In my last post, I made some suggestions on how to modify the trauma activation process to better protect your team members from exposure to the Coronavirus. Today, I’ll discuss some things you can do to reduce the exposure of your in-house team that provides care for patients.
First off, I’m not going to discuss the obvious things like personal protective equipment, or what to do when performing risky procedures such as intubation or extubation. Those have been covered elsewhere and each hospital has adopted its own standards.
I will be discussing more general concepts that help limit team member exposure to possible contamination or infected individuals. Here are some of my suggestions:
- Make sure your hospital conserves the resources it needs to be a trauma center. A certain number of ICUs, operating rooms, and floor beds must be reserved for trauma patients. Your hospital should make contingency plans such that if COVID-19 patients are getting close to taking too many beds or other resources, there is an escape valve so they can be diverted or transferred to other non-trauma hospitals.
- Save your trauma surgeons for things only they can do. Many hospitals have general surgeons on staff in addition to their trauma/critical care surgeons. Remove the trauma surgeons from emergency general surgery / acute care surgery services and concentrate them on the trauma and critical care services. Have the general surgeons cover the other services, and send all idle trauma surgeons home where it is safer. Rotate them through trauma and critical care on a regular basis. Imagine what would happen if you lose 2 or 3 of your trauma surgeons at the same time, and don’t let it happen to you!
- Eliminate non-essential meetings and conferences. This includes morbidity and mortality conferences, journal clubs, and all educational conferences. These things have to go on the back burner for now and can be re-instituted once things return to normal.
- Practice social distancing at essential meetings. Certain gatherings are unavoidable, such as care handoffs (“morning report,” and “afternoon check-out”). Reduce the attendees to only those whose input is critical. If needed, they can gather information from other small groups of providers to prepare for the essential meeting. But no more crowded rooms, please.
- Don’t congregate with other providers unnecessarily. This means outside your office, in the lounge, and in the lunchroom. The usual social norms need to take a back burner to your own safety and health.
- Use telephone conferencing as much as possible. You will be surprised at how many of these less-than-essential meetings can be handled virtually, or eliminated. One tip, though: print a copy of the agenda for reference. It seems to be more difficult to follow the flow of the meeting (and take/make notes) if you don’t have something you can visually refer to.
- Redesign your care team. Do you really need your entire team (APPs, residents, nurses) hanging around all day like they usually do? The reality is that the bulk of the work on any trauma service generally takes place in the morning. The rest of the day is spent waiting for incoming trauma patients. Calculate the optimal number of providers based on your service census. Do the morning work, go on rounds (smaller groups, please), finish any post-rounds chores, then send the extras home. And rotate those providers so that some can spend time at home while the others are in-house.
- Use residents wisely if you have them. They are part of your care team, too, so be sure to minimize their exposure. The previous tip on redesigning the care team applies to them, too. And frequently, they rotate through several hospitals, many of which are not doing elective surgery. So they may not have a lot to do. Work with the residency program director to see if you can temporarily add them to the trauma center coverage pool. This allows you to keep a larger number of residents at home while maintaining a reasonable number for your care team.
In my next post, I’ll cover changes you should consider in your Massive Transfusion Protocol.