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The Boston Medical Center Coronavirus Disease 2019 (COVID-19) Procedure Team: Optimizing the surgeon's role in pandemic care at a safety-net hospital.
Aly, Sherif; Talutis, Stephanie D; Richman, Aaron P; Hess, Donald T; McAneny, David; Tseng, Jennifer F; Drake, F Thurston.
  • Aly S; Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
  • Talutis SD; Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
  • Richman AP; Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
  • Hess DT; Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
  • McAneny D; Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
  • Tseng JF; Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
  • Drake FT; Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA. Electronic address: Frederick.Drake@bmc.org.
Surgery ; 168(3): 404-407, 2020 09.
Article in English | MEDLINE | ID: covidwho-633989
ABSTRACT

BACKGROUND:

The coronavirus disease 2019 pandemic has claimed many lives and strained the US health care system. At Boston Medical Center, a regional safety-net hospital, the Department of Surgery created a dedicated coronavirus disease 2019 Procedure Team to ease the burden on other providers coping with the surge of infected patients. As restrictions on social distancing are lifted, health systems are bracing for additional surges in coronavirus disease 2019 cases. Our objective is to quantify the volume and types of procedures performed, review outcomes, and highlight lessons for other institutions that may need to establish similar teams.

METHODS:

Procedures were tracked prospectively along with patient demographics, immediate complications, and time from donning to doffing of the personal protective equipment. Retrospective chart review was conducted to obtain patient outcomes and delayed adverse events. We hypothesized that a dedicated surgeon-led team would perform invasive bedside procedures expeditiously and with few complications.

RESULTS:

From March 30, 2020 to April 30, 2020, there were 1,196 coronavirus disease 2019 admissions. The Procedure Team performed 272 procedures on 125 patients, including placement of 135 arterial catheters, 107 central venous catheters, 25 hemodialysis catheters, and 4 thoracostomy tubes. Specific to central venous access, the average procedural time was 47 minutes, and the rate of immediate complications was 1.5%, including 1 arterial cannulation and 1 pneumothorax.

CONCLUSION:

Procedural complication rate was less than rates reported in the literature. The team saved approximately 192 hours of work that could be redirected to other patient care needs. In times of crisis, redeployment of surgeons (who arguably have the most procedural experience) into procedural teams is a practical approach to optimize outcomes and preserve resources.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Disease Transmission, Infectious / Pandemics / Safety-net Providers / Surgeons / Personal Protective Equipment / Betacoronavirus Type of study: Observational study Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: Surgery Year: 2020 Document Type: Article Affiliation country: J.surg.2020.05.030

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Disease Transmission, Infectious / Pandemics / Safety-net Providers / Surgeons / Personal Protective Equipment / Betacoronavirus Type of study: Observational study Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: North America Language: English Journal: Surgery Year: 2020 Document Type: Article Affiliation country: J.surg.2020.05.030