study at RWJBH. “The next day he ended up in the ICU. He was as sick as you can get with COVID. I wasn’t optimistic that he would survive.” On Tuesday night, Jessee was put on a ventilator to help him breathe. In the coming days, doctors tried everything to help him fight the virus. “Jessee was sedated, unconscious and paralyzed by medications to keep him still, and on a breathing machine,” says Dr. Nahass. “It was a very tenuous situation.” But in his darkest hour, Jessee’s body started to come back to life. “I’d describe it almost as a switch that flips suddenly,” says Dr. Nahass. “You watch patients and you absolutely can tell: Oxygen goes up, carbon dioxide goes down and blood pressure normalizes. It’s like the virus says, ‘I give up.’ From then on, all of a sudden there’s steady improvement.” Could Remdesivir be a COVID-19 cure? “It’s clearly an advance,” says Dr. Nahass. “We’ve seen clinical and lab-based evidence now that it works. But it’s not the final answer. We’ve lost some people who took this drug, too. The hope is that what we’re learning now will lead to better solutions in the future.” After a month in the hospital, Jessee was discharged. The staff celebrated by clapping as he came through the hallway in his wheelchair, which they’d decorated with streamers “I’d like to thank the doctors and nurses who cared for me, as well as all the people involved in my care who I never even met,” says Jessee. “They’re absolutely heroes. Everybody was aces.”

COVID-19 Special Issue

Somerset_PatientStory_Covid19_final.indd 8

6/2/20 9:58 AM

Dr. Ghinassi. “Create ways to communicate with people who are important to you, using FaceTime, letters, phone calls or whatever medium you do best. And keep in mind that Snapchat and Instagram are oneway communication, not true socializing.”

STAYING STRONG WHILE SOCIAL DISTANCING SIMPLE STEPS CAN HELP YOU REGAIN A FEELING OF CONTROL.

he COVID-19 pandemic has brought all kinds of uncertainty— to our finances, our health and our ability to make plans. “People have lost an important aspect of control over their activities,” says Frank Ghinassi, PhD, ABBP, Senior Vice President, Behavioral Health and Addiction, RWJBarnabas Health, and President and CEO of Rutgers University Behavioral Health Care. “As a result, we’re seeing a lot of people feeling stressed—and even a little more than that, feeling distressed. “We all had a rhythm and routine for our days,” he continues, “from what time we took a shower to how we dressed for work to the kinds of things we did for fun. Now all of those old rhythms are challenged, and that makes people feel confused and offbalance.” While that’s a perfectly normal FRANK GHINASSI, PHD reaction, Dr.

Ghinassi says it’s important to take the next step. “Ask yourself, ‘What can I do in this new reality to help myself feel better and more in control?’” The answer lies in reintroducing predictability, to the degree possible in this unpredictable time. • Create a new routine. “Establish a new set of patterns,” advises Dr. Ghinassi. “Go to bed and get up in a regular way. Eat at set intervals, not all day long just because you’re not far from the refrigerator. Work out or take a walk regularly. These new routines will become familiar and comforting.” • Make plans to socialize with others. “Meaningful connection with family and friends is not going to happen automatically,” says

• Build a new set of activities that give you pleasure. “A lot of things we like to do can’t happen now because they involve going to crowded places like movie theaters, restaurants, concerts and stadiums. We need to find activities that will bring us pleasure and are doable within our current limitations,” says Dr. Ghinassi. “That could involve playing or listening to music, streaming films, gardening, painting or any other enjoyable hobby.” If social distancing has led to behaviors that could be destructive, such as overeating or drinking too much, or if the blues have crossed the line into depression, don’t hesitate to reach out for help. “There are many front doors to behavioral healthcare,” Dr. Ghinassi says. “You can ask a trusted healthcare provider to recommend a counselor. If your employer has an Employee Assistance Program, take advantage of that. Seek out your local mental health facility or call the New Jersey Hopeline at 855.654.6735. Call the RWJBarnabas Health Access Center, which is available 24/7, at 800.300.0628.” • And take heart. “We’ll get through this,” says Dr. Ghinassi. “Humans are enormously adaptable. Through millennia of plagues, famines, wars and pestilence, we’ve risen to every challenge. It’s in our DNA. We’re going to learn and restructure, draw strength from each other and find solutions.”

For help accessing mental health services, call the RWJBarnabas Health Access Center at 800.300.0628.

RWJBarnabas Health

System_BehavioralHealth_Covid19_Final.indd 9

RWJBH.ORG

| 9

6/3/20 9:29 AM

Q&A

ASK THE DOCTOR

6 QUESTIONS ABOUT TELEMEDICINE, ANSWERED YOU DON’T HAVE TO BE A TECHNOLOGY WHIZ TO HAVE A VIDEO VISIT WITH YOUR DOCTOR.

Healthy Together

| 10 |

System_TeleMed_COVID19_Final.indd 10

irtual online doctor visits have been available for some time—but since the COVID-19 pandemic, they’ve soared. “During just one week in April, doctors in our medical group conducted more than 10,000 telemedicine visits,” says Andy Anderson, MD, ANDY ANDERSON, MD President and Chief

Executive Officer of the RWJBarnabas Health medical group. Stay-home orders during the lockdown have played a huge role in the increase, but other causes are also speeding up telemedicine’s adoption. Dr. Anderson tells how and why:

What factors are contributing to telemedicine’s surge?

