Table 1.

COVID-19–driven changes in the Department of Surgery

Change	Goals	Challenges	Level
Telemedicine patient visits	•Minimizing risk of nosocomial COVID-19 infections to patients/providers •Minimizing need to staff and support services	•Inability to examine patients •Difficulties obtaining outpatient studies •Technical issues with Telehealth applications •Lack of technical savvy among patients	•Division •Department •Hospital •Enterprise
Case volume reduction	•Minimizing risk of nosocomial COVID-19 infections •Preserving PPE, vital equipment, medications •Preserving floor and ICU beds •Opening space for additional ICU capacity (ORICU) •Making providers available to care for patients with COVID-19	•Balancing risk of delaying operations versus risk of in-hospital COVID transmission •Disruption of trainees' education and surgical skills •Significant drop in revenue	•Division •Department •Hospital •Enterprise
Attending/staff/resident redeployment	•Serving as ICU attendings, ICU fellows, mid-level providers, junior residents, SWAT team, perfusion, and support staff in EDs, medicine floors, step-down units and newly created COVID-19 ICUs	•Adequate training and expertise in newly created roles •Maintaining adequate core staffing of divisional and departmental services •Increased risk of contracting COVID-19 •Family exposure to COVID-19 •Mental and emotional well-being given increased levels of stress	•Division •Department •Hospital •Enterprise
Service and on-call staffing	•Making residents, attendings and staff available for redeployment to COVID-19 units	•Maintaining staffing levels to safely care for remaining patients without COVID-19 (floors and ICUs) •Availability of adequate senior resident/fellow and attendings to cover emergent cardiothoracic cases, urgent procedures, heart/lung transplantation, and organ procurement	•Division •Department

COVID-19, Coronavirus disease 2019; PPE, personal protective equipment; ICU, intensive care unit; ORICU, operating room intensive care unit; SWAT, Surgical Access Workforce Team.