COVID-19 Curbside Consults

The hospitalized patient with COVID-19 on the medical ward: Cleveland Clinic approach to management

Maria Miklowski, MD, FACP, Bruce Jansen, MD, Moises Auron, MD, FAAP, FACP, SFHM and Christopher Whinney, MD, FACP, SFHM
Cleveland Clinic Journal of Medicine November 2020, DOI: https://doi.org/10.3949/ccjm.87a.ccc064

ABSTRACT

SARS-CoV-2-infected inpatients who are admitted to a noncritical care medical ward require a standardized approach that is based on evidence if available, and effective supportive and respiratory care. Outcomes are better when patients receive standardized care, in special COVID-19 wards in the hospital, from clinical teams with expertise. Available evidence and guidelines should be continuously appraised and integrated into clinical protocols for all domains of treatment, including isolation, and personal protective measures, pharmacologic therapy, and transitions of care. Inpatient pharmacologic therapy at this time consists primarily of dexamethasone and remdesivir, along with thromboprophylaxis, given the coagulopathy associated with COVID-19. This article summarizes current practices in our organization.

Footnotes

  • The authors report no relevant financial relationships which, in the context of their contributions, could be perceived as a potential conflict of interest.

  • The statements and opinions expressed in COVID-19 Curbside Consults are based on experience and the available literature as of the date posted. While we try to regularly update this content, any offered recommendations cannot be substituted for the clinical judgment of clinicians caring for individual patients.

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  1. Maria Miklowski, MD, FACP⇑
  1. Department of Hospital Medicine, Cleveland Clinic Community Care, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. Correspondence:
    Maria Miklowski, MD, Department of Hospital Medicine, Cleveland Clinic, M2 Annex, 9500 Euclid Avenue, Cleveland, OH 44195; miklowm{at}ccf.org
  1. Bruce Jansen, MD
  1. Department of Hospital Medicine, Cleveland Clinic Community Care, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. Moises Auron, MD, FAAP, FACP, SFHM
  1. Department of Hospital Medicine, Cleveland Clinic Community Care, Cleveland Clinic; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
  1. Christopher Whinney, MD, FACP, SFHM
  1. Chairman, Department of Hospital Medicine, Cleveland Clinic Community Care, Cleveland Clinic; Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH

ABSTRACT

SARS-CoV-2-infected inpatients who are admitted to a noncritical care medical ward require a standardized approach that is based on evidence if available, and effective supportive and respiratory care. Outcomes are better when patients receive standardized care, in special COVID-19 wards in the hospital, from clinical teams with expertise. Available evidence and guidelines should be continuously appraised and integrated into clinical protocols for all domains of treatment, including isolation, and personal protective measures, pharmacologic therapy, and transitions of care. Inpatient pharmacologic therapy at this time consists primarily of dexamethasone and remdesivir, along with thromboprophylaxis, given the coagulopathy associated with COVID-19. This article summarizes current practices in our organization.

Footnotes

  • The authors report no relevant financial relationships which, in the context of their contributions, could be perceived as a potential conflict of interest.

  • The statements and opinions expressed in COVID-19 Curbside Consults are based on experience and the available literature as of the date posted. While we try to regularly update this content, any offered recommendations cannot be substituted for the clinical judgment of clinicians caring for individual patients.

View Full Text
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