Historically, demand for telemedicine was driven by urgent issues, rather than by routine or other kinds of care. Habit has played a role, too—the expectation that

COVID-19 Special Issue

6/3/20 9:32 AM

patients and physicians need to physically be together in order to get the best possible care. Now, there’s a greater openness to using technology platforms in all realms of our lives. Those platforms are increasingly sophisticated, so that patients and providers can really see each other, see the parts of the body in question and read each other’s expressions. In the RWJBarnabas Health medical group, we have an easy-to-use platform for telemedicine visits. It’s as simple as a click to get into a virtual room for an appointment. It’s also secure and is fully HIPAA-compliant.

What are some examples of conditions that can be treated in a virtual visit?

Let’s say a person falls and cuts himself. A telemedicine visit can help determine whether he needs stitches and/or an antibiotic. Symptoms and treatment for a urinary tract infection can also be discussed virtually. If someone has a sore throat, he or she can show the back of the throat and tonsils to the doctor via video. Chronic conditions, such as COPD [chronic obstructive pulmonary disease], congestive heart failure or asthma could be managed through a video visit, as a physician is able to observe whether a person is short of breath, for example, or whether his legs are swollen. Diabetes that is not well controlled can also be discussed, as the patient can report his blood sugar levels and medication can be adjusted accordingly. It’s important to note that in any of these cases, a visit can begin as a video visit and then become an in-person visit if the condition warrants it. If you aren’t sure what the best course of action is— video, in-person office visit or Emergency Department visit—don’t feel you have the burden of having to make the decision on your own. Call your physician’s office and have a conversation.

What about well visits and checkups?

Clearly, some exams and procedures require an in-person visit. However, many aspects of a wellness visit, specifically a Medicare Annual Wellness Visit, can be conducted virtually. A physician can ask about, for example, colon cancer screenings or mammograms, home safety and more. Patients like that they can save time and don’t have to travel. In addition, we’re hoping to see increased use of monitoring devices that can transmit information from patient homes to physician offices, including blood pressure monitors, blood glucose monitors, pulse oximeters and even wireless scales.

Am I at risk for contagion if I visit a physician’s ofﬁce?

At RWJBarnabas Health medical group offices, we’ve taken the necessary steps to make it very safe to visit in person. We have social distancing plans, including the use of Plexiglas barriers, a distance line at checkout areas, modified waiting room seating and limitations on the number of patients scheduled during a specified time frame. We also follow rigorous cleaning regimens, offer hand sanitizer stations and more.

Are telemedicine visits covered by insurance?

During the early stages of the pandemic, Medicare, Medicaid and many private insurances expanded their coverage for telemedicine. The situation is evolving, so check with your insurer, but our sense is that coverage for telemedicine will continue to expand.

How will telemedicine change healthcare in the future?

While the COVID-19 crisis has pushed us into this world fast, I think healthcare will be sticking with telemedicine from now on. Telemedicine is not a solution for everything, but it is a solution for a lot

CHECKLIST FOR THE BEST VIRTUAL VISIT • Be sure the device you’re using (phone, tablet, computer) is fully charged. • Make the call from a well-lit and quiet room to enhance the quality of the video and audio feeds. • If you need an interpreter, let your physician’s ofﬁce know ahead of time. • In advance, write down your symptoms, when they began and how frequent they are, and any medications you’re taking. • Keep a pen and notepad handy during the visit.

more things than we realized. It’s a great tool to have in our toolkit. The most important message we have for patients is to continue to make your health a priority. Don’t put off care if you aren’t feeling well, or postpone contacting your physician for help managing any chronic health conditions. Whether virtually or in person, your provider is there to help you.

To connect with an RWJBarnabas Health medical group provider, call 888.724.7123 or visit www.rwjbh.org/medicalgroup.

RWJBarnabas Health

System_TeleMed_COVID19_Final.indd 11

RWJBH.ORG

| 11

6/3/20 9:32 AM

RWJBarnabas Health, together with Rutgers Cancer Institute of New Jersey—the state’s only NCI-Designated Comprehensive Cancer Center— provides close-to-home access to the latest treatment options. For more information, call 844.CANCERNJ or visit www.rwjbh.org/beatcancer.

CLINICAL I TRIALS:

WHAT EVERY CANCER PATIENT SHOULD KNOW TRIALS OFFER PATIENTS A CHANCE TO BENEFIT FROM THE LATEST TREATMENT.

Healthy Together

| 12 |

System_ClinicalTrials_Spr20_Final.indd 12

f you or a loved one is diagnosed with cancer, you’ll want to seek the highest possible level of care—and clinical trials can be a critical aspect of that care. “Clinical trials offer tomorrow’s treatments today,” says Howard S. Hochster, MD, FACP, Director, Oncology Research for RWJBarnabas Health, and Associate Director, Clinical Research and Director, GI Oncology for Rutgers Cancer Institute. “As the state’s only NCIDesignated Comprehensive Cancer Center, Rutgers Cancer Institute of New Jersey and RWJBarnabas Health provide patients access to a wide range of clinical trials, many of which are not available elsewhere. We do this at Rutgers Cancer Institute in HOWARD S. HOCHSTER, MD New Brunswick and

COVID-19 Special Issue

6/3/20 9:36 AM

across the state at RWJBarnabas Health hospitals.” What should patients know about clinical trials? Dr. Hochster explains:

What happens in a clinical trial? Clinical trials are research studies that evaluate new treatment options for diseases and help doctors learn which treatments are most effective. Generally, clinical trials evaluate the safety and effectiveness of new drugs, use current drugs in a new manner or combine drugs to evaluate their effectiveness. Every clinical trial must be approved by regulatory authorities to be sure the scientific evidence merits this kind of investigation and that it’s ethically sound. Clinical trials are undertaken only when we have evidence that the new approach is likely to be better than the standard treatment. Patients should speak with their physicians about the risks and benefits, including possible side effects, of the treatment being studied. During a trial, patients will have many staff members paying attention to them— physicians and research staff including nurses, data managers and others—whose job is to make sure they get the treatment exactly as written in the protocol.

