Reply To: Response to COVID-19 by the surgical community

Writing in response to the many valid points in the paper “Response to COVID-19 by the surgical community,”¹ which provided thoughtful insight into the challenges proposed for surgical departments during the coronavirus disease 2019 (COVID-19) outbreak. The central response in the United Kingdom was to postpone the majority of elective surgery to increase inpatient capacity for the influx of COVID-19 patients.² However, the reorganization and management of emergency surgical care was very much led locally and differed between centers. In this paper, though authored in the United States, the authors gave valuable thought to the many conundrums faced by surgical units in the United Kingdom.

For example, the stratification of elective surgery, including the identification of procedures that are medically necessary and time-sensitive,¹ to ensure patient safety is optimized. In the United Kingdom, urgent cancer care was continued, and hub hospitals were made available for safe operating.³ However, medically necessary and time-sensitive operations are not limited to cancer patients, and the use of an elective operation stratification system should be used to clear the backlog of elective procedures in the United Kingdom in a safe manner.

Furthermore, the protection of surgical workforces remains a complex problem, and solutions proposed in the paper have been mirrored by practice in the United Kingdom. The shift of outpatient work to telephone consultation and team meetings to video conferences is widespread. Additionally, the use of “stand-by” staff, who can cover sickness at short notice, is also being employed by surgical centers in the United Kingdom. These simple but important changes ensure our workforce is safe and ready to operate on our most vulnerable patients when needed.

Lastly and most importantly, the paper discusses methods of protecting inpatient capacity and effective triage of surgical patients. A safe and targeted triage system allows us to keep our patients safe by identifying and isolating them quickly from COVID-19 patients. It also allows us to access our most unwell patients quickly and discharge or ambulate our less unwell patients efficiently. The emphasis on reducing admissions benefits all, as the patient has reduced exposure to COVID-19, and the hospital bed which that patient may have inhabited in the pre-COVID-19 era is now free for surge capacity. In the United Kingdom, surgical departments have had to change their clinical pathways and triage systems to shift to a more discharge-focused, ambulatory model of care so that surge capacity is maintained.

In conclusion, the points highlighted in “Response to COVID-19 by the surgical community” provide rationale for reflection on our work and impetus for our future response to COVID-19 in the United Kingdom. The key domains of discussion remain the safe restart of elective surgery and whom to prioritize, the protection of our workforce, and the continual development of triage systems to ensure that we are accessing our sickest patients. The challenges are global, and our response in the United Kingdom appears to be identifying and meeting similar challenges to our colleagues in the United States.