The Boston Medical Center Coronavirus Disease 2019 (COVID-19) Procedure Team: Optimizing the surgeon’s role in pandemic care at a safety-net hospital

Abstract

Background: The coronavirus disease 2019 pandemic has claimed many lives and strained the US health care system. At Boston Medical Center, a regional safety-net hospital, the Department of Surgery created a dedicated coronavirus disease 2019 Procedure Team to ease the burden on other providers coping with the surge of infected patients. As restrictions on social distancing are lifted, health systems are bracing for additional surges in coronavirus disease 2019 cases. Our objective is to quantify the volume and types of procedures performed, review outcomes, and highlight lessons for other institutions that may need to establish similar teams. Methods: Procedures were tracked prospectively along with patient demographics, immediate complications, and time from donning to doffing of the personal protective equipment. Retrospective chart review was conducted to obtain patient outcomes and delayed adverse events. We hypothesized that a dedicated surgeon-led team would perform invasive bedside procedures expeditiously and with few complications.

Impact of the COVID-19 pandemic on the practice of endocrine surgery

“…Hospital systems reported decreased revenue from the suspension of elective procedures, which make up a bulk of income for hospitals and often support less profitable services( 5 ). Many surgeons were reassigned to other roles during this time – some providing ancillary care such as line-placement in COVID-19 patients, others taking general surgery or trauma call so their critical-care surgeon colleagues could manage COVID-19 intensive care units( 6 ). To further prevent spread of the virus, measures were put in place to better encourage social distancing: outpatient practices converted visits to telemedicine formats( 7 ), educational sessions were moved to virtual platforms, and trainees were prohibited from certain care settings to preserve resources or permit social distancing( 8 ).…”

Development of a Low-Resource Operating Room and a Wide-Awake Orthopedic Surgery Program During the COVID-19 Pandemic

“…The team performed 272 procedures on 125 patients, saved approximately 192 hours of work for other patient care needs, and maintained a complication rate lower than those previously reported. 23 In addition to modifying systems of care through approaches such as our institution's LROR or the development of a surgical procedure team, rapid prototyping of multiple forms of PPE and equipment have been described. Duke University orthopedic surgeons retrofitted arthroplasty helmets with a novel 3D-printed manifold to provide a possible solution to the shortage of powered air-purifying respirators, 24 while Massachusetts General Hospital 25 developed a COVID Innovation Center to rapidly evaluate potential solutions ranging from the decontamination of N95 masks to 3D printing of ventilators.…”

Creation of a dedicated line team for critically ill patients with COVID-19: A multidisciplinary approach to maximize resource utilization during the COVID-19 pandemic

“…2,3 Multidisciplinary teams are increasing in healthcare. 8,9 Organizations are utilizing innovative ways to deploy experts like those described in this study to form expert teams. [9][10][11] This would provide expertise and limit stress on the clinical overload that the primary teams have in taking care of the COVID-19 patients and improving this vulnerable group of patients.…”