COVID-19 and UVA IM
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Dr. Haug on the South Tower courtyard
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PGY3 Kajal Shah providing care via iPad
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SPU ICU team rounds
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SPU resident and attendings
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SPU room
Special Pathogens Units
The Department of Medicine and its residency program have played a major role in the clinical care of patients with COVID-19. As the Health System completed construction and outfitting of the South Tower in the spring of 2020, the Special Pathogens Unit (SPU) opened to both ICU and acute care patients with COVID-19. Our Internal Medicine residents began rotating in both the SPU ICU and SPU Floor services in May 2020. They have been front and center alongside ICU APPs, attendings and fellows along with Hospitalist and Gen Med attendings learning about this disease firsthand, from its clinical presentation to the application of clinical trials to the significant impact of social determinants of health. Our residents are exposed to both innovations in care delivery, such as robust telemedicine platforms allowing providers to limit unnecessary room entry and PPE use, and outstanding clinical education. The care of patients with COVID-19 in both the ICU and floor settings has been incorporated into our medical ICU and general medicine workflow since the spring of 2021.
Resident Testimonials
As I am writing this, the COVID-19 pandemic has been raging for 6 months and I’ve spent approximately 3 weeks working as the senior resident for UVA’s Special Pathogen Unit Intensive Care Unit, aka the SPU ICU. Working in the SPU ICU has been both a challenging and rewarding experience.
The SPU ICU has forced me to practice creatively. Management strategies that are sufficient on the floor/regular MICU often need to be modified in real time to ensure safety of both patient and staff members. Residents also work closely with other team members to implement new technologies to ensure safety of both patients and staff. Examples include: ventilators with extension tubing so the control units are outside the door, iPads for video-chat communication, and giant monitors that ensure vital signs are clearly visible from outside the room. I am grateful for the intellectual challenges of COVID care and for the opportunity to work alongside other innovators at UVA.
The SPU ICU has grown me as a physician as I have served as the primary team for patients not usually encountered on a medicine service. I’m talking about patients who, pre-COVID, would have been sent directly to the trauma service or surgical ICU. As I have coordinated care for these patients, I have appreciated these new learning opportunities and the chance to educate other healthcare providers about the facts (and fiction) of COVID.
Finally, working in the SPU ICU has further augmented the already strong sense of comradery present amongst MICU staff. I have enjoyed working closely with our nurses/RTs and benefited from the one-on-one instruction from our critical care attendings. Together we celebrated each and every clinical victory; everything from achieving adequate urine output to successful extubations to floor transfers (recognizing that floor transfers meant that the patient is that much closer to going home). I am proud of all the SPU ICU staff who work together to provide high quality care for our patients and I am grateful for the small part I could play.
It was a unique feeling arriving at work the first day in the Special Pathogens Unit (SPU) ICU. As a third year, I felt that I had certainly found my rhythm in the hospital and as a trainee. But working in our SPU-ICU is familiar in some ways, and wholly different in others.
The staff is the same staff from our non-COVID ICU. The core tenets of ARDS management remain the same. But working in a unit dedicated to a single pathogen was a different approach to caring for and learning from patients. At the start of the week we had six patients at different stages of severe COVID-19 ARDS, and viewing the condition as a continuum generated new ideas and questions throughout the day. While so much of the care in our SPU-ICU is derived from standard critical care practice, we are constantly educating ourselves about new ways to care for our critically ill patients. Learning about VV-ECMO from our colleagues in Cardiothoracic surgery, calling the clinical trial specialists to see if ours patients can be enrolled in a new study, or reviewing the latest practice guidelines regarding testing with our Hospital Epidemiology team, every day had something new. It was quite exhilarating.
But it was also sobering. As one of the tertiary referral centers in the state, we have taken care of patients from all over Virginia. Our patients are some of Virginia’s most vulnerable, and with time we have witnessed that this disease does not impact the Virginia community in equal fashion. This realization has offered up a challenge to us as residents to provide exemplary care for our patients and their families, understanding that these are extraordinary times and they require a flexible approach to keeping families informed and patients well cared for.
It has been an immense privilege to rotate through our SPU-ICU. We get to work with some of the most dedicated and thoughtful staff in the entire health care system and grow as trainees in a truly unique fashion. While I cannot guarantee that this opportunity will exist by the time you start training at UVA, know that our residency program leadership is comprised of doctors and support staff who are constantly searching for similarly unique and purposeful ways to educate trainees at UVA.
COVID-19 Community Outreach
UVA’s Department of Medicine has been integral in the fight against COVID-19 both locally in Charlottesville and statewide in its service to Virginia. Our residents have also been active serving Charlottesville and Virginia! During the early days of the pandemic, UVA’s Internal Medicine residents pitched in to the Health System’s efforts to care for our community. As we rapidly developed our COVID testing capabilities, UVA IM residents managed positive test results and patient counseling for weeks across the continuum of the Health System. In late summer 2020, UVA Health System organized regular community testing events to help identify local cases and increase access to testing, especially among some of our vulnerable populations. A number of our residents have volunteered their time as COVID testers or in results callback. We have also adapted our Haven mobile shelter for the homeless to a virtual format thanks to an amazing team of University and School of Medicine volunteers in addition to residents, chief residents and faculty.