How did the organisation adapt to the pandemic?
It became immediately evident that communication between the organisation leadership and staff is key and a daily e-mail COVID-19 update was established. It provided information about the number of cases in the system, changes in policy, advice for staff on seeking support both mentally and physically. The daily updates provided reassurance to the working force and a reliable source to be informed; they were greatly appreciated by both clinical and non-clinical staff alike. The daily communication was particularly appreciated with regard to the availability of Personal Protective Equipment (PPE), as concerns over a worldwide shortage were voiced.
As the situation evolved the organisation developed seven guidelines developing teams to guide staff and patients. These teams addressed the following needs: patients’ communication and documentation; COVID-19 positive patients requiring surgery; trainees’ oversight and independent procedural/care guidelines; nasopharyngeal and aerosol generating procedures; physicians and providers redeployment strategy; COVID-19 perioperative evidence review; and surgical telemedicine.
The number of COVID-19 positive cases across the system in March was 179 cases of which 85 cases were admitted to the intensive care unit. Events across the Atlantic suggested that an increase in demand on ICU care is to be expected. The organisation asked for volunteers to be redeployed to frontline services including emergency department and ICU. The cardiothoracic surgery clinical team skill set, meant that as a team we were most suited to support our ICU colleagues.
The American College of Surgeons published guidelines for triaging elective surgery. At Emory all elective surgeries were postponed. Time sensitive surgeries were scheduled if they met any of the following criteria: the procedure is required for the patient’s discharge, the procedure can be done with a very small likelihood of postoperative admission, or the procedure is required to avoid a re-admission to hospital. Procedures not meeting these criteria, as most cardiothoracic urgent procedures, had to go through an adjudication process. A site-specific surgeon adjudicator, site nurse-in-charge, and site anaesthetist carried out the adjudication. Elective activity was only resumed at a quarter of the normal capacity by May, and we resumed our usual level of activity by June. To date, all patients undergoing elective or urgent surgery are screened within 48 hours of their procedure. We certainly identified COVID-19 positive patients and these cases were postponed.
Telemedicine took a centre stage during the pandemic with an increase in utilisation (4). Initially, all outpatient consultants were cancelled. When it became clear that the pandemic is going to last for few more months, a move to on-line and phone consultations took place. The use of web-cameras and on-line consultations became familiar to most providers very quickly. To this date, as in-person outpatient appointments are resumed, some patients still prefer on-line consults.
Emory’s Vaccine and Treatment Evaluation Unit (VTEU) was also involved in a phase 1 trial evaluating a vaccine for COVID-19, that was in addition to a rich portfolio of academic activities centred around the pandemic. Staff were encouraged to identify research areas related to their speciality or contribute to on-going research projects.