Schwartz Andrew M, Wilson Jacob M, Boden Scott D, Moore Thomas J, Bradbury Thomas L, Fletcher Nicholas D
Emory University School of Medicine, Atlanta, Georgia.
Emory University Orthopaedics & Spine Hospital, Tucker, Georgia.
JB JS Open Access. 2020 Apr 15;5(2):e0045. doi: 10.2106/JBJS.OA.20.00045. eCollection 2020 Apr-Jun.
The novel coronavirus and associated Coronavirus Disease 2019 (COVID-19) is rapidly spreading throughout the world, with robust growth in the United States. Its drastic impact on the global population and international health care is swift, evolving, and unpredictable. The effects on orthopaedic surgery departments are predominantly indirect, with widespread cessation of all nonessential orthopaedic care. Although this is vital to the system-sustaining measures of isolation and resource reallocation, there is profound detriment to orthopaedic training programs.
In the face of new pressures on the finite timeline on an orthopaedic residency, the Emory University School of Medicine Department of Orthopaedics has devised a 5-pronged strategy based on the following: (1) patient and provider safety, (2) uninterrupted necessary care, (3) system sustainability, (4) adaptability, and (5) preservation of vital leadership structures.
Our 5 tenants support a 2-team system, whereby the residents are divided into cycling "active-duty" and "working remotely" factions. In observation of the potential incubation period of viral symptoms, phase transitions occur every 2 weeks with strict adherence to team assignments. Intrateam redundancy can accommodate potential illness to ensure a stable unit of able residents. Active duty residents participate in in-person surgical encounters and virtual ambulatory encounters, whereas remotely working residents participate in daily video-conferenced faculty-lead, case-based didactics and pursue academic investigation, grant writing, and quality improvement projects. To sustain this, faculty and administrative 2-team systems are also in place to protect the leadership and decision-making components of the department.
The novel coronavirus has decimated the United States healthcare system, with an unpredictable duration, magnitude, and variability. As collateral damage, orthopaedic residencies are faced with new challenges to provide care and educate residents in the face of safety, resource redistribution, and erosion of classic learning opportunities. Our adaptive approach aims to be a generalizable tactic to optimize our current landscape.
新型冠状病毒及相关的2019冠状病毒病（COVID-19）正在全球迅速传播，在美国更是迅猛增长。它对全球人口和国际医疗保健产生的巨大影响迅速、不断演变且难以预测。对骨科手术科室的影响主要是间接的，所有非必要的骨科护理都已广泛停止。尽管这对于隔离和资源重新分配等维持系统的措施至关重要，但对骨科培训项目却造成了严重损害。
面对骨科住院医师有限时间线上的新压力，埃默里大学医学院骨科制定了一项基于以下五个方面的五管齐下策略：（1）患者和医护人员安全；（2）不间断的必要护理；（3）系统可持续性；（4）适应性；（5）保留重要的领导架构。
我们的五项原则支持一种双团队系统，即住院医师被分为轮流的“现役”和“远程工作”两组。考虑到病毒症状的潜在潜伏期，每两周进行一次阶段转换，并严格遵守团队分配。团队内部的冗余安排可以应对潜在疾病，以确保有能力的住院医师团队稳定。现役住院医师参与面对面的手术会诊和虚拟门诊会诊，而远程工作的住院医师则参加由教员主导的每日视频会议式病例教学，并进行学术研究、撰写基金申请和开展质量改进项目。为维持这一模式，教员和行政双团队系统也已就位，以保护科室的领导和决策部分。
新型冠状病毒重创了美国医疗系统，其持续时间、规模和变化难以预测。作为附带损害，骨科住院医师项目在面对安全、资源重新分配以及传统学习机会减少的情况下，面临着提供护理和培训住院医师的新挑战。我们的适应性方法旨在成为一种可推广的策略，以优化我们当前的局面。
