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The Aga Khan University Hospital,
Karachi, Pakistan
Flow of the Presentation
♦ Introduction and Overview
♦ Our Hospital’s COVID-19 Response
♦ Adjusting to the New Normal
♦ Key Learnings
2
Introduction to AKUH, Karachi
The Presenters
4
Shagufta HassanInterim [email protected]
Dr. Asim BelgaumiChief Medical [email protected]
5
♦ Part of the Aga Khan Development
Network
♦ Other hospitals in East Africa and
Afghanistan
♦ Chartered in 1983 as Pakistan’s first
private university
♦ Quaternary care hospital started
operations in 1985
♦ Not for profit
♦ Healthcare network of 5 hospitals,
290+ labs and 25 + medical centres
♦ 766 beds (Main Hospital) + 214 beds
(Secondary Hospitals); 980 beds
overall
♦ JCI and CAP accredited
AKUH Health Network Volumes - 2019
6
1.36mClinic Visits
20.6kBabies Born
29.5kSurgeries
102kAdmissions
0.45mRadiology Tests
13.7mLaboratory Tests
Overview of Pakistan
Overview of Pakistan
8
5th Most Populated Country
Population: 212 m
Population Karachi: 16 m
Literacy Rate: 59%
Expenditure on Health: < 1% of GDP
AKUH
Summary
Pakistan’s COVID-19 Case Load
19,452
24,206
61,227
0
10000
20000
30000
40000
50000
60000
70000
Karachi Sindh Pakistan
Of the 61,000+ cases in the country, > 30% are in Karachi.
9
Source: http://covid.gov.pk
*24-27 May estimates for Karachi;
actuals not available.
AKUH’s COVID-19 Response
COVID-19 Task Force
♦ Set up on 25 Jan 2020, two days before arrival
of first suspected cases
♦ Planning for different COVID-19 influx
scenarios
♦ Worked in areas of:
♦ Medical protocols
♦ Staffing & Employee Health & Safety
♦ Emergency protocols
♦ Procurement
♦ Facility changes
♦ Government relations
♦ Public awareness & Media management
♦ Internal communications
Chair: CEO and Dean, MC
Liaison Officer
Medical HRSafety and
SecurityLogistics
Communication
sFinance
Govt.
Relations
Hospital Incident Command System
(HICS)
♦ Initiated on 11 March, 2020
♦ The team met diligently every day, sometime twice a day, without fail since 11th March, with the last meeting taking place on16th April.
♦ Review of the circumstances and nature of this pandemic and our learning, it was implied that AKUH-K need to:
♦ Accept this new reality and plan operations around it
♦ Plan to resume to normal operations; and
♦ Define our capacity for Covid-19 patients
♦ The HICS was concluded on 17 April, 2020
Chair: CEO and Dean, MC
Liaison Officer
Medical HRSafety and
SecurityLogistics
Communications FinanceGovt.
Relations
Timeline of Major Events
20 Jan
Emerging Alert
Issued
25 Jan
COVID
Taskforce
initiated
13 Feb
Table Top Drill
- John Hopkins
11 March
Orange Alert
Announced –
HICS activated
23 April
New
Screening and
Testing Site
17 April
Orange Alert
Lifted
26 Feb
HICS defined
11 Feb
Screening and
Testing
Started
26 Jan
Awareness
Campaign
Launched
30 April
New
Diagnostic and
Treatment
Zone
12 May
Resumption of
Services
26 Jan
26 Chinese
workers
screened
12 Feb
1st COVID
detecting test
performed
11 March
N95 fit test
started for
healthcare staff
26 Feb
First COVID-
19 Patient
Admitted
1 March
COVID-19
patient
admitted
15 March
First PCR kit
arrived at
AKUH- Lab
16 March
CHC normal
operations
closed
16 March
Home Blood
Test Services
18 March
Service
Curtailment
Started
18 March
COVID ki
Khaber – staff
videos started
19 March
COVID-19
Helpline for
public started
23 March
Govt.
