Society of Dermatology Hospitalists

“To strive to develop the highest standards of clinical care of hospitalized patients with skin disease by promoting clinical expertise, fostering research, and furthering education in the management of hospitalized patients with cutaneous disease.”

IMPORTANT ANNOUNCEMENT:

Due to travel restrictions and cancellation of the 2020 AAD meeting, the SDH annual meeting has been cancelled.

SDH statement on caring for inpatients with Covid-19

As dermatology hospitalists and active participants in the House of Medicine, we are often caring for some of the most medically complex patients in the world. We have worked hard to highlight the huge difference that access to inpatient dermatologic care can make in patient outcomes, diagnosis, and treatment.  There is a shortage of access to inpatient dermatology, and the Society of Dermatology Hospitalists (SDH) is committed to closing that gap.

Experts predict that access to care will be strained over the coming weeks and months. Currently, there are efforts underway to preserve personal protective equipment (PPE), address mask, faceshield, and hand sanitizer shortages, and position ventilators and other care supplies to be at the ready.  To position themselves optimally to provide care to all who need it, hospital systems and clinics are rolling out novel ways to limit physician exposure to infected patients.

The SDH supports members in taking proactive measures to do what we can to flatten the curve of transmissions, reduce unnecessary exposure, and continue to be available to provide essential inpatient dermatologic care to our patients.

Recognizing that sites are different and have access to varying degrees of resources, the SDH would like to offer the following suggestions regarding routine inpatient dermatology care of patients with signs/symptoms/exposures concerning for Covid-19 infection but not yet under investigation, PUI (patients under investigation), or patients with confirmed Covid-19 infection:

1.     Patients with symptoms or with potential Covid-19 infection may be managed remotely whenever possible

a.     Cases may be subject to teletriage based on urgency, including providing remote tele-dermatological consultation without physically seeing the patient where appropriate

2.      If patients require in-person dermatologic evaluation,

a.     Physicians should be trained in appropriate donning and doffing of PPE

b.     Immunosuppressed members of the team should avoid seeing such patients

c.     Try to limit exposure by limiting number of visits per day

d.     Minimize the number of care givers on the team; some ideas include:

i.     Assign one resident per team to the patient

ii.     Limit or avoid “pre-rounding“

iii.     Medical students on the dermatology team may abstain from seeing patients with confirmed infections, or according to individual institutional policy

3.     All sites should develop back-up plans for situations where the inpatient or on-call dermatology teams are quarantined, ill, or otherwise unavailable

SDH asks that you consider implementing and individualizing the above recommendations to your clinical care sites to best serve your patient population.

CMS is working on rolling out urgent telemedicine rules and regulations during this crisis.  The SDH will send useful updates about this as they become available.  Please do not hesitate to reach out to the group with questions, concerns, or important observations (ie, re: skin issues in Covid-19 patients or their caretakers).

We are including a link to UCSF’s Covid-19 website which is very thorough and includes a video on how to correctly don and remove PPE (though we encourage you to follow your institution protocols first and foremost).

Be safe, wash hands, and good luck to everyone.  Thank you for taking care of the most vulnerable patients in dermatology.

https://infectioncontrol.ucsfmedicalcenter.org/ucsf-health-covid-19-resources

Misha Rosenbach, MD
and
the SDH BOD
Lindy Fox MD
Daniela Kroshinsky MD
Alex Ortega MD
Helena Pasieka MD
Michi Shinohara MD