The Boston Medical Center COVID-19 Procedure Team: Optimizing the Surgeon’s Role in Pandemic Care at a Safety Net Hospital

Aly, Sherif; Talutis, Stephanie D.; Richman, Aaron P.; Hess, Donald T.; McAneny, David; Tseng, Jennifer F.; Drake, F. Thurston

BACKGROUND: The COVID-19 pandemic has claimed many lives and strained the US health care system. At Boston Medical Center (BMC), a regional safety net hospital, the Department of Surgery created a dedicated, COVID-19 Procedure Team to ease the burden on other providers coping with the surge of infected patients. As restrictions on social distancing are lifted, health systems are bracing for additional surges in COVID-19 cases. Our objective is to quantify the volume and types of procedures performed, review outcomes, and highlight lessons for other institutions that may need to establish similar teams. STUDY DESIGN: Procedures were tracked prospectively along with patient demographics, immediate complications, and time from donning to doffing of the personal protective equipment (PPE). Retrospective chart review was conducted to obtain patient outcomes and delayed adverse events. We hypothesized that a dedicated, surgeon-led team would perform invasive bedside procedures expeditiously and with few complications. RESULTS: From March 30 to April 30, 2020, there were 1,196 COVID-19 admissions. The Procedure Team performed 272 procedures on 125 patients, including placement of 135 arterial catheters, 107 central venous catheters, 25 hemodialysis catheters, and 4 thoracostomy tubes. Specific to central venous access, the average procedural time was 47 minutes, and the rate of immediate complications was 1.5%, including 1 arterial cannulation and 1 pneumothorax. CONCLUSIONS: Procedural complication rate was less than rates reported in the literature. The team saved approximately 192 hours of work that could be re-directed to other patient care needs. In times of crisis, redeployment of surgeons (who arguably have the most procedural experience) into procedural teams is a practical approach to optimize outcomes and preserve resources.