Rapid Modification of Workflows and Fellow Staffing at a Single Transplant Center to Address the COVID-19 Crisis

Thiessen, Carrie; Wisel, Steven A.; Yamaguchi, Seiji; Dietch, Zachary C.; Feng, Sandy; Freise, Chris E.

Abstract Background Although hospital systems have largely halted elective surgical practices in preparing their response to the SARS-CoV-2 pandemic, transplantation remains an essential and lifesaving surgical practice. In order to continue transplantation while protecting immunocompromised patients and healthcare workers, significant restructuring of normal patient care practice habits is required. Methods This is a non-randomized, descriptive study of the abdominal transplant program at one academic center (University of California, San Francisco) and the programmatic changes undertaken to safely continue transplantations. Patient transfers, fellow utilization, and patient discharge education were identified as key areas requiring significant reorganization. Results The University of California, San Francisco abdominal transplant program took an early and aggressive approach to restructuring inpatient workflows and healthcare worker staffing. We formalized a COVID-19 transfer system to address patients in need of services at our institution while minimizing the risk of SARS-CoV-2 on our transplant ward and utilized technological approaches to provide virtual telehealth where possible, We also modified our transplant fellow staffing and responsibilities to develop an adequate backup system in the case of potential exposures. Conclusion Every transplant program is unique, and an individualized plan to adapt and modify standard clinical practices will be required to continue providing essential transplantation services. Our experience highlights areas of attention specific to transplant programs, and may provide generalizable solutions to support continued transplantation in the COVID-19 era.