Restructuring the surgical service during the COVID-19 pandemic: experience from a tertiary institution in Singapore

Low, Tze Yi; So, Jimmy Bok Yan; Madhavan, Krishnakumar; Hartman, Micah

doi:10.1002/bjs.11701

Cited by 12 publications

(10 citation statements)

References 4 publications

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“…Healthcare services are reshaped to face the increasing number of patients and increased demand of intensive care unit (ICU) beds and clinical staff, most of the services opted to cancel the elective surgeries and run virtual outpatient clinics 2 . We have read with a great interest how Low et al 3 . were able to restructure the surgical services in their centre in Singapore, and we concur with what they have mentioned.…”

supporting

confidence: 77%

Conducting the mortality and morbidity meetings during COVID-19 pandemic, a tertiary care centre experience in Qatar

Ahmed

Alfkey

Zarour

2020

British Journal of Surgery

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supporting

confidence: 77%

Conducting the mortality and morbidity meetings during COVID-19 pandemic, a tertiary care centre experience in Qatar

Ahmed

Alfkey

Zarour

2020

British Journal of Surgery

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“…After the first cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 in China, COVID-19 rapidly evolved towards a pandemic, requiring complete restructuring of healthcare systems worldwide [ 1 ]. With more than 6000 cases of COVID-19 diagnosed between March 1st and March 15th, France was one of the first European countries to be strongly affected by the pandemic [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

The role of a pediatric tertiary care center in avoiding collateral damage for children with acute appendicitis during the COVID-19 outbreak

et al. 2020

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Purpose To evaluate the impact of the COVID-19 pandemic-related lockdown on management and outcomes of children with acute appendicitis. Methods A retrospective cohort study was conducted, including children treated for acute appendicitis (January 20th–May 11th, 2020). The data regarding the severity of appendicitis and outcome were collected and compared for two time periods, before and after the nationwide lockdown (March 17th, 2020). Results The number of cases of acute appendicitis increased by 77% during the lockdown ( n = 39 vs. n = 69, p = 0.03). During the lockdown, children treated for appendicitis were older (11.1 vs. 8.9 years, p = 0.003), and were more likely to live more than 5 km away from our institution (77% vs. 52%, p = 0.017). Less children had previously consulted a general practitioner (15% vs. 33%, p = 0.028), whereas more children were transferred from other hospitals (52% vs. 31%, p = 0.043). There was no difference in terms of length of hospital stay, rate of postoperative intra-abdominal abscess, ER visits, and readmissions between both periods. Three children (4%) were diagnosed with COVID-19 and appendicitis. Conclusions Despite an increase in the number of children with appendicitis managed at our hospital during the COVID-19-related lockdown, management, and outcome remained similar. Although our pediatric center was strongly affected by this pandemic, maintaining our prior practice strategies for acute appendicitis avoided the occurrence of collateral damage for those children.

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“… 1 2 We had earlier trialled a similar concept within our surgical department, which had been divided into separate teams which alternated between inpatient and outpatient duty on a rotational basis. 3 Junior staff from the outpatient team provided real-time but remote support to the inpatient team during ward rounds. This reduced junior burn-out rates by obviating the need for the inpatient team to arrive earlier to ‘pre-round’ the patients and increased efficiency while preserving geographical segregation between teams.…”

Section: Methodsmentioning

confidence: 99%

Close air support: enhancing emergency care in the COVID-19 pandemic

et al. 2020

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The COVID-19 pandemic has taken the world by storm and overwhelmed healthcare institutions even in developed countries. In response, clinical staff and resources have been redeployed to the areas of greatest need, that is, intensive care units and emergency rooms (ER), to reinforce front-line manpower. We introduce the concept of close air support (CAS) to augment ER operations in an efficient, safe and scalable manner. Teams of five comprising two on-site junior ER physicians would be paired with two CAS doctors, who would be off-site but be in constant communication via teleconferencing to render real-time administrative support. They would be supervised by an ER attending. This reduces direct viral exposure to doctors, conserves precious personal protective equipment and allows ER physicians to focus on patient care. Medical students can also be involved in a safe and supervised manner. After 1 month, the average time to patient disposition was halved. General feedback was also positive. CAS improves efficiency and is safe, scalable and sustainable. It has also empowered a previously untapped group of junior clinicians to support front-line medical operations, while simultaneously protecting them from viral exposure. Institutions can consider adopting our novel approach, with modifications made according to their local context.

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Restructuring the surgical service during the COVID-19 pandemic: experience from a tertiary institution in Singapore

Cited by 12 publications

References 4 publications

Conducting the mortality and morbidity meetings during COVID-19 pandemic, a tertiary care centre experience in Qatar

Conducting the mortality and morbidity meetings during COVID-19 pandemic, a tertiary care centre experience in Qatar

The role of a pediatric tertiary care center in avoiding collateral damage for children with acute appendicitis during the COVID-19 outbreak

Close air support: enhancing emergency care in the COVID-19 pandemic

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