Reflections on the implementation of an acute general surgical COVID‐19 roster at North Shore Hospital, Auckland – a prospective observational study

TL;DR

This study evaluates a surgical roster implemented during New Zealand's first COVID-19 lockdown and suggests improvements for future use.

Contribution

The paper introduces a feasible pandemic surgical roster and proposes enhancements for future adaptations.

Findings

Acute general surgical admissions decreased by 19.8% during the CCR period compared to 2019.

Acute cholecystectomies increased, while procedures like carbuncle/cyst excision and endoscopy decreased significantly.

The roster was feasible without compromising patient safety, but adaptations are recommended for future use.

Abstract

Nearly 5 years after the arrival of coronavirus disease (COVID‐19) in New Zealand (NZ), many lessons have been learned. At North Shore Hospital (NSH) in Auckland, NZ, a general surgical COVID‐19 Crisis Roster (CCR) was established for the first lockdown in 2020. This study summarizes the prospective monitoring of our CCR and offers a framework for adapting our roster for future pandemics.

A prospective observational review of all acute general surgical admissions (from 30 March 2020 to 26 April 2020) was performed and compared with admissions over the same period in 2019.

A total of 443 patients were admitted to NSH during the CCR period compared with 552 patients in 2019 (−19.8%, P = 0.001). The rate of acute cholecystectomies increased (+54.5%, P = 0.002) whilst operations related to carbuncle/cyst excision (−83.3%, P < 0.02), endoscopy (−62.5%, P = 0.04), and surgical interventions for postoperative complications (−72.2%, P = 0.03) decreased. No significant differences in the rate of (re)admissions for postoperative complications or grade of complication were observed (P = 0.66). Within the context of no surgical team members contracting COVID‐19, the cancellation of outpatient clinics, and elective operating lists, the CCR was deemed feasible and easy to implement.

While patient safety was not compromised during the implementation of our pandemic roster, we advocate that our roster should be adapted and improved to include Māori health expertise, a prospective monitoring data expert committee and our nursing and allied health staff should we seek to use this CCR in future.

The implementation of our pandemic roster was feasible and did not compromise patient care in the first lockdown in New Zealand. However, we advocate that our roster should be adapted and improved to include Māori health expertise, a prospective monitoring data expert committee and our nursing and allied health staff should we seek to re‐use this CCR in future.

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