COVID-19 Update from Dr. Smith: 4/20/20

Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.

Dear Colleagues,

Formal meetings focused on restarting the clinical enterprise began in earnest this morning.  It is too soon to report details, but several themes are clear, some of them obvious.  Availability of PPE, testing for virus and antibody, surface cleaning, equipment sterilization, and streamlining of outpatient encounters cuts across all medical, surgical, and research activities.  Infrastructure limitations will be least limiting for specialties that don’t require ICU capacity or an inpatient stay.  Thankfully, that includes much of what is done in our Department, and in many others, such as Orthopedics and Ophthalmology.  To me, the most obvious theme is that our inpatient population of COVID patients is a crippling rate-limiting obstacle to restarting service lines dependent on ICU capacity, such as transplantation, neurosurgery, vascular surgery, and cardiac surgery.  Those happen to be among CUIMC’s most notable specialties, along with many others that support NYP’s #5 USNWR ranking.  Please don’t conclude that the pace of restarting is all about revenue and maintaining reputation.  We have a large pool of postponed patients who are directly harmed by delay because they need procedures that extend life and improve quality of life.

Forgive me for beginning with dreary process and politics.  I will shift gears by reviewing some of our achievements.  The ED was the earliest point of strain in the pandemic.  Patients were arriving in extremis and requiring intubation before they could be moved to an ICU.  The existing ICUs quickly filled to capacity, so intubated ED patients had nowhere to go.  ICU space was more than doubled by building the ORICUs and other pop-up ICUs, but those filled immediately, and ED patients still had no place to go.  A de facto ICU of 15-20 beds settled into the ED like a tent city of lost souls.  It became obvious that ED staff were stretched to their limits by patients streaming through the front door, and could not be expected to simultaneously manage an ICU full of intubated respiratory failure patients.

In response, a spirited coalition of the willing sprang up to fill the void, comprised of resident-attending pairs from Urology, Radiation Oncology, Orthopedics, Dermatology, Ophthalmology, ENT, and Rehab Medicine (URODOER).  Note these are not people for whom ICU care is a commonplace feature of practice, unlike the groups already managing the ORICUs and other pop-up units.  After cramming diligently with a rapidly assembled on-line ICU-care curriculum, this fearless rabble mustered into the field.  The ED ICU quickly became another capably managed front line in the battle against coronavirus.

Three days ago it was announced that the Department of Medicine would be taking over management of the ED ICU.  The URODOER subspecialty team pivoted instantly.  The following email was sent by the Chair of Urology:  “We are ready to go into any critical care role you need.  Anywhere.”   They are being added today to the ORICU coverage schedule.  For anyone wanting to label us a “COVID hospital,” that is the kind of performance they should have in mind.  Best today, better tomorrow.

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC

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