At the US Epicenter of the COVID-19 Pandemic, an Orthopedic Residency Program Reorganizes
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RESPONSE TO COVID-19 / COMMENTARY
At the US Epicenter of the COVID-19 Pandemic, an Orthopedic Residency Program Reorganizes Kyle W. Morse, MD & Lauren E. Wessel, MD & Ajay Premkumar, MD, MPH & Evan W. James, MD & Benedict U. Nwachukwu, MD, MBA & Duretti T. Fufa, MD, on behalf of the Orthopaedic Surgery Residency Program at the Hospital for Special Surgery Received: 17 April 2020/Accepted: 19 May 2020 * The Author(s) 2020
Keywords residency . education . COVID-19 . communication . organization Background Declared a pandemic by the World Health Organization in mid-March 2020, COVID-19, the disease caused by the novel coronavirus (SARS-CoV-2), spread rapidly in New York City, causing such upheaval that many facilities were forced to modify the care they provided in unexpected ways. One example: on March 13, the Hospital for Special Surgery (HSS) was notified that an entire trauma team of nine orthopedic residents had high-risk exposure from a co-worker who tested positive for COVID-19; all nine were quarantined. With this single exposure affecting 20% of the orthopedic residents, our residency program was tasked with restructuring in order to meet the needs of the five institutions we serve, while minimizing the risk to residents of nonessential exposures. In this article, we share the guiding framework we used in our institutional reorganization, in the hope that it may help other orthopedic programs responding to similar situations in the future. The principles we used included safety to all patients and staff, transparent communication, organized leadership, and teamwork. Hospital Operational Reorganization Like many large orthopedic surgical training programs, the HSS residency provides orthopedic coverage to several area Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-020-09765-5) contains supplementary material, which is available to authorized users. K. W. Morse, MD (*) : L. E. Wessel, MD : A. Premkumar, MD, MPH : E. W. James, MD : B. U. Nwachukwu, MD, MBA : D. T. Fufa, MD Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA e-mail: [email protected]
hospitals, each with different needs during the COVID-19 pandemic (Table 1). Due to the severity of the pandemic in New York City, which in March 2020 was responsible for well over half the nation’s cases of COVID-19, the unprecedented strain on capacity within area hospitals was tremendous. In turn, the traditional services provided at each of these five hospitals changed dramatically. Across the state, institutions canceled nonessential procedures and patient visits to increase hospital bed capacity in response to COVID-19, with guidance provided from government agencies and medical societies [2, 12]. On March 17, HSS suspended nonessential procedures, and lists of “essential procedures” were developed for each hospital [8]. Essential procedures are time sensitive and cannot be scheduled in an outpatient setting due to possible loss of life or limb [8]. I
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