1Department of Neurosurgery, Universitas Airlangga Faculty of Medicine-Dr. Soetomo Academic General Hospital, Surabaya; and.
2The COVID-19 Curative Taskforce for The East Java Region, East Java Provincial Government, Surabaya, Indonesia.
Neurosurg Focus. 2020 Dec;49(6):E5. doi: 10.3171/2020.9.FOCUS20559.
Global outbreak of the novel coronavirus disease 2019 (COVID-19) has forced healthcare systems worldwide to reshape their facilities and protocols. Although not considered the frontline specialty in managing COVID-19 patients, neurosurgical service and training were also significantly affected. This article focuses on the impact of the COVID-19 outbreak at a low- and/or middle-income country (LMIC) academic tertiary referral hospital, the university and hospital policies and actions for the neurosurgical service and training program during the outbreak, and the contingency plan for future reference on preparedness for service and education.
The authors collected data from several official databases, including the Indonesian Ministry of Health database, East Java provincial government database, hospital database, and neurosurgery operative case log. Policies and regulations information was obtained from stakeholders, including the Indonesian Society of Neurological Surgeons, the hospital board of directors, and the dean's office.
The curve of confirmed COVID-19 cases in Indonesia had not flattened by the 2nd week of June 2020. Surabaya, the second-largest city in Indonesia, became the epicenter of the COVID-19 outbreak in Indonesia. The neurosurgical service experienced a significant drop in cases (50% of cases from normal days) along all lines (outpatient clinic, emergency room, and surgical ward). Despite a strict preadmission screening, postoperative COVID-19 infection cases were detected during the treatment course of neurosurgical patients, and those with a positive COVID-19 infection had a high mortality rate. The reduction in the overall number of cases treated in the neurosurgical service had an impact on the educational and training program. The digital environment found popularity in the educational term; however, digital resources could not replace direct exposure to real patients. The education stakeholders adjusted the undergraduate students' clinical postings and residents' working schemes for safety reasons.
The neurosurgery service at an academic tertiary referral hospital in an LMIC experienced a significant reduction in cases. The university and program directors had to adapt to an off-campus and off-hospital policy for neurosurgical residents and undergraduate students. The hospital instituted a reorganization of residents for service. The digital environment found popularity during the outbreak to support the educational process.
新型冠状病毒病 2019（COVID-19）的全球爆发迫使世界各地的医疗系统重塑其设施和规程。尽管神经外科服务和培训不被认为是管理 COVID-19 患者的一线专业，但它也受到了重大影响。本文重点介绍了 COVID-19 爆发对中低收入国家（LMIC）学术三级转诊医院的影响、大流行期间神经外科服务和培训计划的大学和医院政策及行动，以及为未来服务和教育准备的应急计划。
作者从包括印度尼西亚卫生部数据库、东爪哇省政府数据库、医院数据库和神经外科手术病历在内的几个官方数据库中收集数据。政策和法规信息是从利益相关者（包括印度尼西亚神经外科学会、医院董事会和院长办公室）处获得的。
到 2020 年 6 月的第二周，印度尼西亚的确诊 COVID-19 病例曲线尚未趋于平稳。印度尼西亚第二大城市泗水成为印度尼西亚 COVID-19 爆发的中心。神经外科服务的所有方面（门诊、急诊室和外科病房）的病例数量均大幅下降（正常日的 50%）。尽管有严格的入院前筛查，但在神经外科患者的治疗过程中仍发现了术后 COVID-19 感染病例，且 COVID-19 感染阳性患者的死亡率很高。神经外科服务中治疗的总病例数减少对教育和培训计划产生了影响。数字化环境在教育领域受到欢迎；然而，数字资源无法替代直接接触真实患者。出于安全原因，教育利益相关者调整了本科生的临床实习和住院医师的工作方案。
中低收入国家学术三级转诊医院的神经外科服务量大幅减少。大学和项目主任不得不适应神经外科住院医师和本科生的校外和院外政策。医院对住院医师进行了服务重组。大流行期间，数字化环境受到欢迎，以支持教育过程。
