Patient Safety Drives Clinical Operations

Kellogg’s clinical leadership has been focused on increasing safety in our clinics for many years. This commitment to safety enabled Kellogg to quickly adapt to the challenges of COVID-19 and to improve safety for patients and our care teams. “We have great support from leadership to think outside the box in designing new ways of doing things,” says Beth Hansemann, COT, continuous improvement specialist at Kellogg. Building on this long-standing commitment to a “culture of safety,” Kellogg clinics adopted a process of proactive planning for multiple scenarios, implementing steps common across scenarios, rapidly assessing performance and quickly making needed adjustments.

Safety Processes and Equipment:

Kellogg clinics were the first in Michigan Medicine to implement patient screening, masking for all staff, and the use of plexiglass barriers for encounters. Rather than waiting for commercial suppliers, Drs. Rebecca Wu and Shahzad Mian, together with other faculty and staff and Dr. Lauro Ojeda of the School of Engineering quickly designed, tested, had manufactured, and installed enhanced slit-lamp shields. The shields were larger than any then commercially available. Subsequent studies showed that shields of this size would block more than 99% of droplets between a patient or physician or technician. The success of these slit lamp shields has spurred development of safety shields for other instruments that previously had no shields of any kind, such as the special viewing system for clinical examination of the periphery of the eye (“indirect ophthalmoscope”), led by Dr. Lev Prasov.

Caring for Patients with

COVID-19: Kellogg’s teams, led by Dr. Roni Shtein, medical director of our main Wall Street clinic, rapidly established a safe way of seeing our COVID-19 patients with urgent eye problems while maximizing safety for everyone else. “We encourage as little contact as possible with minimal face-toface interaction for COVID-19 patients.” Although the number of patients seen in this “Red Clinic” has been small, “We’re prepared,” says Dr. Shtein. The protocol keeps our non-COVID-19 patients safe so they can come to Kellogg for their eye care issues with peace-of-mind.

Ensuring a Safe Environment:

In addition to regular cleaning, eye protection, hand sanitation, and physical distancing, airflow and air quality concerns have been identified as potential risk factors for the spread of COVID-19, especially in indoor environments. Working with environmental health at Michigan Medicine, Kellogg rooms were rechecked to make sure that all air flow had HEPA filtration and that air exchanges met or exceeded Joint Commission standards of at least 6 exchanges per hour.

Applying Data Sciences: Kellogg’s Dr. Joshua Stein, Director of Analytics, along with Dr. Mian and clinical leadership, created a risk algorithm for glaucoma patients that provided a personalized estimate of both the risk of vision loss and the risk of severe COVID-19 outcomes. This “score” facilitated the appropriate rescheduling of patients when clinical care was limited to urgent and emergent patients by state regulations. Doctors used this data to better balance the risks of vision loss with risks from COVID-19 infection, while enabling patients to understand their risk profile.

Changes Here to Stay:

Together with the advances in data sciences, COVID-19 has catalyzed significant changes in how eye care can be delivered. Kellogg’s “drive through” and “virtual plus” clinics (see page 10) as well as other innovative approaches pioneered during the pandemic are here to stay. “We’ve been open to new ways to make things work, and we’ve been able to continue our journey to increase safety for patients and staff.” says Jennifer Weizer, M.D., ophthalmology professor and Kellogg Safety Committee chair. “We’re confident that we’ve learned important lessons for the future if we have another outbreak and for issues such as the seasonal flu.”