A CLINICAL TRIAL FOR COVID-19 TREATMENT Rutgers Cancer Institute is spearheading a statewide clinical trial for the drug hydroxychloroquine as a potential treatment for COVID-19 patients. Though the trial is not limited to cancer patients, Rutgers Cancer Institute is well positioned to lead such a study because of its extensive experience with clinical trials as the state’s only NCI-Designated Comprehensive Cancer Center. Hydroxychloroquine, while a subject of much public discussion, has not yet been tested in a large, controlled clinical trial to determine its effectiveness. “Until we get the results of a clinical trial, we just don’t know if there’s any role for hydroxychloroquine in treatment for COVID-19,” says Rutgers Cancer Institute Director Steven K. Libutti, MD, who is also Senior Vice President, Oncology Services, RWJBarnabas Health, and Vice Chancellor, Cancer Programs, Rutgers Biomedical and Health Sciences. “Both the initial hype about the benefits of hydroxychloroquine and the stigma that followed were inappropriate. With this trial, we’ll have well-analyzed data from a well-conducted study in order to make a recommendation about that agent’s use.” THREE PATHWAYS The study consists of three “arms.” One will test hydroxychloroquine in conjunction with the antibiotic azithromycin; one will test hydroxychloroquine alone; and one will provide supportive care for six days, followed by a course of hydroxychloroquine. Patients’ blood will be tested for levels of the SARS CoV-2 virus prior to treatment and at regular intervals thereafter. The study is open to people who are age 18 or over, have been diagnosed with COVID-19 and meet other eligibility requirements. In addition to Rutgers Cancer Institute in New Brunswick, the trial is being offered at Robert Wood Johnson University Hospital in New Brunswick; Monmouth Medical Center in Long Branch; Saint Barnabas Medical Center in Livingston; Morristown Medical Center; Overlook Medical Center in Summit; and University Hospital in Newark.

Who’s eligible for a clinical trial? Every patient who has a cancer diagnosis should ask whether a clinical trial might be right for him or her, and should consider a clinical trial at every step of the cancer journey. Sometimes a trial isn’t appropriate at the beginning, but may be later on. Requirements for participation vary. Criteria may include age, gender, type and stage of cancer, other existing medical conditions and treatment history. Before patients can participate in a clinical trial, they must sign an informed consent document, which explains all aspects of the trial as well as alternative treatment options.

What are some examples of cancer research taking place in clinical trials? For years, everyone with certain cancer diagnoses received the same type of

STEVEN K. LIBUTTI, MD

For information on how to take part in the trial, call Rutgers Cancer Institute’s Office of Human Research Services at 732.235.7356 or email statewide_research@cinj.rutgers.edu.

treatment for their cancers, but not everyone reacted the same way. Now we’re able to use clinical trials to make progress in precision medicine, where we can specifically target, on a molecular level, the gene mutations or changes that make an individual’s normal cells turn into cancer cells. Another exciting area now is immunotherapy—using a person’s own immune system to fight cancer. We’ve learned that cancer cells have ways to mask themselves from the immune system. Today, we’ve seen many breakthroughs in drugs that restore the body’s ability

to fight off cancer cells. CAR T-cell therapy is another promising area of research. It involves obtaining immune cells from a patient, reengineering them in a lab to make them as effective at fighting cancer as possible, then reinjecting them into the patient’s body. This results in a “living” therapy with ongoing benefit. Currently, Robert Wood Johnson University Hospital in New Brunswick, in conjunction with Rutgers Cancer Institute, is one of only two certified programs in the state to offer this form of immunotherapy.

To learn more about clinical trials, visit www.cinj.org/clinical-trials. To speak with a clinical trial navigator to explore your options, call the Oncology Access Center at 844.CANCERNJ.

RWJBarnabas Health

System_ClinicalTrials_Spr20_Final.indd 13

RWJBH.ORG

| 13

6/3/20 9:36 AM

NEW WAYS TO LEAD IN

CANCER TREATMENT COLLABORATION AND INNOVATION ARE DRIVING A NEW ERA IN ONCOLOGY.

very week, up to 40 of New Jersey’s top cancer experts virtually convene as part of the new N.J. Statewide Cancer Programs Collaboration—a unique approach initiated and implemented by Steven K. Libutti, MD, Director, Rutgers Cancer Institute of New Jersey, and Senior Vice President, Oncology Services, RWJBarnabas Health. “As the state’s only NCI-Designated Comprehensive Cancer Center, we felt that it was important that we communicate with other cancer programs in New Jersey during the COVID-19 pandemic,” says Dr. Libutti. “We felt we could learn quite a bit from hearing about other experiences, and that each program shouldn’t have to go through the learning curve on its own.” In addition to Rutgers Cancer Institute and RWJBarnabas Health, all major cancer programs in the state participate, including those at Atlantic Health System; Capital Health Cancer Center; MD Anderson Cancer Center at Cooper; John Theurer Cancer Center at Hackensack University Medical Center, Hackensack Meridian Health; Hunterdon Healthcare; Inspira Health Network; Regional Cancer Care Associates; Saint Peter’s Healthcare System; St. Luke’s University Health Network, Warren; Summit Medical Group; Trinitas Comprehensive Cancer Center; and Penn Medicine|Virtua Cancer Program.

