Components of a safe cystectomy service during coronavirus disease 2019 in a high-volume centre

Abstract

Objective: Delivery of a safe cystectomy service is a multidisciplinary exercise. In this article, we detail the measures implemented at our institution to deliver a cystectomy service for bladder cancer patients during coronavirus disease 2019 (COVID-19). Methods: A ‘one-stop’ enhanced recovery clinic had been established at our hospital, consisting of an anaesthetist, an exercise testing service, urinary diversion nurses, clinical nurse specialists and surgeons. During COVID-19, we modified these processes in order to continue to provide urgent cystectomy safely for bladder cancer. We collected patients’ outcomes prospectively measuring demographic characteristics, oncological and perioperative outcomes, the presence of COVID-19 symptoms and confirmed COVID-19 test results. Results: From March to May 2020, 25 patients underwent radical cystectomy for bladder cancer. Twenty-four procedures were performed with robotic assistance and one open as part of a research trial. We instituted modifications at various multidisciplinary steps, including patient selection, preoperative optimisation, enhanced recovery protocols, patient counselling and perioperative protocols. Thirty-day mortality was 0%. The 30-day rate of Clavien ⩾3 complications was 8%. Postoperatively, none of the patients developed COVID-19 based on World Health Organization criteria and testing. Conclusion: We safely delivered a complex cystectomy service during the peak of the COVID-19 pandemic without any COVID-19-related morbidity or mortality. Level of evidence: Level 2b.

Response and innovations of advanced practice nurses during the COVID‐19 pandemic: A scoping review

“…Disruption from the pandemic resulted in the transformation of multiple aspects of care and healthcare administration; 10 articles describing this were categorized as ‘multifaceted’ innovations (Table 1). Seven described the response within a particular facility or organization (Bleazard et al., 2021; Duncan et al., 2021; Lucciola et al., 2021; Nelson et al., 2020; Pate et al., 2021; Phillips et al., 2021; Sayer et al., 2020) and three described regional responses (Franzosa et al., 2021; McGilton et al., 2021; Popejoy et al., 2020). Five articles included clinical nurse specialists, four included nurse practitioners, and one included multiple types of APNs.…”

“…Eight articles outlined measures aimed at preventing or curbing the spread of COVID‐19 (Bleazard et al., 2021; Duncan et al., 2021; Lucciola et al., 2021; McGilton et al., 2021; Nelson et al., 2020; Phillips et al., 2021; Popejoy et al., 2020; Sayer et al., 2020) with APNs responsible for obtaining and conserving personal protective equipment, teaching staff techniques for donning/doffing, and personal protective equipment storage. APNs educated staff by creating, and distributing guidelines and protocols, and communicating and interpreting policy changes from public health agencies (Bleazard et al., 2021; McGilton et al., 2021; Pate et al., 2021; Phillips et al., 2021; Popejoy et al., 2020).…”

“…APNs played a role in participating in workflow planning (Lucciola et al., 2021; Pate et al., 2021), assessing nursing staff readiness for redeployment (Lucciola et al., 2021), planning and providing education and resources to redeployed nurses (Lucciola et al., 2021), and adapting their own role in response to organization needs (McGilton et al., 2021; Phillips et al., 2021; Sayer et al., 2020). APNs also planned and supported logistical and structural changes to clinical care such as using telehealth (Nelson et al., 2020; Sayer et al., 2020), surge planning (Lucciola et al., 2021), creating new clinical care units (Bleazard et al., 2021; Phillips et al., 2021), establishing testing centers (Lucciola et al., 2021), and managing the care of COVID‐19 positive patients (Phillips et al., 2021; Popejoy et al., 2020). APNs responded to isolated patients by enhancing communication with families (Pate et al., 2021), leveraging technology to connect patients and families (McGilton, et al., 2021; Pate et al., 2021; Phillips et al., 2021), providing psychosocial support (Popejoy et al., 2020; Sayer et al., 2020), and helping patients obtain short‐term disability or letters of medical necessity to stay at home (Sayer et al., 2020).…”

“…Most innovations incorporated established evidence‐based guidelines and tools from national health agencies or included newly developed guidelines designed as part of the innovation to support specialty practice (Supplement 2). Guidelines directed COVID‐19 testing, clinical management, and infection prevention/control (Bernhardt, 2020; Bleazard, et al., 2021; Duncan et al., 2021; Lucciola et al., 2021; Mao et al., 2021; Murphy et al, 2021, Nelson et al., 2020; Pate et al., 2021; Phillips et al., 2021; Renke et al., 2020; Steeves‐Reece et al., 2021); program design and reorganization, including staffing recommendations (Ambrosini et al., 2020; Lucciola et al., 2021; Murphy et al, 2021); and implementation of telehealth (Sinha et al., 2020).…”

“…Adverse events or complications were assessed in four articles, of which none were reported (Giver et al., 2022; Lim et al., 2020; McLachlan et al., 2021; Santos et al, 2021). A multifaceted cystectomy service for patients with bladder cancer had a 30‐day mortality of 0% and 30‐day grade 3 complications of 8% (Nelson et al., 2020).…”