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.