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PAPR and CAPR and/or N95 and Goggles were reserved for patients undergoing AGP procedures. Evergreen as well as the University of Washington moved to gowns, gloves, surgical masks, and goggles for patients who weren’t undergoing aerosolized-generating procedures (AGPs), such as nebulizers, intubation, or suctioning, which aerosolize droplets that cause infection. But that swiftly changed as the State Department of Health recommended modified droplet and contact precautions for patients with Covid-19. Initially, Evergreen instituted airborne PPE (PAPR and CAPR or N95 & Goggles) for every patient with or suspected to have Covid-19. As a result, guidelines for PPE level and conservation, testing protocols for patients and staff, policy for non-essential care, and return-to work-protocol for sick employees had to change on the fly, making communication one of the most important responsibilities of leadership. Mickey identified change as both hallmark and challenge in navigating a highly fluid situation in which guidelines from government agencies conflicted and changed rapidly as knowledge was acquired. “We then experienced constant change.”Īs the CMO of a health care facility at the bleeding edge of the crisis, Dr. “We activated incident command immediately, and on Saturday began identifying and tracking all exposed employees, implementing airborne PPE, expanding testing, and implementing a communications network,” said Aileen Mickey, MD, FCCP, chief medical officer and pulmonologist, EvergreenHealth Medical Group. Evergreen’s medical director of infectious disease decided to test two such patients in the ICU as a precautionary measure. On Feb 27, the CDC expanded Covid-19 testing guidelines to include severely ill patients with lower respiratory infections without other explanations. was navigating constant change.ĮvergreenHealth includes a 320-bed regional hospital, a rural hospital, Evergreen Medical Group-including 48 clinics and 300 physicians and providers-and a large home health and hospice division. For Aileen Mickey, MD, FCCP, chief medical officer and pulmonologist, EvergreenHealth Medical Group, Kirkland, Wash., a key challenge in managing response to one of the initial outbreaks of the novel coronavirus in the U.S.