Announced
lockdown
23 March
Staff housing
for quarantine
& isolation
27 March
ER patient
flow changed
for safety
purpose
28 March
Tele clinics
started
31 March
Home health
services
3 April
CDU converted
to COVID bay
in ER
4 April
Decision to
convert PW
into COVID
Hospital
3 April
CDU converted
to COVID bay
in ER
Preparedness Response Recovery
Drop of Avg. census due to COVID-19
suspected & positive admissions
14
69
% 74
%7
8%
79
%7
6%
76
%7
3%
64
%6
7% 7
5%
75
%7
4%
74
%7
0%
67
%6
8%
69
%7
0%
68
%6
5%
57
%4
5%
38
%3
8%
40
%3
9%
36
%3
4%
33
%3
4% 39
%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1/0
3/2
02
0
3/0
3/2
02
0
5/0
3/2
02
0
7/0
3/2
02
0
9/0
3/2
02
0
11/0
3/2
02
0
13/0
3/2
02
0
15/0
3/2
02
0
17/0
3/2
02
0
19/0
3/2
02
0
21/0
3/2
02
0
23/0
3/2
02
0
25/0
3/2
02
0
27/0
3/2
02
0
29/0
3/2
02
0
31/0
3/2
02
0
Mar
% o
f O
cc
up
an
cy
Average Census Whole Day
0100
1010100
10100000000000000000000
100
1123
10122
1
44
11
6
1
44
2
11
99
14
910
6
14
6
20
12
20
13
7
20
13
1718
11
16
9
1213
17
19181717
19
0000000000000000000000000000000000010000000
100
10
8
00
23
112
5
1000
100
11
3
5
223
1211
0
232
0
4
233
0
5
10
15
20
25
22/0
1/2
02
02
5/0
1/2
02
02
8/0
1/2
02
03
1/0
1/2
02
03
/02
/202
06
/02
/202
09
/02
/202
01
2/0
2/2
02
01
5/0
2/2
02
01
8/0
2/2
02
02
1/0
2/2
02
02
4/0
2/2
02
02
7/0
2/2
02
01
/03
/202
04
/03
/202
07
/03
/202
01
0/0
3/2
02
01
3/0
3/2
02
01
6/0
3/2
02
01
9/0
3/2
02
02
2/0
3/2
02
02
5/0
3/2
02
02
8/0
3/2
02
03
1/0
3/2
02
03
/04
/202
06
/04
/202
09
/04
/202
01
2/0
4/2
02
0
Jan Feb Mar Apr
# o
f C
as
es
Total Admissions vs Admitted Positive Cases
Sum of Admitted suspected
Early Challenges
♦ New Virus:
♦ No verified tests available initially
♦ No standard treatment
♦ No standard medication
♦ Safety concerns:
♦ Limited negative pressure areas
♦ Testing at Emergency had to be closed
♦ Moved to open spaces but high volumes made
social distancing impossible as well
♦ Lockdown:
♦ Dwindling supplies of PPE, testing reagents
and sanitizer
♦ Tents and other logistical material
♦ Procurement shortages
♦ Construction material shortages
♦ Public and Media:
♦ Fake news about the hospital
♦ Misinformation about the disease
15
Curtailing Services
♦ Lockdown ♦ In Karachi: March 22, 2020
♦ In Pakistan: March 23, 2020
♦ At the Hospital♦ Essential services continued
♦ Clinics halted on March 20, 2020 based on
government directive
♦ Elective cases halted on March 20, 2020
♦ COVID-19 screening and testing had to
be stopped on March 21, 2020 for
outside patients
16
Changing Care Paradigms and
Processes
♦ Defining algorithms
♦ Screening
♦ Testing
♦ Employee Health
♦ Guidelines for PPE for each area
♦ Clinical rounds for students suspended
17
Collaboration with the Government
♦ Experts on provincial and federal task
forces
♦ SOP and guidelines development
♦ Design and establishment of 1,200-bed
field hospital in Karachi
♦ Testing support
♦ Training and capacity building:
♦ Doctors
♦ Nurses
♦ Doctor-to-Doctor Tele-ICU Services
18
Technology and Innovation
♦ One ventilator for multiple patients in
case of a surge
♦ Low-cost emergency ventilators
♦ 3-D printing of swabs – expected to
produce 400/day
♦ CoronaCheck – self-screening app
♦ SehatCheck – employee screening app
♦ Teleconsultation app
♦ Remote monitoring of ICUs
19
Adjusting to the New Normal
Safety Measures at the Hospital
♦ For everyone:
♦ Mandatory screening
♦ Mask made compulsory
♦ No visitors, one attendant policy
♦ 2/3 waiting area seats removed
♦ Cafeteria made takeaway only
♦ Congregational prayer area closed
♦ Enhanced infection control protocols
employed
♦ For staff:
♦ Appropriate PPE made mandatory
♦ Rotational schedules for frontline staff
♦ Work from home for other staff
21
Making the Staff Feel Safe
♦ Screening everyday
♦ Free testing and treatment if positive
♦ Availability of full PPE
♦ Guidelines developed
♦ PPE
♦ Surgical procedures
♦ Each service also created own
guidelines
♦ Hostels for isolation/quarantine
♦ Separate donning and doffing areas
♦ Transport services
22
Making Patients Feel Safe…
COVID-19 Testing and Screening Site
♦ Outdoors
♦ Away from clinics and
other hospital areas
♦ Separate areas for
employees and patients
♦ Modular booths
♦ Free tele-screening, up
to 700 tests/day
23
Making Patients Feel Safe…
COVID-19 Diagnostic and Treatment Zone
♦ Enhanced capacity:
♦ Respiratory Care Unit in ED
♦ Acute Care Unit converted to negative
pressure facility
♦ Isolation facility with negative pressure
ICU and negative pressure step down
unit
♦ Structural changes:
♦ Conversion of existing ORs to Negative
Pressure ORs
♦ Electronic monitors for pressure and
airflow
♦ Donning and doffing areas
♦ Doors modified to put glass panels for
external monitoring of patients
24
Resumption of Services
♦ COVID-19 screening, testing and
treatment away from other patients
♦ Outpatient options for patients:
♦ In-person clinics with mandatory
screening before consultation
♦ Tele-clinics
♦ Home health solutions
♦ Outreach and Community Hospital
clinics
♦ Surgeries:
♦ Pool testing for elective cases
♦ Full PPE for emergency cases
25
Key Learnings
♦ Accepting the new normal
♦ Learning and unlearning
♦ Collective decision making
♦ Swift action
♦ Investment in staff
♦ Changing culture
♦ Agility
26
Thank you
