When I decided to focus on this topic, top of mind was a desire to talk about the significant contribution of our entire inpatient service to the care of hundreds each day. Our focus on the COVID-19 pandemic and our spectacular response moved me to note the ongoing heavy lift of our faculty and trainees to effectively care for a diverse array of patients with all possible medical conditions, even as our health system has had to adapt at multiple levels to operating in the COVID era, which will represent our ongoing reality for the foreseeable future. During this past week, our attention shifted to confront the consequences of racism, which I addressed earlier this week. Since that time, I have watched the world mobilize to speak out against this and to rally all of us to work toward a more equitable future. I share with you two links from two relevant professional societies—the National Academy of Medicine and the Alliance for Academic Internal Medicine—that broadly represent some of our core missions in academic medicine to give you a sense of the solidarity that our entire profession is expressing in this moment. At noon today many of us will take a knee to remember the many victims of racial violence and commit to being part of the solution. [UPDATE: See photos from the event.] As I have said before, I am heartened by the deep resilience of our community and our department, as we continue adapting to COVID-19 while at the same time expanding our imagination, focus, and commitment to addressing the pervasive public health and societal crisis that racism represents. Our ability to do both tells us that we have reserves of compassion and commitment yet untapped. I hope that you have sought out the support of colleagues and loved ones this week and will continue to do so, as you restore your faith and confidence as necessary to continue on in our good work.
When it comes to our COVID-19 response, so much of that good work has come from our hospitalists. During this transitional period of recovery and resumption of “new normal” non-COVID patient care, it is worth reflecting on the many and speedy adaptations our hospitalists performed. As we consider our path forward, their achievements contain lessons for how we will meet our next challenges. The success of University of Iowa Health Care in addressing the threat of an unknown and highly infectious agent is due in no small part to the creativity and boldness of Iowa’s hospitalists. Their story may be familiar to many of you. The purpose, composition, and success of the Home Treatment Team led by Dr. Andy Bryant, which kept infected individuals at home for as long as possible and off our wards, is here. We even heard from Dr. Bradley Manning in one of our Grand Rounds in April, in which he described the establishment of the Influenza-like Illness Clinic as well as what providers encountered when people did finally need to be admitted here.
But there are other aspects of the hospitalists’ efforts that are worth exploring in more detail. Three of that group’s leaders in the COVID-19 response—Dr. Jeydith Gutierrez Perez and Drs. Bryant and Manning—recently offered their perspective on the events of this spring. For example, although the hospital quickly emptied out of non-urgent cases, Dr. Gutierrez said,
administrative responsibilities, coordination, and the effort that took to prepare our response to COVID made things very busy for us in other fronts. Coordinating management strategies with sub-specialists, ensuring that we had similar standards for care, scalation of care and monitoring across hospital units, and coordinating an organized response from all the people involved in the care of COVID patients was no small task. We had great leadership and support from the hospital and our hospital leadership team worked tirelessly to guarantee that we were taking good care of all the patients and that we were keeping our staff and patients safe.
Dr. Manning had words of praise for his colleagues on the wards, citing both their willingness to step onto the front lines, calling it a recognition of “their duty,” but also how their solutions began to serve as role models for others. “I was very proud,” he wrote, “of the way the group stepped up to care for both the COVID inpatients, using appropriate PPE and excellent teamwork with the MICU and ER, and for outpatients with the Home Treatment Team.” Dr. Bryant also praised everyone’s adaptability, particularly around issues of PPE. Necessarily shifting guidelines and uncertainty around sustainable supplies increased anxiety and made consistency a challenge, he said, “but our hospitalist and [4 South and 5 South] nursing teams bought in to the face shields quickly. This added protection from droplets and deterrent for inadvertently touching your own face was well appreciated by everyone.” My thanks to these three for taking the time to evaluate what worked and for showing us in detail what we all knew we could do together. The hospitalists should be proud of what they achieved. I know the rest of us are grateful for the spirit of innovation that has always been part of that team’s DNA. You can read more of their reflections here.
Stories of achievement continue throughout the rest of our department. We will have some new grant announcements to share soon, as well as the resumption of our profiles of our sub-specialty faculty, starting with our oncologists. Our recent story on the cancer center’s ability to maintain 95% of their therapeutic clinical trials throughout the hospital’s tightest restrictions should be getting some wider attention. Our faculty has continued to publish highly visible manuscripts, three examples (of many) which are highlighted here. Dr. Saket Girotra and others have evaluated the use of a new patient-centered metric in patients with acute myocardial infarction in Circulation. Dr. Jack Stapleton describes a promising new therapy against HIV and other pathogens in the American Society for Microbiology’s open-access journal mBio. And a research assistant in Dr. Chris Benson’s lab, Dr. Tahsin Khataei, published his research that identified a mechanism for the potential pain-relieving benefits of high-intensity interval training. The scope of Internal Medicine is broad, but we all continue to remain focused on excellence.