Editors’ Note: This article was accepted on March 11, 2020, and was accurate at that time. Because information about SARS-CoV-2 and COVID-19 is evolving rapidly, please verify these recommendations and information.
Explore This IssueACEP Now: Vol 39 – No 04 – April 2020
As chief residents, we are proud to lead a group of residents who provide around-the-clock staffing for three busy hospitals. Additionally, our residents travel internationally to provide medical care, travel to conferences to disseminate their scholarly work, and raise families. The recent spread of SARS-CoV-2, the novel coronavirus that causes COVID-19, has raised a series of challenges over the last few days and weeks that have caused us to consider how we might prepare as a residency for this and other pandemics.
Our immediate concern was the possibility of increased need for sick call, particularly in the event of resident quarantine. Routinely, we have daily sick call coverage, and the shift is later repaid by the person activating. If a second absence requires coverage beyond initial sick call activation, the on-call chief solicits same-day availability from the resident pool with chief resident coverage as a backstop. Our solution was to develop a second string of sick call. The upcoming schedule was already published, so we relied on volunteers for this and successfully filled our backup sick call schedule.
The decision to develop a backup sick call system was not easy. We had concerns about whether this was a resident responsibility. How many layers of coverage are residents responsible for providing? When do we consider mechanisms like altering shift times and duration or having gaps in coverage? When do we pull residents from electives? What happens when we run out of additional sick call volunteers?
Resident Safety, Well-Being, and Health
As emergency medicine residents, we are part of the team on the front line of patient care. This station puts the emergency department team at particularly high risk in an infectious outbreak. Keeping residents safe and healthy is an important goal itself and because they are an integral part of the workforce. We had added concerns about our residents who were pregnant, immunocompromised, or otherwise at increased risk.
Treating affected patients requires safety measures like special triage procedures and use of personal protective equipment (PPE). It is important that programs ensure team members are educated on how to appropriately use PPE and new departmental protocols. Simulation is a powerful training tool when infectious rates are low. We are currently implementing a simulation to model these issues.
We also considered how to involve residents in care of these patients. Residents are not generally excluded from taking care of any patient population, including patients with infectious diseases. However, there are practical issues to consider like the limited availability of PPE, limiting the number of individuals who come into contact with an identified case, and the fact that all patients are seen by an attending. Currently, we are limiting direct resident involvement in identified ED cases of COVID-19.
Finally, there is the issue of educational activities. Limiting large gatherings can be helpful to prevent transmission of a disease, but certain educational requirements like conference and journal club are organized as large in-person gatherings. We are moving to teleconferencing educational programming where possible.