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

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.