MANY MINDS Subgroups in the areas of medical oncology, radiation oncology, surgical oncology and operations meet throughout the week to discuss topics relevant to their programs. On Friday mornings, all participants join a call to exchange information and insights. “We’ve come up with plans for how to safely continue and then augment surgical oncology and other care during the pandemic,” says Dr. Libutti. “What are the right testing regimens to use? How do you open up surgery facilities safely to protect patients and providers from exposure? Which treatment regimens can be delivered at home, and which can be delayed without bad consequences for patients? “Oncology itself is a very collaborative field, because so many modalities are used to treat a cancer patient in a very coordinated way,” continues Dr. Libutti. “It’s not a huge leap for us to extend collaborations beyond the borders of health systems.” Patients in New Jersey will reap the benefits. “Our state sees 50,000 new diagnoses and 16,000 deaths from cancer every year,” says Dr. Libutti. “We’re going to leverage the strengths of STEVEN K. LIBUTTI, MD each program to work together to help cancer patients.” Healthy Together

| 14 |

VIRTUAL CARE FOR CANCER PATIENTS The Rutgers Cancer Institute of New Jersey, in partnership with RWJBarnabas Health (RWJBH), had already begun a pilot program for cancer consultations via video. The pandemic accelerated the expansion of the plan to almost all of the groups’ cancer specialists. The specialists are using a secure platform, which is private and simple for patients to access. In addition to convenience, telemedicine has a number of benefits for cancer patients: • The elimination of potential exposure for patients with compromised immune systems • The ability to have several specialists virtually present at the meeting • The capacity to have geographically distant family members at the meeting • The means to effectively share information with patients. “As I’m talking to a patient, I can show a picture of, for example, lymph nodes, and also type out instructions on the screen and then email these to the patient,” says Andrew M. Evens, DO, MSc, Associate Director for Clinical Services and Director, Lymphoma Program, Rutgers Cancer Institute, and Medical Director, Oncology Service Line, RWJBH. “As we always say, ‘Cancer doesn’t travel well,’” explains Dr. Evens. “Telemedicine doesn’t replace in-person care, but we knew there was an appetite for this service. Who wants to drive an hour or more on the parkway or turnpike for a consult when you don’t have to?” ANDREW M. EVENS, DO

COVID-19 Special Issue

System_CancerLeaders_COVID19_Final.indd 14

6/3/20 10:25 AM

ADVANCED OPTIONS FOR

TREATING AUTISM TELEHEALTH SERVICES AND INTENSIVE TREATMENTS OFFER NEW HELP.

tay-at-home orders during the pandemic have posed particular challenges for children and adults with autism spectrum disorder (ASD). Deprived of face-to-face services, they have been lacking the stimulation and training they need, and have spent much less time interacting with others than usual. “It’s a situation where problem behavior is more likely to occur,” says Wayne Fisher, a professor in the Department of Pediatrics at Rutgers Robert Wood Johnson Medical School and Director of the Rutgers Center for Autism Research, Education and Service (RUCARES). “We wanted to provide support for kids and families to help them manage the situation more effectively.” The result was the development of ABA (Applied Behavior Analysis) Short-Term Telehealth Services provided by Children’s Specialized Hospital (CSH). The services begin with a quick-start evaluation. For children with severe problems whose behavior may be dangerous to themselves, a behavior stabilization and safety program is developed in two 90-minute appointments. For children with mild to

moderate ASD, a quick-start behavior management program and behavior management group are available over the course of eight appointments via a simpleto-access, private telehealth platform. Though telehealth services for people with autism have been available in other states, it was not an option in New Jersey until an executive order as part of the COVID-19 response allowed it. Fisher hopes the trend continues. “This method has many benefits. It really helps families, many of whom travel quite a distance for in-person specialized care, in terms of convenience,” he says. “For specialists, there’s therapeutic value in seeing the child and family at home, under naturalistic conditions.”

EXPANDED SERVICES The ABA short-term telehealth program is part of an expansion of autism services that CSH now offers through a collaboration with RUCARES. This summer will see the opening of CSH RUCARES, the first center of its kind in New Jersey dedicated to innovative research, education and service to support children and adults with ASD. CSH RUCARES will accept patients for a new Severe Behavior Disorders Program, which will provide specialized

An RWJBarnabas Health facility

services to children and adolescents with autism and other developmental disabilities who display dangerous behavior such as self-injury and aggression. Patients will undergo intensive outpatient treatment from a team of board-certified behavior analysts and registered behavior technicians. “Our program has a data-based approach based on empirical research, and all of our staff and faculty are highly trained,” explains Fisher, who is the Director of CSH RUCARES. CSH is also expanding its Pediatric Feeding Disorders Program with a new program for children who have not progressed through traditional feeding programs. “It’s a data-based, intensive, goal-driven day program. We see patients for about eight weeks, then transition to outpatient follow-up services once or twice a week,” says Cathleen Piazza, Director of the Pediatric Feeding Disorders Program at CSH and a professor in the Rutgers Graduate School of Applied and Professional Psychology. “We also find telehealth services very valuable because we can work with and see the patient where he or she eats, in real time.” To learn more about Children’s Specialized Hospital, call 888.244.5373 or visit www.childrens-specialized.org.

At Children’s Specialized Hospital, we provide world-class care for children and young adults who face special health challenges across the state of New Jersey and beyond. Our locations in Bayonne, Clifton, East Brunswick, Egg Harbor Township, Hamilton, Jersey City, Mountainside, New Brunswick, Newark, Toms River and Warren treat everything from chronic illnesses and complex physical disabilities like brain and spinal cord injuries to developmental and behavioral issues like autism and mental health.

RWJBarnabas Health

System_CSH_Covid19_Final.indd 15

RWJBH.ORG

| 15

6/3/20 9:41 AM

Rutgers Men’s Basketball co-captain Akwasi Yeboah shared important safety information and the need to fight the virus together with fans via social media. The Lakewood BlueClaws held a remote game of “Horse” (renamed “Claws”) to support RWJBH healthcare heroes. The winning hospital gets a private field day at FirstEnergy Park.

