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

Low, Tze Yi; Hartman, Mikael; Chee, Corissa; Mohankumar, Bhuvaneshwari; Ang, Sophia Bee Leng; San, Moe Thu; Shabbir, Asim; Madhavan, Krishnakumar; So, Jimmy Bok Yan

doi:10.1016/j.amjsurg.2020.05.021

Cited by 15 publications

(20 citation statements)

References 3 publications

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“…The healthcare facilities have encouraged the healthcare workers to work in rotational duties to minimise contacting COVID-19 infection as an occupational risk and maintain a healthy workforce. [7] Healthcare workers worked in teams with rotational duties to minimise COVID-19 infection among the healthcare workers. [8] As the occupational risk has increased, the providers are having to deal with ethical dilemmas, regarding their own safety, patients' condition and judicious use of the available resources.…”

Section: Resultsmentioning

confidence: 99%

“…[25] Reserving dedicated healthcare facilities or dedicated teams within the existing facilities for emergency surgical and medical care was also documented in various studies. [7,8] In a limited resource country like India, some health care facilities initially were reserved as dedicated COVID-19 facilities, however, this may not be sustainable solution. Strengthening government healthcare facilities to take the additional disease burden of COVID affected patients, reserving different teams for continuing the emergency surgical services in patients affected with COVID as well as other patients, could be explored.…”

Section: Discussionmentioning

confidence: 99%

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Understanding the Effect of COVID-19 Pandemic on Emergency Surgical Care Delivery in India: A Multicenter Cross-Sectional Study

Gadgil¹,

Bhandoria²,

Khajanchi³

et al. 2020

Preprint

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Background: The ongoing COVID-19 pandemic and subsequent lockdown have adversely affected global health care services to varying extent. Emergency Services were also affected along with elective surgeries, which were deferred to accommodate the added burden of COVID 19 affected patients, on the healthcare systems. We aimed to assess the change in delivery of essential and emergency surgeries due to the pandemic. Methodology: A research consortium led by WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in Low- and Middle-Income countries (LMIC), India, conducted this retrospective cross-sectional study with 12 recruited centers. All surgeries performed during the months of April 2020 were compared with those performed in April 2019. These surgeries were stratified into emergency and elective, and further categorized based on NHS surgery prioritization documents. Results: A total of 4396 surgeries were performed at these centers in April 2019 and 1216 surgeries were performed in same month during 2020, yielding a fall of 72.3% (1216 /4396).We found a 54% reduction in emergency surgeries and a 91% reduction in the elective surgeries. Number of cesarean sections reduced by 29.7% and fracture surgeries declined by 85.3% Laparotomies and surgeries for local soft tissue infections with necrotic tissue reduced by 71.7% and 69.5% respectively. Conclusion: Our study quantifies the effects of COVID 19 pandemic on surgical care delivery in India and documents that the overall surgical volume reduced by three fourths in the pandemic period. Emergency surgeries reduced to half when compared with pre-pandemic period. Cesarean section surgeries were affected the least by pandemic, whereas the fracture surgeries and laparotomies were affected the most.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Understanding the Effect of COVID-19 Pandemic on Emergency Surgical Care Delivery in India: A Multicenter Cross-Sectional Study

Gadgil¹,

Bhandoria²,

Khajanchi³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Práticas anteriormente não consideradas passaram a ter status de essenciais para a prevenção de contaminação profissional e da contaminação cruzada 19 . As taxas de utilização de SO diminuíram, aumentou o tempo de espera e também a notificação de incidentes, tanto no serviço da instituição deste estudo quanto em outros 10,11 .…”

Section: Discussionunclassified

“…Muitos departamentos cirúrgicos relataram como a pandemia tem impactado nas suas rotinas de agendamento de cirurgias, alterado suas filas e sua forma de priorização. Contudo, há significativa falta de discussões de como a pandemia influenciou as rotinas, dentro da SO, de manejo da paramentação, montagem, desmontagem e desparamentação [7][8][9][10][11][12] .…”

Section: Introductionunclassified

Preparação de um centro cirúrgico do Nordeste do Brasil para cirurgias durante a pandemia da COVID-19

et al. 2021

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Objetivo: Relatar a experiência da preparação do centro cirúrgico de um hospital universitário brasileiro para o atendimento de cirurgias em pacientessuspeitos e confirmados de COVID-19. Método: Relato da experiência do centro cirúrgico de um hospital universitário do Nordeste do Brasil, em março e abrilde 2020, para o atendimento durante a pandemia da COVID-19. Resultados: A implementação do protocolo de atendimento a pacientes suspeitos e confirmadosde COVID-19 foi realizada por meio da sua elaboração por um time de profissionais norteados por diretrizes nacionais e internacionais, treinamentos e atualizações.Os ciclos de aprimoramento permitiram que o protocolo fosse aperfeiçoado ao longo dos dois meses relatados. Barreiras e facilitadores para o processosão discutidos e estratégias são elaboradas para adequações possíveis. Conclusão: Houve adequação de protocolos assistenciais relacionados à rotina de fluxo depacientes e da assistência em sala operatória no intuito de melhor atender os pacientes e reduzir os riscos de contaminação de outros pacientes e profissionais.

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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 15 publications

References 3 publications

Understanding the Effect of COVID-19 Pandemic on Emergency Surgical Care Delivery in India: A Multicenter Cross-Sectional Study

Understanding the Effect of COVID-19 Pandemic on Emergency Surgical Care Delivery in India: A Multicenter Cross-Sectional Study

Preparação de um centro cirúrgico do Nordeste do Brasil para cirurgias durante a pandemia da COVID-19

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

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