ANNOUNCER: Welcome to Mayo Clinic COVID-19 Expert Insights and Strategies. The following activity is supported in part by an independent medical education grant from Pfizer Inc and is in accordance with ACCME guidelines.

ALEX NIVEN: Welcome to the Mayo Clinic Critical Care Insights COVID edition. My name is Alex Niven. I'm a consultant in the division of Pulmonary Critical Care and Sleep Medicine here at Mayo Clinic in Rochester, Minnesota, and also the education chair for both our division and for the independent multi-specialty critical care practice.

The COVID pandemic has changed the way that we practice likely forever. And the critical care community has been particularly impacted by the current pandemic. Critical Care Insights COVID-19 edition is intended for health care providers who are caring for patients with COVID-19 across the world in the ICU.

Best practices to care for these patients have been rapidly evolving and busy bedside providers-- I know I have-- struggled to keep up with the volume of information, especially given that the information sources that have been providing it are frequently less than rigorously peer reviewed.

In response, Mayo Clinic has developed an Ask Mayo Expert COVID-19 Task Force that have collected and curated the available content into a free public website under the Mayo Clinic Ask Mayo Expert COVID-19 Navigator.

This source provides basically a curated site for best practice recommendations in the care of COVID-19 patients developed collaboratively by an interprofessional stakeholder group of Mayo Clinic subspecialists. And these information is continuously informed by rapid literature scoping reviews performed by the current center for the science of health care delivery.

This online CME course is designed to speed dissemination and implementation of these best evidence-based guidelines, best practice innovation, and provide discussion of ongoing clinical controversies that we face in critical care as we take care of these patients.

These discussions will feature the original authors of the content that is available on Ask Mayo Expert and allow them to discuss the evidence and best practices that they have used to provide these recommendations and the why behind the information that they've shared.

We will be continuously updating this content as time goes on based on the available high quality evidence that comes through our rapid scoping reviews and our evolving innovations and evolution of clinical practices within our own health care delivery platform here at Mayo Clinic.

This initial CME offering consists of seven lectures, including topics from intubation safety, infection control, workflow considerations, navigating drug shortages, maximizing team performance, mindset training for the individual, humanizing critical care, respiratory therapy innovations, among others.

We will continue to evolve this content as time goes on with new information on the epidemiology, virology, clinical features of COVID-19 patients, and also evolving recommendations with regards to testing and the care, in addition to infection control, considerations in this challenging population.

We hope that you enjoy this work. This information has been provided as a series of Grand Rounds presentations to our critical care community over the course of the last five weeks, and will continue to evolve over time. Welcome to Critical Care Insights. I hope you enjoy our work.

Welcome, everybody, to this edition of Critical Care Insights COVID-19 edition. My name is Alex Niven. And it's a true privilege to introduce the panel today that is talking on the topic of maximizing COVID ICU team performance, workflow, mindset training, and resilience.

So I'm a pulmonary critical care consultant here at Mayo Clinic. And I'm just going to work around our circle here, our virtual circle, to have everybody else on our panel introduce themselves. And I'm going to start with Katie.

KATIE JONES: Hi, my name's Katie Jones. I'm one of the physician assistants in the medical ICU at [INAUDIBLE] Hospital. Thanks for having me.

ALEX NIVEN: Welcome, Katie. Lori?

LORI FAULHABER: My name's Lori Faulhaber. I'm one of the respiratory therapists in the medical intensive care unit. Taking care patients is what we do every day. So I'm happy to be here. Thank you.

ALEX NIVEN: Thanks for joining us, Lori. Chris.

CHRIS KELM: Hi, I'm Chris Kelm, respiratory therapy educator. Thanks for having me.

ALEX NIVEN: Roberto.

ROBERTO BENZO: Hi, I'm Roberto Benzo, one of the pulmonologists here at Mayo Clinic. I also am a behavioral scientist at [INAUDIBLE] lab. I thank you very much for having me here.