NJ Devils Hall of Fame goaltender Martin Brodeur provided video messages of strength and support to our team on the front lines.

Seton Hall Men’s Basketball Coach Kevin Willard sent a video recognizing and thanking our healthcare heroes.

NJ Devils star Travis Zajac led a stick tap at 7 p.m. nightly across social media platforms to celebrate and support all frontline workers.

For the Somerset Patriots’ Virtual Opening Day, Michael Rodricks, MD, threw the ceremonial first pitch to Brittany Roper, RN. Both work in the Critical Care Unit at RWJUH Somerset.

Special Olympics New Jersey athletes offered video recognition for doctors, nurses and hospital workers saving lives and treating patients at RWJBH facilities.

WORKING TOGETHER TO HELP MAKE NEW JERSEY HEALTHIER

t RWJBarnabas Health (RWJBH), we have always been committed to meaningful partnerships with organizations that share our vision to create healthier communities. Their efforts during the COVID-19 pandemic, however, have taken their support to a whole new level. “We asked our partners to help us in several ways—through donations, through disseminating educational information and through support for our frontline healthcare heroes,” says Justin Edelman, Senior Vice President, Corporate Partnerships, RWJBH. “The response was beyond what we ever could have imagined.” Our corporate partners had our back. New Jersey Devils/Prudential Center provided a significant and impactful monetary donation in addition to protective equipment and more than 10,000 tickets to future events for our healthcare heroes. Rutgers University Athletics donated protective equipment and used its reach on social media to educate our communities on important safety tips, while the Somerset Patriots raised funds through online memorabilia auctions, merchandise sales and a pop-up food truck event. Too numerous to mention, the supportive efforts from so many of RWJBH’s partners (see list at right) have been crucial to our mission. On behalf of RWJBH and all of our partner organizations, we wish you good health and good fortune at all times. Together, we’ll be there for you.

To learn more about corporate partnerships at RWJBarnabas Health, visit www.rwjbh.org/partnerships.

Healthy Together

| 16 |

System_Partnership_Covid19_Final.indd 16

COVID-19 Special Issue

FRIENDS IN NEED Warmest thanks to these partners: • Cedar Stars Academy • Cure Insurance Arena • George Street Playhouse • Lakewood BlueClaws • Mets Radio Network • Monmouth University Athletics • MSG Networks • New Jersey Devils/Prudential Center • New Jersey Golf Foundation • NJPAC • New Jersey Youth Soccer Association • Novo Nordisk New Jersey Marathon & Half Marathon • Princeton University Athletics • Pure Basketball • Rutgers University Athletics • RWJBarnabas Health Arena • Seton Hall University Athletics • Somerset Patriots • Special Olympics New Jersey • Trenton Thunder • Yankees Radio Network

6/3/20 9:49 AM

YOUR SUPPORT SUSTAINS US

COMMUNITIES HAVE STEPPED UP FOR THEIR LOCAL HOSPITALS IN A BIG WAY—AND YOU CAN STILL HELP.

he offers from the public began as soon as the crisis did. People emailed, texted and called hospitals, some in tears, wanting to know how they could help local healthcare providers. They sent money. They donated dinners. They sent cards. Someone had a friend who had a friend whose company could provide personal protective equipment (PPE). A small painting business had 20 face masks to donate. A hardware store provided gloves. The contributions came in a steady stream. “The donations were from longtime loyal donors as well as those who had never made a gift to one of our hospitals before,” says Glenn Miller, Executive Vice President and

Chief Development Officer at RWJBarnabas Health (RWJBH). “People wanted to make sure that our doctors, nurses and staff had what they needed to stay healthy and do their jobs. “The word ‘heroes’ gets used a lot, and admiration for the dedication of our caregivers was driving this outpouring of support,” he continues. “Supporters saw our caregivers getting up to go to work every day under incredibly difficult circumstances, fighting to save lives.” As of mid-May, the RWJBH system as a whole had received nearly $11 million in support. Of that amount, $6.7 million came in checks and online gifts, large and small;

$3.2 million in donated PPE and other supplies; and $870,000 in food donations. “RWJBH hospitals have always enjoyed wonderfully generous support from the communities they serve,” Miller says. “In recent months, I think our doctors and nurses were certainly reminded about how much people value them and the work they do.”

ONGOING NEED The money raised goes into the RWJBH system’s Emergency Response Fund, where it’s used to purchase much-needed equipment and supplies. The fund also is used to support frontline hospital workers. “When employees need to be quarantined away from their families, we’ve been able to help make that happen,” Miller says. “Other colleagues needed childcare so they could come to work. And sadly, we’ve lost colleagues, and we’re working to develop resources to address the repercussions of such terrible losses.” Beyond tangible support, the outpouring from the community provided an invaluable morale boost. “For healthcare workers going through this experience, to take a break and find a hot meal or a card or a note—it’s meant the world to them,” Miller says. “When you feed someone, you’re enriching their body, obviously, and also their soul.” The Emergency Response Fund remains open. “We’re in an ongoing crisis, and philanthropy will continue to play an important role in helping us prepare for any surges or future outbreaks,” Miller says. In addition, capital projects, new programs and equipment upgrades will still need to be funded for each medical center. “We’re incredibly grateful for the outpouring of support, and the tremendous positive impact it has on our work and our commitment to keeping communities healthy,” Miller says. “We cannot thank people enough.” The gifts also have a benefit for the giver. “We’ve heard that people in the community want to feel that they have the ability to bring hope,” says Miller, “and that they’re empowered to make a difference.”

