Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, Florida.
Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, Florida.
Am J Obstet Gynecol. 2020 Jul;223(1):85.e1-85.e19. doi: 10.1016/j.ajog.2020.03.038. Epub 2020 Apr 3.
The coronavirus disease 2019 pandemic warrants an unprecedented global healthcare response requiring maintenance of existing hospital-based services while simultaneously preparing for high-acuity care for infected and sick individuals. Hospitals must protect patients and the diverse healthcare workforce by conserving personal protective equipment and redeployment of facility resources. While each hospital or health system must evaluate their own capabilities and surge capacity, we present principles of management of surgical services during a health emergency and provide specific guidance to help with decision making. We review the limited evidence from past hospital and community responses to various health emergencies and focus on systematic methods for adjusting surgical services to create capacity, addressing the specific risks of coronavirus disease 2019. Successful strategies for tiered reduction of surgical cases involve multidisciplinary engagement of the entire healthcare system and use of a structured risk-assessment categorization scheme that can be applied across the institution. Our institution developed and operationalized this approach over 3 working days, indicating that immediate implementation is feasible in response to an unforeseen healthcare emergency.
2019 年冠状病毒病大流行需要史无前例的全球医疗保健应对，这要求在维持现有的基于医院的服务的同时，为感染和患病个体的高重症监护做好准备。医院必须通过节约个人防护设备和重新部署设施资源来保护患者和多样化的医疗保健人员。虽然每个医院或医疗系统都必须评估自己的能力和应急能力，但我们提出了在卫生紧急情况下管理外科服务的原则，并提供具体指导以帮助做出决策。我们回顾了过去医院和社区对各种卫生紧急情况的反应中的有限证据，并重点关注调整外科服务以创造能力的系统方法，解决 2019 年冠状病毒病的特定风险。成功的分层减少手术病例策略涉及整个医疗保健系统的多学科参与，并使用可以在整个机构应用的结构化风险评估分类方案。我们的机构在 3 个工作日内制定并实施了这种方法，表明可以针对不可预见的医疗保健紧急情况立即实施。
