When SARS-CoV-2 arrived in the U.S. last winter, health care systems had to quickly adapt to its spread and the evolving understanding of the virus and its pathology. By spring, a national emergency had been declared and many hospitals were shifting staff and resources in response to a surge in COVID-19 cases.
In the Tuesday, October 6, session Leadership, Workforce, Communication during COVID-19 Pandemic: Lessons Learned, a panel of experts shared their personal experiences from this crisis and offered guidance for preparing the surgical workforce for future systemic health care disasters. The presentation will be available for on-demand viewing through the virtual Clinical Congress meeting platform through December 31.
Eileen M. Bulger, MD, FACS, professor, University of Washington, Seattle, and Chair, American College of Surgeons (ACS) Committee on Trauma, highlighted the importance of surgeons as leaders in disaster response.
“Surgeons have a legacy of mass casualty experience,” she said. “Whether it be dealing with natural disasters or manmade disasters, we frequently care for large numbers of patients that are injured acutely and require a significant coordination of response.”
The pandemic has presented challenges different from trauma or burn mass-casualty incidents. To start, a pandemic is an ongoing versus a discrete event. It also has a broad demographic distribution with sporadic surges, Dr. Bulger said. Additionally, a pandemic presents an underlying risk to health care workers.
Dr. Bulger identifies three groups that need to join forces and work seamlessly during a pandemic: public health, emergency management, and acute health care systems.
“These are groups that are very high functioning on their own but are not used to working together in a coordinated and consistent way,” she said. One path to overcoming this challenge, she explained, is creating a regional medical operations center (RMOC) built on the framework of an emergency care–trauma system.
George Agriantonis, MD, FACS, trauma medical director, NYC Health + Hospitals, Elmhurst Hospital, described how the largest municipal hospital system in the U.S. confronted the COVID-19 surge in New York City, including redeployment of its workforce. With elective surgeries temporarily cancelled, all surgeons were reassigned to manage expanded intensive care units (ICUs) and the sudden influx of COVID-19 patients.
Elmhurst, one of 11 acute care hospitals in the NYC Health + Hospitals system, is a Level One Trauma Center in Queens. COVID-19 hit the densely populated area hard and early, peaking in March and early April when New York City experienced more than 6,000 new cases and 1,500 related hospitalizations a day, Dr. Agriantonis explained. The week of March 9, the Elmhurst Emergency Department daily census exceeded 160 COVID-19 patients. The Washington Post described Elmhurst as “the epicenter of the epicenter” of the coronavirus outbreak. Its ICU increased from 30 beds to 160 ventilator-capable beds to meet the spike in COVID-19 cases.
“As your volume of patients goes up, you need to both maximize your current workforce and increase the current workforce,” said Renee Spiegel, MD, director of surgery, NYC Health + Hospitals, Elmhurst, who also detailed how the hospital’s workforce has met continually shifting demands during the pandemic.
She outlined the benefits of establishing clearly defined triggers for implementing a tiered staffing deployment—such as the positivity rate in the community, ICU bed capacity, or a government declaration of a state of emergency—to ease the transition to new roles when the need arises.
“Make sure your workforce is adept but can also adapt,” she said.
Panelist Rachel C. Forbes, MD, MBA, FACS, division chief, kidney and pancreas transplantation, Vanderbilt University Medical Center, Nashville, TN, underscored the value of clear communication and the critical need for virtual and rapid communication at the national level, the hospital system level, the surgeon–practice level, and down to the surgeon–patient level. The swift proliferation of telemedicine since the start of the pandemic supports this idea, she said, as COVID-19 forced health care providers to become serious about telemedicine and onboarding patients to their online platforms.