To donate to Robert Wood Johnson University Hospital Somerset or to RWJBarnabas Health, visit the Emergency Response Fund at www.rwjbh.org/give.

Robert Wood Johnson University Hospital Somerset

Somerset_Foundation_Covid19_final.indd 17

RWJBH.ORG/SOMERSET

| 17

6/2/20 10:01 AM

INSIDE THE FRONT LINES FIVE HEALTHCARE PROVIDERS SHARE WHAT THEIR ROLES MEAN TO THEM AND TO THE PATIENTS THEY CARE FOR AT ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL SOMERSET.

MICHAEL RODRICKS, MD

MEDICAL DIRECTOR, INTENSIVE CARE UNIT As the medical director of the intensive care unit (ICU), I care for critically ill patients. Our facility has 16 ICU beds, and at any given moment we have four or five ventilators in use. During the pandemic, we saw a massive influx of patients suffering from COVID-19 who were critically ill and required mechanical ventilation (life support). We doubled the size of our ICU and called in all possible resources to help care for the critically ill in our community. For a patient to benefit from a ventilator, a wholescale team approach is neededâ€”these arenâ€™t magical devices that work on autopilot. A critical care nurse with extensive training serves as the linchpin in the care of patients. The amount of labor to care for a ventilated patient is significant, so a nurse ideally cares for no more than two patients at a time. In addition to bedside nurses and physicians of several specialties, other providers who are integral to the care team include respiratory therapists and clinical pharmacists (to help guide constantly evolving treatment plans). As an intensivist, I serve as the captain of the ship, ensuring that everything is being done according to the best evidencebased guidelines. The specter of exposure and falling ill is omnipresent for all frontline providers.

Healthy Together

| 18 |

Somerset_StaffStory_Covid19_final.indd 18

COVID-19 Special Issue

6/2/20 10:05 AM

KATIE DUNCIL, RN, BSN

JOHN BUCEK, MD, FAAFP

MARIA KALOGIROS, RT

I’m a night-shift nurse working from 7 p.m. to 7 a.m. on one of our dedicated COVID-19 units. During the pandemic, we saw people of all ages—as young as their 30s—with COVID-19. This disease can affect anybody of any age. It’s a scary illness because some patients who come in seem to be OK, but then their illness can quickly progress. It’s heartbreaking to know that patients have to go through this alone, isolated in their rooms. Physical contact with family is so important when you’re ill, but visitors are currently restricted to prevent the spread of COVID-19. Phone calls and FaceTime are their only connection to their friends and family right now. As I reflect on this experience, it has made my passion for nursing even stronger. I love being a nurse. There’s nothing else that I would want to do.

We developed dedicated teams to care for patients on our COVID-19 units. I led the first team, made up of a family medicine physician, an infectious disease specialist, a pulmonologist, a pharmacist and an advanced practice nurse. It’s been remarkable how everyone has come together, and very beneficial to have the same group of people taking care of the same patients and sharing ideas. After three weeks of caring for patients with COVID-19, I began to experience symptoms. It started with a nosebleed and then I lost my sense of smell followed by the telltale fever. Fortunately, my symptoms were mild so I was able to recover at home. After I fully recovered, I was back at the hospital caring for our COVID-19 patients. Now that I have the antibodies for COVID-19, I plan to donate my plasma to help others battling this virus.

I’ve been a respiratory therapist for 45 years, and have worked at Robert Wood Johnson University Hospital Somerset for the past 20 years. Many COVID-19 patients who are hospitalized develop coughing, congestion and shortness of breath as their bodies try to fight this invader. When lung congestion worsens, patients often need supplemental oxygen and respiratory care. If their breathing worsens and pneumonia develops, some patients need to have an endotracheal tube placed in the airway so their breathing can be supported by a ventilator. We monitor patients’ exhaled carbon dioxide and blood oxygen levels continuously, and we adjust their ventilator settings frequently in response to disease progression. The goal is to support their breathing enough to allow their bodies to fight and heal.

SHARON PARRILLO, BSN, RN, CIC, CPPS DIRECTOR, INFECTION PREVENTION

I spend time educating staff about how diseases are transmitted and what precautions to take to prevent the spread of infection. I’m able to help people navigate through scary situations so they can remain calm and focused on their work. The COVID-19 pandemic has been the most challenging time in my 18 years as a nurse. COVID-19 is much more widespread than other infectious diseases we’ve dealt with, including measles and tuberculosis, and so many people are at risk. We’ve seen increasing numbers of patients of all ages coming to us with symptoms. Fortunately, many are able to go home. However, others are severely ill and require intensive care. The safety of our staff is a major focus, and we’re working hard to ensure that they have the personal protective equipment needed, including masks, gowns and goggles. I feel a tremendous weight of responsibility to ensure that everybody is safe, especially while they navigate unfamiliar processes.

Robert Wood Johnson University Hospital Somerset

Somerset_StaffStory_Covid19_final.indd 19

RWJBH.ORG/SOMERSET

| 19

6/2/20 10:05 AM

SAFE AND SOUND

IN THE E.D.

RIGOROUS PROCEDURES ENSURE THE SAFETY OF EMERGENCY DEPARTMENT PATIENTS AND STAFF.

mergency Department (ED) visits fell sharply during the height of the coronavirus crisis, in New Jersey and nationally as well—and that has doctors worried. “In the RWJBarnabas Health system, we’ve seen our ED volume decline by 50 percent overall, and by up to 85 percent for pediatric EDs,” says Marc Milano, MD, Medical Director, ED, Robert Wood Johnson University Hospital (RWJUH) Somerset. “The problem is that disease prevalence doesn’t change,” he explains.

