Escobar Natalie, Crown Angelena, Pocock Ben, Joseph Kathie-Ann
From the Department of Surgery, Bellevue Hospital Medical Center, NYU Langone Medical Center, New York, NY.
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; and.
Ann Surg Open. 2020 Oct 19;1(2):e018. doi: 10.1097/AS9.0000000000000018. eCollection 2020 Dec.
The COVID-19 pandemic has stretched hospitals to their capacities and has forced them to restructure and divert resources to accommodate the influx of critically ill patients. Surgical specialties are particularly vulnerable to restructuring given the need for highly trained personnel with intensive care unit (ICU) experience and procedural skills and need for ventilators and spaces that can function as ICUs. The diversion of hospital resources and redeployment of staff to the care of COVID patients has led to unintended consequences, including delays in care for patients with oncologic diagnoses, such as breast cancer. These unintended consequences are illustrated by the COVID-19 experiences of 2 New York City public hospitals: Bellevue Hospital and Elmhurst Hospital. The Breast Services of both hospitals treat the city's vulnerable, medically underserved breast cancer patients. Despite similar patient populations, Bellevue and Elmhurst had divergent COVID-19 experiences. With a larger surge capacity and an affiliation with New York University, the Breast Service at Bellevue Hospital was able to continue to offer essential breast operations, albeit at reduced volumes, whereas the Breast Service at Elmhurst Hospital was completely shut down. These experiences serve as a harbinger of the continually widening health care disparities and force hospital systems and policymakers to critically examine the impact of the COVID-19 pandemic on underserved patient populations that receive care at smaller public hospitals.
新冠疫情使医院不堪重负，迫使它们进行重组并重新分配资源，以接纳大量重症患者。鉴于需要具备重症监护病房（ICU）经验和操作技能的高技能人员，以及对呼吸机和可作为ICU使用的空间的需求，外科专科尤其容易受到重组的影响。医院资源的转移以及工作人员重新调配去照顾新冠患者，导致了一些意外后果，包括乳腺癌等肿瘤诊断患者的治疗延误。纽约市的两家公立医院——贝莱维医院和埃尔姆赫斯特医院的新冠疫情经历就说明了这些意外后果。这两家医院的乳腺科都为该市弱势且医疗服务不足的乳腺癌患者提供治疗。尽管患者群体相似，但贝莱维医院和埃尔姆赫斯特医院在新冠疫情中的经历却有所不同。贝莱维医院乳腺科凭借更大的应急能力以及与纽约大学的合作关系，尽管手术量有所减少，但仍能够继续开展基本的乳腺手术，而埃尔姆赫斯特医院的乳腺科则完全关闭。这些经历预示着医疗保健差距将不断扩大，并迫使医院系统和政策制定者认真审视新冠疫情对在较小公立医院接受治疗的服务不足患者群体的影响。
