Measures to decrease risk of infection
One critical resource needed to protect patients and residents is personal protective equipment (PPE). Online instruction and in-person training were used to educate residents and staff on appropriate techniques for donning, doffing, and conserving PPE. Surgical teams were limited to 1 surgeon and 1 resident in each case. In an effort to limit direct contact with COVID-19 infected patients, the number of health care providers rounding on inpatients was restricted, and phone or video conversations were used for communication.
The workforce was modified to decrease exposure to infection and maintain a reserve of healthy residents who were working from home—anticipating that some residents would become ill and this reserve would be called for duty. Similar to other specialties, our programs organized the workforce by arranging residents into teams in which residents worked a number of shifts in a row.8-12 Regular block schedules were disrupted and non-core rotations were deferred.
As surgeries were canceled and outpatient visits curtailed, many rotations required less resident coverage. Residents were reassigned from rotations where clinical work was suspended to accommodate increased staffing needs in other areas, while accounting for residents who were ill or on leave for postexposure quarantine. Typically, residents worked 12-hour shifts for 3 to 6 days followed by several days off or days working remotely. This team-based strategy decreased the number of residents exposed to COVID-19 at one time, provided time for recuperation, encouraged camaraderie, and enabled residents working remotely to coordinate care and participate in telehealth without direct patient contact.
To minimize high-risk exposure of pregnant residents or residents with underlying health conditions, these residents also worked remotely. Similar to other specialties, it was important to determine essential resident duties and enlist assistance from other clinicians, such as fellows, nurse practitioners, physician assistants, and midwives.
To protect residents and patients, maximizing testing of patients for COVID-19 was an important strategy. Based on early experience at 1 center with patients who were initially asymptomatic but later developed symptoms and tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), universal testing was implemented and endorsed by the New York State COVID-19 Maternity Task Force.13 Notably, 87.9% of patients who were positive for SARS-CoV-2 at the time of admission had no symptoms of COVID-19 at presentation. Because the asymptomatic carrier rate appears to be high in obstetric patients, testing of patients is paramount.3,14 Finally, suspending visitation (except for 1 support person) also was instrumental in decreasing the risk of infection to residents.13
Resources for residents with COVID-19
This pandemic placed residency program directors in an unusual situation as frontline caregivers for their own residents. It was imperative to track residents with physical symptoms, conduct testing when possible, and follow the course of residents with confirmed or suspected COVID-19. As serious illness and death have been reported among otherwise healthy young people, we ensured that our homebound residents were frequently monitored.15 At several of our centers, residents with COVID-19 from any program who chose to separate from their families were provided with alternative housing accommodations. In addition, some of our graduate medical education offices identified specific physicians to care for residents with COVID-19 who did not require hospitalization.
Continue to: Deployment to other specialties...