Healthy Together

| 20 |

“Heart attacks, strokes, asthma, intraabdominal diseases such as appendicitis and diverticulitis—COVID-19 didn’t make them go away, but we’ve been seeing these patients in the ED less and less.” The probable reason: fear. “The likelihood is that people have been putting off care because they’re afraid to go into the hospitals and be exposed

to COVID-19,” says Dr. Milano. “That concerns us greatly because delaying medical care for many conditions can lead to disability and even death, and those risks are not necessary. “The main message we want people to hear is that it’s safe to come to the ED, so don’t put it off,” he continues. “We’ve put many layers of protection in place for our patients and for our staff.”

SAFETY MEASURES

MARC MILANO, MD

ASHOK PATEL, MD

SRINIVASA POTLURI, MD

Safety steps taken by Emergency Departments throughout the RWJBH system include:

COVID-19 Special Issue

Somerset_HeartStroke_Covid19_final.indd 20

6/2/20 10:09 AM

WARNING SIGNS OF HEART ATTACK Pain or discomfort in chest Lightheadedness, nausea or vomiting Jaw, neck or back pain Discomfort or pain in arm or shoulder Shortness of breath Sweating

• Separation of COVID-19 and nonCOVID-19 patients upon entry • Setting aside special areas that are completely separate from COVID-19 patients and caregivers • Creation of “negative pressure” isolation rooms that prevent airborne contaminants from drifting to other areas in the hospital • Provision of masks for all staff and patients • Frequent disinfectant wiping of surfaces and equipment. “Our environmental services staff is doing a fantastic job of deep-cleaning our EDs,” says Dr. Milano. “Every doorknob, every surface, is continuously being wiped with disinfectant.”

seems to exacerbate a range of other cardiovascular problems. “COVID-19 is a vascular disease as well as a respiratory disease,” says Dr. Patel. “It can lead to clotting in the arteries. It’s possible that a patient may have heart disease that has not been recognized, and with the stress of COVID-19 illness a cardiac event occurs. The event can be any of the known cardiac syndromes, including heart attack or heart failure. We just don’t have all the answers yet.” The important thing to know, he says, is that the advice for going to the hospital emergency room is the same now as it was before COVID-19. “Pay attention to symptoms,” says Dr. Patel, “and don’t hesitate to call 911.”

CARDIAC CONCERNS

STROKE RISK

Doctors have long pounded the drum for patients to call 911 if they experience symptoms of a heart attack. “Time is critical in preventing damage to the heart muscle,” says Ashok Patel, MD, Chair of Medicine, RWJUH Somerset. “The sooner we can treat you after the onset of symptoms—ideally, within 90 minutes—the less damage to your heart.” Dr. Patel urges people to be aware not only of the classic symptoms of a heart attack (see list, above) such as chest pain or a feeling of heaviness in the chest, but of non-traditional symptoms such as shortness of breath as well. Adding complexity to the situation is the fact that the novel coronavirus

The coronavirus-related clotting that can lead to heart attacks also appears to increase risk for stroke. A stroke occurs when a blood vessel that leads to the brain is blocked by a clot, or ruptures, leading to death of brain cells as they’re robbed of oxygen- and nutrient-rich blood. Immediate treatment can minimize the long-term effects of stroke, such as speech and movement difficulties, and even prevent death. People with uncontrolled high blood pressure or diabetes are at increased risk of stroke, as are smokers. But the pandemic has introduced a new wrinkle: a striking increase in strokes among COVID-19 patients as young as their 30s and 40s, who

had no stroke risk factors and no other COVID-19 symptoms. This new risk makes it all the more important for people to act when they have symptoms (see list, below). “Pay attention to the suddenness of the symptoms, which could include confusion and severe headache, and call 911 so you can be taken to the hospital right away,” advises Srinivasa Potluri, MD, Chief of Neurology, RWJUH Somerset. COVID-19 can affect the nervous system in other ways, too, says Dr. Potluri. “One of the most common ways is the loss of smell,” he says. “Another is exacerbation of seizures in people who are prone to them. All of these things have to be further investigated.” What’s not in question is this emphatic advice from doctors: Don’t be afraid to go to the hospital if you need to. “You really have to weigh the risks and benefits,” says Dr. Potluri, “and realize that the risks are much higher if you stay at home.”

WARNING SIGNS OF STROKE Use the acronym BE FAST to remember these:

To learn more about how we’re ensuring your safety at RWJBarnabas Health, visit www.rwjbh.org/welcomeback.

Robert Wood Johnson University Hospital Somerset

Somerset_HeartStroke_Covid19_final.indd 21

BALANCE:

Sudden dizziness, loss of balance or coordination

EYES:

Sudden trouble seeing out of one or both eyes

ACE: Facial weakness, uneven smile

ARM:

Weakness, unable to raise both arms evenly

SPEECH:

Impaired, slurred, difficulty repeating simple phrases

TIME:

Call 911 immediately

RWJBH.ORG/SOMERSET

| 21

6/2/20 10:09 AM

WELCOME

BACK!

EXTENSIVE COVID-19 TESTING OF STAFF AND PATIENTS, EXTREME CLEANING AND MANY OTHER MEASURES MAKE OUR FACILITIES SAFE FOR CARE.

he safety and health of our patients and team members have always been top priorities at RWJBarnabas Health (RWJBH). Now we’ve taken everything the medical profession has learned about COVID-19 and implemented best practices at Robert Wood Johnson University Hospital Somerset and all of our facilities.

