Maximizing the Calm before the Storm: Tiered Surgical Response Plan for Novel Coronavirus (COVID-19)

Abstract

The novel coronavirus (COVID-19) was first diagnosed in Wuhan, China in December 2019 and has now spread throughout the world, being verified by the World Health Organization as a pandemic on March 11. This had led to the calling of a national emergency on March 13 in the US. Many hospitals, healthcare networks, and specifically, departments of surgery, are asking the same questions about how to cope and plan for surge capacity, personnel attrition, novel infrastructure utilization, and resource exhaustion. Herein, we present a tiered plan for surgical department planning based on incident command levels. This includes acute care surgeon deployment (given their critical care training and vertically integrated position in the hospital), recommended infrastructure and transfer utilization, triage principles, and faculty, resident, and advanced care practitioner deployment.

What the COVID-19 pandemic tells us about the need to develop resilience in the nursing workforce

“…Critical care nurses, for example, are at risk of burnout if they have reduced resilience (Jackson et al 2018) and are at a high risk of developing PTSD (Mealer et al 2012), which is a particular concern for nurse leaders during the COVID-19 pandemic. This shows the need for clear and definitive leadership to determine staffing levels, organise staff rotas that include extra time for rest and recuperation, and ensure adequate provision of equipment (Ross et al 2020, WHO 2020c Organisational resilience Building resilience in the nursing workforce has long been considered important (Gray 2012), but recently there has been a shift to supporting organisational resilience (HEE 2019). In the current context, organisational resilience is important as the NHS has had little time to prepare for the COVID-19 pandemic (Qian et al 2020).…”

Ethical surgical triage of patients with head and neck cancer during the COVID‐19 pandemic

“…Our policies must change and evolve depending on the magnitude of the situation. 9,28 In the absence of data to guide us, we involved the most experienced surgeons available, and extensive open discussion in multiple forums was followed by formal committee review in order to make decisions. While in theory the committee chairman had the final word, there was always a consensus regarding the appropriate approach.…”

COVID-19 Utilization and Resource Visualization Engine (CURVE) to Forecast In-Hospital Resources

“…While healthcare utilization for non-COVID-19 illness declined early in the pandemic due to canceling of all in-person elective care, 25 this demand is also expected to surge back over time and increasingly become a contributor to overall health system resource consumption. [26][27][28] There are some limitations and scope conditions that should be noted. First, although the CURVE app was developed for healthcare systems to insert local data using either csv files or through direct connection to their enterprise data warehouse, users still require R and R Shiny proficiency to modify or to add more tables, charts, or graphs.…”