ALEX NIVEN: Thanks for joining us, Roberto. Jenn?

JENN ELMER: I'm Jenn Elmer. I'm a critical care clinical nurse specialist here in the medical ICU. I also support our high consequence infectious disease team.

ALEX NIVEN: Welcome, Jenn. Ben?

BENJAMIN DAXON: Hi, my name is Ben Daxon. I'm an anesthesiologist and intensivist here at Mayo Clinic in Rochester, Minnesota, and previously spent seven years on active duty where team performance in high stress environments was a regular part of the job.

ALEX NIVEN: Well, welcome, guys, and thank you very much for taking the time to talk about a really important issue, in my eyes, talking about team performance. So I'll tell you, I got really interested in talking about this early on in the pandemic. As you might see behind me, I've got an American flag there. I'm a retired army guy, as is Ben.

And we all have experienced a lot of disruption in our personal and professional lives over the course of the last couple of months. And honestly, to me, early on, it felt very much like a deployment in terms of the number of changes, the degree of stress, and the amount of sort of disruption that I felt in both my personal and professional life.

And so one of the things that I remember from my past deployments is the importance of being deliberate about preparing oneself for that experience, and the importance of also being deliberate in sustaining that high level of performance that we all have to bring every day in these challenging sorts of situations.

So, for me, I was in the medical intensive care unit right at the beginning of our COVID wave starting and came back just for a day last week. And it was really striking to see the massive difference that has happened in that practice environment in just a short period of time.

And I think for me to be impacted that way, I think, says a lot, and that says nothing about-- and when I compare what I do every day compared to the nurses at the bedside, the respiratory therapists, and the advanced practice providers who are doing 10 times the amount of bedside care that I am on a regular basis and whose lives have been even more affected by these changes, I thought it was really important to talk about ways to deal with that, our experiences, and talk about some practical approaches to sustain a high level of performance for what, unfortunately, is probably going to be a marathon, and not a sprint.

So I don't know if there's other folks that would be willing to share just a word or two in terms of their experiences or reflections over the course of this COVID pandemic, but I'll open that up first and see if anybody else wants to say something.

JENN ELMER: Thanks. I'd actually add that based off of our previous five years of experience of getting ready for emerging infectious diseases, that this was definitely building on skills that we maybe have already thought about, which, to me, was a huge advantage.

But I've told people that, to me, preparing for COVID-19 was like dealing with people on steroids. We thought we had good plans in place. We thought we had workflows worked out, but until this really hit and was at our doorstep, we realized that those were good foundations, but not necessarily had been put into fruition. So this was kind of an experience for at least me and my staff to build on those skills that maybe we had thought about at least before.

ALEX NIVEN: Yeah, I like that, Ebola on steroids. I mean, the rate of change that we've all had to deal with, from day to day, minute to minute, has been crazy. Lori, you've done a lot of time over the course of the last six weeks in the unit. Can I pick on you for a minute?

LORI FAULHABER: You sure can.

ALEX NIVEN: So tell us a little bit about your experience as a respiratory therapist.

LORI FAULHABER: Yeah, I think you said-- and you mentioned that the change that you had seen just in a week's difference of from the start of this to where we are now, I hope you meant a good change. But I think we've had conversations along the way that this has almost become a new normal for us, that we've transgressed through this, and we're at a spot now where this is just a new normal for us in the medical ICU.

I'm part of the practice committee for the enterprise within respiratory care, and we've talked for years about pandemic style thoughts, and are we prepared. And I never thought this would be part of my career, and I've been here for 17 years now. H1N1, Ebola have all been in the past. And this, again, Ebola on steroids is a great, great term to use.

But I think we've all come together as a team. And it seems to be working really well. I think we've fostered more of a teamwork between the different groups, nursing, respiratory therapy, our mid-level providers, and even on up to our consultants and residents and things. And that, to me, is what actually makes us work the best, is knowing that we're collaborating as a team and helping each other out to get through it.