Healthy Together

| 22 |

“At RWJBarnabas Health, we’ve been on a safety journey to becoming a High Reliability Organization for three years,” says John Bonamo, MD, Executive Vice President, Chief Quality Officer and Chief Medical Officer for RWJBH. “The high safety standards we had before the pandemic are making it possible for us to come back confident.” Safety is an all-encompassing effort. “Every little thing we do is a building block aimed at making our facilities COVID-free,” says JOHN BONAMO, MD Dr. Bonamo.

WHAT WE’RE DOING Testing is a major way RWJBH hospitals are keeping COVID-19 from spreading. Every admitted patient, every surgical patient and every Emergency Department patient with flu-like symptoms is tested. In addition, team members—whether they work directly with patients or not— are tested, many of them multiple times. Hospital administrators and staff also have taken a hard look at all relevant processes, including how rooms are cleaned, how personal protective equipment (PPE) is used—even how air in the hospitals is circulated. “As we discharge COVID-19 patients, the rooms in which they were cared for get a special deep cleaning,” Dr. Bonamo says. “We clean everything in the room

COVID-19 Special Issue

Somerset_WelcomeBack_Covid19_final_REV1.indd 22

6/3/20 6:36 AM

to the nth degree, from top to bottom— including changing all the air filters and cleaning all the vents.” RWJBH has taken the enormous step of retooling all of its heating and cooling systems to pull in fresh air from outside, rather than continuously recirculating the air inside a building. “It’s a big expense for the small number of infections it’s likely to prevent,” says Dr. Bonamo, “but each small yield of prevented cases adds up and is very important because of how quickly this disease spreads.”

WHAT YOU CAN DO Although healthcare is an essential service, many people have avoided going to the doctor or hospital to limit their risk of exposure to COVID-19.

That fear is unfounded when visiting RWJBH facilities—and it could be dangerous. Putting off urgent medical care or physician visits for chronic disease management, childhood immunizations and other health services can have devastating effects. “You don’t want the virus, but you also don’t want a heart attack or a stroke, or for your child to get a different infectious disease,” says Dr. Bonamo. “You’re not protecting your health by staying away, you’re jeopardizing it. “We take public health and safety extraordinarily seriously,” Dr. Bonamo continues. “We understand why people might want to avoid coming to the hospital, but it’s important for everyone to know that we can keep them safe and help them get healthy.”

NO EFFORT SPARED Preventing the spread of COVID-19 We’re going beyond the recommendations of the Centers for Disease Control and Prevention, the New Jersey Department of Health and other trusted organizations to implement best practices for preventing the spread of COVID-19. Steps we’re taking: • Stringent cleaning and disinfection of all rooms, including all equipment, surfaces and air vents • COVID-19 testing for all surgical patients, all admitted patients and all patients with ﬂu-like symptoms in the Emergency Department

TELEHEALTH

• COVID-19 testing for doctors, nurses and other staff. Those who have a negative test will be retested to guard against false negatives

You now can receive physical, occupational and speech therapy from home.

• Continued restriction of visitors based on directives from the state of New Jersey

REHABILITATION SERVICES

Robert Wood Johnson University Hospital (RWJUH) Somerset now offers telehealth for physical therapy, occupational therapy and speech therapy appointments for both new and current patients. Through a video camera on your smartphone, tablet or computer, you can have convenient, easy access to an RWJUH Somerset physical, occupational or speech therapist from the comfort of your home. This secure, user-friendly technology is a great option for anyone who cannot attend in-person appointments due to disability, health issues, work schedules, travel plans or lack of transportation. For more information about Telehealth for Rehabilitation Services, please contact one of our locations: PHYSICAL THERAPY BEDMINSTER: Excellent Physical Therapy: 908.234.9668 Sports Rehab and Balance Center: 908.234.2488 BRIDGEWATER: RWJ Sports Physical Therapy and Performance Center: 908.203.5972 FLEMINGTON: RWJ Sports Physical Therapy: 908.806.2000 HILLSBOROUGH: RWJ Sports Physical Therapy: 908.359.8800 PRINCETON: RWJ Sports Physical Therapy: 609.419.0455 SOMERVILLE: RWJUH Somerset Physical Therapy: 908.685.2944 OCCUPATIONAL THERAPY: 908.685.2945 SPEECH AND HEARING SERVICES: 908.685.2946

• Active screening of team members, patients and visitors (when permitted), as they enter a facility • Requirement for everyone who enters a facility to wear a mask or face covering • Strict requirements for the use of personal protective equipment (PPE) with both COVID-19 positive and non-COVID patients • Social and physical distancing measures for all people in our facilities—in all employee and patient areas • Strict hand hygiene rules, with hand sanitizer in all employee and patient areas • Retooling of the heating and cooling systems in our facilities to bring fresh air in from outside rather than recirculating inside air • Continued preparation and readiness for potential future surges.

Robert Wood Johnson University Hospital Somerset

Somerset_WelcomeBack_Covid19_final_REV1.indd 23

RWJBH.ORG/SOMERSET

| 23

6/3/20 6:36 AM

NONPROFIT

U.S. POSTAGE PAID Lebanon Junction, KY

PERMIT #799

110 Rehill Avenue, Somerville, NJ 08876

You’ve taken every precaution. So have we. Welcome back. If you’ve put off any medical care due to COVID-19, please don’t delay it any longer. As a high reliability organization, we’ve taken every precaution and continue to provide health care services. We have initiated a resumption of services in adherence to all public health guidance and regulatory policies. Learn more at rwjbh.org/WelcomeBack

RWJ-107 Welcome Back_8.375x7.29_Somerset.indd 1 Somerset_BackCover_Covid19_final.indd 24

5/21/20 3:22 PM 6/2/20 10:14 AM