key: cord-0921769-9nhzn7i3
authors: Petrone, Brandon; Iturriaga, Cesar; Mauri, Thomas; Sgaglione, Nicholas
title: Impact of Covid – 19 Pandemic on Orthopaedics at Northwell Health, New York
date: 2020-05-23
journal: Arthrosc Sports Med Rehabil
DOI: 10.1016/j.asmr.2020.05.009
sha: 23e26f1109a522d5620ce97f61802015e7139e2c
doc_id: 921769
cord_uid: 9nhzn7i3

Abstract The Novel Coronavirus (COVID-19) pandemicplaced an immense strain on healthcare systems and orthopedic surgeons across the world. To limit the spread, federal and state governments mandated the cancellation of all non-urgent surgical cases to address surging hospital admissions and manage workforce and resource reallocation. During the pandemic surge, thousands of surgical cancellations have been required. We outline our experience through the onset and advance of the surge, detail our incident response, and discuss the transition toward recovery.

In New York (NY) State, the first confirmed COVID-19 case was on March 1st, 2020, 26 and exponential spread of the virus across the NY City metropolitan area resulted in a global 27 epicenter. The first COVID-19 patient was admitted to a Northwell Health hospital on March 4 th , 28 2020. The Northwell Health System is the largest healthcare system in NY State with 23 total 29 hospitals, 5,692 beds, 18 office sites, and 14 ambulatory surgery center (ASC) sites carrying out 30 over 33,000 orthopedic surgical cases yearly. A surge of infected patients followed, culminating 31 in a peak of cases requiring admissions and complex resuscitative treatment. Our purpose is to describe our experience through the onset and advance of the surge, 39 detail our incident response, and discuss the transition toward recovery. As the largest healthcare provider in the state, Northwell Health was on the frontlines 44 during the response to the outbreak. Emergency Departments (ED) first witnessed the 45 devastating consequences as the proportion of daily hospital admissions from the ED exploded 46 from 20% to over 45% at the peak in early April. More than 6,000 patients with suspected 47 COVID-19 were admitted across the health system, with 28% requiring ICU admissions and 48 25% requiring mechanical ventilators. Our Emergency Operations Center saw the early need for personnel and resource reallocation at the 5 tertiary and 11 community hospitals in which 50 orthopedic surgery is performed in our health system. By early April, institutional hospital 51 capacity increased by 23%, effectively creating 1,200 additional beds above the pre-existing 52 capacity of 5,200. To "load balance" the patient surge across the system, ICU patients were 53 transferred from overcrowded smaller hospitals to larger tertiary centers. The ramifications of this pandemic and the anticipated radical changes that it may have 253 on our healthcare system and society are still not fully understood. The future remains unclear, 254 but clearly the scope of our practice has been dramatically altered 30,31 . Orthopaedic surgery and 255 healthcare in general will rapidly evolve and changes will be incorporated into our standards of 256 care. Evidence-based protocols and innovative technology enables efficient identification of risk, 257 resource utilization, and minimization of exposure 31 .

The challenges we face are shared among the orthopaedic community and should serve to 259 galvanize our efforts. As we progress through this ordeal, preparations must be made to safely Pending cases submitted to system database Department Chair and Admin Director confirm priority level

The Department Chairs will approve cases to fill allocated service time slots

The Surgical Emergency Operations Committee leadership reviews all data Patient medical clearance performed at ambulatory office; surgeon's office confirms time with patient COVID testing 24 to 48 hours prior to the scheduled surgery date, results sent to OR leadership Medical clearance is the responsibility of the attending physician COVID positive cases will be cancelled unless they are Level 4 (emergent) priority The Endoscopy unit operates as a non-COVID facility and does not currently treat COVID positive patients All patients are screened for COVID-19 prior to entry into the preoperative areas and tested before admission or any procedure.

Ample personal protective equipment is available for both patients and healthcare workers

WHO Director-General's Opening Remarks at the Media Briefing on COVID-19 -11