ALEX NIVEN: Yeah, so I couldn't agree more with that. I felt very well supported going back through my donning and doffing after I was a good five or six weeks out of my last experience with that. Katie, can I turn to you, just to share your thoughts real quick?

KATIE JONES: Sure. Yeah, so as somebody who hates change, when this all started, I certainly struggled. And it was like, you guys all saw the deluge of emails. There was one at 10:00 PM. The next day, there's one at 4:00 AM and then 5:00. There was just so many emails updating you.

But then I try and I sit back and I try to reflect on that. And I find myself so grateful for, again, all the teamwork that I've seen, but also the leadership that's been very proactive, instead of reactive. I felt like we evolved our changes and our practices to what was happening.

But I didn't feel like it was just simply reactive, that we waited for something bad to happen. It was people just kept thinking through the policies and the processes that we were implementing and came up with a change that was something for the better.

So I think that's kind of what I have to add and echo, I guess, to what you guys are saying is that there's been a lot of change. And I've been really inspired by all the teamwork that I've seen, but just also how proactive everyone has been.

ALEX NIVEN: Yeah. No, I'm very grateful to be part of a really, really great team. Ben, let me ask you as well if you want to share a few thoughts. What I've learned about Ben Daxon in the short time that we've worked together is that somehow or other, he always seems to be in the eye of the storm. So he's had a lot of experience in a lot of different situations in a very short period of time here.

BENJAMIN DAXON: Oh, that's true. Yeah, I'd say it's the eye of the storm right now because it's very calm right now because I'm at home in self-quarantine. I recently got back after volunteering through SECM to help out with one of the overflow surge ICUs up in New York and was there for a week.

Got to work in an ICU of people that had come in from all over the country to help out. And it's quite the contrast to what we do here at Mayo where everybody works together on a regular basis, and we have protocols in place, and people know each other's names, and we thought through all this. And it was a stark difference to what we do here.

Coming back from that, I've thought a lot about what worked, what didn't, what's different from how we've practiced at Mayo. And two of the things that really stood out to me were the importance of protocols and plans.

Since I'm an army guy and, Dr. Niven, you are, too, I'll quote Eisenhower. He always had a quote I like, which was no plan survives first contact with the enemy. But you must always plan. And I think that's very true here. Dr. Niven and I spent a lot of time working on an innovation guideline for all of Mayo. And I volunteered at this hospital.

This was great. It'll bring the Mayo protocol. We could do what I spent weeks preparing for. And our first patient did not go at all like we planned. But because we had a plan, and we thought some things through, and we're able to talk about it, it went a lot better than if we hadn't done that. So this is an evolving process. We've got plans. They'll still need to be adjusted, especially as we learn more about the disease.

But Mayo's I think leaps and bounds ahead of a lot of places because we've thought through so much of what we're doing. And briefly, the second thing that I realized was really important was maybe the exact opposite, which was just people and being a leader and having to deviate from the plan. Like I said, it's never going to survive first contact with the enemy.

And I think part of the responsibility for everybody involved, whether you're top of the food chain or bottom of the food chain here is you recognize where the plan doesn't work, and you individualize the care for what's best for the patient in front of you.

And knowing when that is and how to proceed and to do it as a group is really difficult. Easy to talk about here in a Zoom meeting, but it takes a lot of thought and humility and just graciousness and working with the rest of the team there at the bedside.

ALEX NIVEN: I think that you've highlighted just one of the many challenges that we face going forward. And like I said before, my fear-- and I think that this is probably valid-- is this really is going to be a marathon, not a sprint. We've been able to successfully flatten the curve, but that also means that we're going to have a fair number of new COVID cases extending on for a while.

And so, really, what we wanted to talk about today was how to maximize that team performance using, really, the key members of our practice here, assembled, and talk about ways that we have worked together to try to innovate our practice to make it easier for us to do the right things for our--