COVID‐19 response by New Zealand general surgical departments in tertiary metropolitan hospitals

Abstract

Background Worldwide, coronavirus disease 2019 (COVID‐19) has significantly challenged the delivery of healthcare. New Zealand (NZ) faced similar potential challenges despite being geographically isolated. Given the rapid change in the COVID‐19 pandemic, hospitals in NZ were tasked with formulating their own COVID‐19 responses based on the Ministry of Health's (MoH) recommendations. Methods This paper evaluates how six metropolitan general surgical departments in NZ had responded to COVID‐19 in terms of changes made to rosters, theatres, clinics, acute admissions as well as additional measures taken to reduce the risk of staff exposure. It also explores how NZ fared in comparison with international guidelines and recommendations. Data from each centre were provided by an appointed clinician. Results All centres had adapted new rosters and a restructuring of teams. Handovers, multidisciplinary team meetings and educational sessions were held virtually. Different strategies were implemented to ration hospital resources and reduce the risk of staff exposure. Non‐urgent operations, endoscopies and clinics were deferred with allocation of dedicated COVID‐19 operating theatres. Potential COVID‐19 suspects were screened prior to admission and treated separately. Various admission and imaging pathways were utilised to increase efficiency. Conclusion General surgical departments in NZ had implemented a comprehensive COVID‐19 response but there is room to work towards a more unified national response. Our analysis shows that these centres across NZ had taken a similar approach which was aligned with international practices.

Impact of the COVID‐19 pandemic on outcomes of cholecystectomy for acute cholecystitis: a national cohort study

“…26 With regards to the pandemic phase timepoints used in this study, from March to May 2020 (classified in our analysis as the "pandemic phase"), all of Aotearoa New Zealand moved between Level 3 and 4 lockdown, which was associated with stringent social isolation protocols, reallocation and reprioritization of healthcare resources, and significant disruption of healthcare services. [27][28][29] In contrast, August to October 2021 (classified in our analysis as the "late-pandemic phase") was characterized by a brief escalation of Alert levels secondary to new-onset community transmission of the Delta variant of COVID-19, followed by a stepwise loosening of Alert level restrictions throughout the majority of Aotearoa New Zealand and gradual restoration of pre-pandemic healthcare service delivery. 26,30 As such, our multicentric and longitudinal analysis assesses three critical timepoints of Aotearoa New Zealand's national pandemic response and so is well-positioned to explore how surgical management of acute cholecystitis was impacted by the COVID-19 pandemic.…”

“…The COVID‐19 pandemic response in Aotearoa New Zealand during 2020 and 2021 was structured around a four‐tiered Alert system, which ranged from level 1 (used during times of isolated COVID‐19 community transmission and marked by an absence of societal restrictions) to level 4 (used during times of uncontrolled and intense COVID‐19 community transmission with closure of all non‐essential services) 26 . With regards to the pandemic phase timepoints used in this study, from March to May 2020 (classified in our analysis as the “pandemic phase”), all of Aotearoa New Zealand moved between Level 3 and 4 lockdown, which was associated with stringent social isolation protocols, reallocation and reprioritization of healthcare resources, and significant disruption of healthcare services 27–29 . In contrast, August to October 2021 (classified in our analysis as the “late‐pandemic phase”) was characterized by a brief escalation of Alert levels secondary to new‐onset community transmission of the Delta variant of COVID‐19, followed by a stepwise loosening of Alert level restrictions throughout the majority of Aotearoa New Zealand and gradual restoration of pre‐pandemic healthcare service delivery 26,30 .…”

Moral Breakdowns and Ethical Dilemmas of Perioperative Nurses during COVID-19: COREQ-Compliant Study

“…Nursing leaders had to divide nursing personnel into different teams, such as first-line and reserve nurses, to reduce the risk of contagion. This change in professional roles caused feelings of unfairness among nurses, as some perceived they had assumed more risk than others [ 17 , 18 ]. Nurse leaders must apply the principle of justice by ensuring fair distribution of burdens and implementing adequate rotation among nurses to balance assignments and workloads, thereby reducing negative feelings [ 57 , 58 , 59 , 60 ].…”

“…The experiences of perioperative nurses during the pandemic are particularly intriguing. In addition to the challenges mentioned earlier, they have had to adapt to significant structural changes in surgical units, such as their conversion into COVID-19 care units [ 16 , 17 , 18 ] or being reassigned to intensive care units (ICUs) [ 19 ]. There is scarce available evidence regarding the specific experiences of perioperative nurses in these environments and, more importantly, how they may contribute to various ethical dilemmas and develop potential moral breakdowns among nurses.…”

Neurosurgery Operating Room Efficiency During the COVID-19 Era

“…Factors that threatened to change OR efficiency-but did not result in meaningful changes in our institutional experienceinclude delays due to pending COVID-19 test results, safety procedures such as PPE donning, and planning difficulties to ensure the existence of teams with non-overlapping providers in the case of a surgeon being infected. 2,[11][12][13] Globally, many surgery centers halted all elective surgeries during the initial COVID-19 spike to prevent a PPE shortage and mitigate risk of infection of patients and health care workers. 8,12,14 However, there is no centralized definition of which neurosurgical procedures are elective, so that decision was made on a surgeon or center level, which could lead to variability in efficiency trends.…”