Development of pediatric surgical decision-making guidelines for COVID-19 in a New York City children's hospital

Abstract

During the COVID-19 pandemic, experience-based guidelines are needed in the pediatric population in order to deliver high quality care in a new way that keeps patients and healthcare workers safe and maximizes hospital resource utilization. Background: The COVID-19 pandemic has created an unprecedented strain on national health care resources, particularly in New York City, the epicenter of the outbreak in the United States. Prudent allocation of surgical resources during the pandemic quickly became essential, and there is an unprecedented need to weigh the risks of operating versus delaying intervention in our pediatric patients. Methods: Here we describe our experience in surgical decision-making in the pediatric surgical population at Morgan Stanley Children's Hospital of New York-Presbyterian (MSCHONY), which has served as a major urban catchment area for COVID-19 positive pediatric patients. We describe how we have adjusted our current treatment of multiple facets of pediatric surgery including oncology, trauma, minimally invasive procedures, and extracorporeal membrane oxygenation (ECMO). Conclusions: Our pediatric surgery department had to creatively and expeditiously adjust our protocols, guidelines, and workforce to not only serve our pediatric population but merge ourselves with our adult hospital system during the COVID pandemic.

Sharing strategies for safe delivery of surgical care for children in the COVID-19 Era

“…CDC guidelines and additional retrospective studies have suggested that sufficient protection is provided to healthcare workers through the use of these PPE measures. The most significant risk of transmission is through the interrupted practice of proper social distancing and universal masking behaviors [12] . At the time of this research letter, there are no reported cases of COVID-19 transmission from an infected pediatric patient to a healthcare worker.…”

Anaesthesia and Critical Care Department at a Major Academic Centre’s Adaptation to Face the COVID-19 Pandemic

“… 18 Many countries were compelled to alter their surgical practices and even postpone many elective and semi-urgent surgical procedures. 16 , 17 At our centre, elective procedures had been postponed in order to decrease disease transmission and conserve resources. This allowed us more flexibility in order to decrease the number of staff coming into the hospital on a daily basis, therefore reducing the risk of cross contamination and burnout.…”

Presidential address—the Black Swan: ISPN and pediatric neurosurgery in times of COVID-19

“…Patients whose treatment had been postponed or cancelled were at risk, a peculiar and dangerous situation in which they could become potential collateral victims [25]. Urgent procedures, here defined as those to be resolved within one day to four weeks, were deferred as much as possible [27]. Shortly after the beginning of the pandemic, the dichotomy Fig.…”

“…Reduction in activity away from home may be a reasonable explanation for the drop in trauma referrals since parents and patients feared to go to the hospital [14,24]. The reduction of referral may also be ascribed to the lower number of trivial or ill-identified problems [28] and also the implementation of virtual consultations [27]. Notwithstanding, some centers noticed an increase in emergency services volume, yet without statistically significant differences [29].…”