Deploying the Physician Workforce During a Respiratory Pandemic: The Experience of an Academic Teaching Hospital During the COVID-19 Pandemic

Abstract

Washington State gave Boston hospitals time to prepare for a surge of patients in need of hospitalization for pneumonia and acute respiratory distress syndrome related to SARS-CoV-2 in the spring of 2020. [1][2][3][4] We present our experience of preparing and organizing physicians to manage this respiratory and critical care disease, employing the resources of an entire physician community, and considering how to deploy for another potential surge later in the year. Tufts Medical Center and Children's Hospital is a 415-bed tertiary and quaternary referral hospital, providing full services, including pediatric, medical, surgical, and neurologic intensive care, extracorporeal therapies including extracorporeal membrane oxygenation (ECMO), level I trauma service, and cardiac care with the largest regional heart transplant program. The primary teaching hospital of Tufts University School of Medicine, the medical center, sponsors a large graduate medical education program, with 453 residents and fellows in 46 programs. The overall faculty is relatively small, with 18 pulmonary and critical care (PCCM) faculty members covering one medical intensive care unit (MICU) at Tufts Medical Center as well as at 2 affiliate hospitals, 25 infectious disease (ID) physicians, and about 200 fulltime clinical internal medicine (IM) faculty members.

Sustaining the Australian respiratory workforce through the COVID‐19 pandemic: a scoping literature review

“…Surveys covered HCW from China, 6 , 8 , 18 Pakistan, 9 India, 20 the United Kingdom, 12 , 17 , 35 , 43 Libya, 23 , 35 , 46 Spain, 32 Singapore, 42 South Africa, 44 the United States, 31 , 47 Australia 3 , 48 , 54 and Turkey. 39 Surveys identified a number of concerns among HCW, including lack of PPE, 17 , 20 , 23 , 32 , 33 , 43 , 44 lack of preparedness, 9 , 17 , 20 , 23 , 44 , 46 , 48 , 55 staff shortages 32 , 33 , 43 and infection risk.…”

“…From the literature reviewed, we have explored possible directions for future respiratory pandemic responses. The papers reviewed have highlighted the benefits of interaction between multiple disciplines, including redeployment of physician staff and cross‐matching of skillsets 47 and tiered staffing models to maximise critical care physician capacity. 45 , 53 Availability of clinical resources affected HCW as they adapted to the needs of the pandemic, including PPE, 7 , 11 , 20 , 23 , 32 , 33 , 36 ICU surge capacity 19 , 21 , 24 , 45 and system factors, such as workforce flexibility 30 and shift structure.…”

“…15,19,26,45 Commentaries Commentary papers identified critical workforce issues, such as early recognition of the need for HCW protection, 5,7 the speed of the outbreak during wave one in globally recognised early hotspots 5,16 and aspects of healthcare systems that might have exacerbated outbreaks (such as just-in-time supply chains that limited access to PPE) 34 and that required rapid adaption to manage the surge (including in-hospital physical distancing strategies, HCW screening for infection, rapid uptake of telehealth and prompt redeployment of staff). 13,29,30,47…”

Medical Knowledge Acquisition during a Pandemic: Pediatric Subspecialty in-Training Examination and Board Certification Exam Passing Rate

“…Though pediatric emergency department (PED) volumes dropped early in the pandemic, PEM fellows remained active in patient care, with some programs deploying trainees to adult emergency departments or adult medical intensive care units to support available staffing, similar to other specialties. 24 , 25 , 26 As PEM training already requires training in critical care, adult emergencies (for pediatrics-trained fellows), and critical procedures, the acuity of illness and procedural needs of adult patients may have augmented the educational experiences of PEM fellows, who are frontline providers. With limited access to primary care and the abrupt transition to telehealth, some parents without access to virtual options or pediatric care sought care in emergency departments, allowing PEM fellows an opportunity to provide hands-on care during the pandemic that was not COVID-related.…”