# patients with confirmed COVID 19 being treated in your hospital (Confirm peds vs adult)Have there been ANY children hospitalized with COVID at your institution?# COVID patients in ICU/on vent?How many COVID+ pediatric patients have been operated on in your hospital? (in any surgical specialty)Have any asymptomatic COVID+ pediatric OR patients had adverse outcomes related to general anesthesia? If so, please describe.Have you altered attending call schedules to minimize exposure/promote social distancing?How have you altered attending call schedules (no change, skeleton weekend crew, Team A/Team B or other - please describe)Are you making an effort to minimize exposure for surgeons over a certain age, pregnant or with comorbidities?If so, how?Have your pediatric beds been "opened" to accept adult patients?If so, COVID+ adults or non-COVID adults?Are surgeons in your group assisting in covering adult surgical/trauma services?Are you sharing equipment resources with other facilities (please specify vents, PPE, other)PPE for trauma bay? (ie are you considering all trauma patients PUI)Cohort PUI in same area of hospital with COVID + patients?are you transferring pediatric trauma patients away from mixed adult/pediatric centers to allow for adult COVID surge?are you transferring general pediatric patients away from mixed adult/pediatric centers to allow for adult COVID surge?have you had residents pulled back to home programs due to COVID-19 workforce realignment?If so, has this affected your ability to care for your patients?have you altered fellow/resident coverage to limit exposure/promote social distancing?If so, how?Are you restricting resident/fellow involvement in COVID+ or PUI cases?If so, how?Are you continuing resident/fellow education? (yes - in person, yes - virtual platform only, no- postponed, other-please describe)if you provide consultation services at outside hospitals, have you altered the level of service you provide (no, yes - telehealth/phone consult only, changed criteria for in-person eval, transfer all children needing intervention/ongoing peds expertise to primary hospital, other-please describe)have you altered approach to daily rounds to minimize exposure? (minimize rounding in large groups, virtual rounds, round in staggered fashion, other- please describe)cancelled elective operations?pre-set metrics for determining what is urgent/elective or up to surgeon to make decision?starting to schedule elective operations again?how are you approaching OR volume re-build?postponed elective clinic visits?starting to reintroduce in-person clinic visits?if so, how are you deciding who should be seen in person?using telehealth for outpt visits?If so, able to conduct telehealth visits from home?performing non-operative management for appendicitis as a result of COVID-19?performing non-operative management for appendicitis FOR COVID + patients as a result of COVID-19?minimizing laparoscopy for COVID-19 + or PUI?What PPE in OR for COVID+/PUI?for COVID+ pts in OR, are you wearing PAPR/N95 for the whole case, or just during aerosolizing procedures (eg intubation)? Does your hospital consider cautery/insufflation for laparoscopy to be aerosolizing procedures in COVID+ patients?Any special practice around intubation? (ie, intubate in negative pressure room, wait 30 min, then move to OR?)preop COVID Testing for all OR patients?what is your turnaround time for COVID test results?Is your institution requiring outpatient COVID-testing for pre-operative patients?If so, how far in advance are patients required to obtain testing (48 hrs? 72 hrs?up to 5 days?)Is your institution requiring caregiver(s) also get tested prior to their child's operation?Has your hospital implemented universal masking? If so, who is wearing a mask?How many visitors are allowed per patient? what is your hospital's policy?Is your hospital re-using or sterilizing N-95 masks? If so, what technique are they using?how is your hospital preparing to ramp up volume? elective cases on weekends? extended OR hours on weekdays? other strategies?any barriers to ramping up volume? (staff limits, postop resources, or space, funding, state legislation restrictions, other?What is your institution's anticipated date/month for scheduling elective (non-urgent, non-semiurgent) cases?Other commentsUpdated byLast updated on
Alberta Children's Hospital, Calgary1 childyes010yesTeam A/Team B with weekend rounding No (no comorbidities)N/Awe have planned and agreed to it; no need yetprefer non-Covid but possible agreed tonot yetuniversal precautions, minimizing staffnot yetN/Ayesnonoyessingle fellow rounding, limit staff to weekend skeleton crew, home fellow taking part in educationnoyes - virtualContinue to see NICU pts as neededskeleton crewyesyes - ACS guidelines + case by casenot yetyesurgent onlyyesyescase by casenoN-95, face shields, gowns, glovesMinimize staff in room during intubation; 0 droplet time for others to enteronly for those that screen positive (ILI, travel, etc)4-8hrsnoyes (all healthcare workers interacting with patients; parents outside of patient room)Yes, one caregivernot yetevolving, eliminate summer slowdownSteve Lopushinsky 4/21
Arkansas Children's Hospital1 childyes000yesskeleton weekend crew- transitioning back to a more normal staffing patternyesexclude from call scheduleno n/anono yesno nononon/ayes- transitioning to normal coverageSkeleton crewnon/ayes- virtualn/askeleton crewallowing them nowcase by caseyesallowed services to ramp up in a staggered fashionyes- but transitioning to normalyes case by caseyesyesnon/ano- filteringN 95 + face shield + standard PPEn/an95 if covid status unknownyes, for ambulatory procedures12-24 hoursyes2 daysnoyes (all healthcare workers; parents outside of patient room; patients over age 2 years)yes- 1 parentnot yetessentially resumed pre-covid block schedule at this pointfamilies still apprehensivewe started a more normal elective schedule June 1Sid Dassinger4/2/2020
Baystate Children's Hospital - University of Massachusetts Medical School Baystate11 childrenyes2/0noWe have not changed our call, but we have changed clinic. No more than one surgeon present at any time.noyespicu space taken over for adult icu space, primarily non-covid icu patients, picu service moved to a section of infants and childrens floornoBCH is within Baystate so equipement is sharedyes - all traumas are PUI, everyone wears n95 mask, gown, gloves, face shieldAll patients for admission are tested with rapid turnaround and kept in the ER until their covid status is known. When admitted patients are sent to separate areas depending on their covid statusnonono, but within our institution some residents have been redistributed along with PA's depending on needsnoyes, to a limited extenton a rotation some residents are dismissed and sent home for the daynoyes - birtual platform onlywe haven't done this traditionally, but now with the roll out of telehealth we cannoyesthree level triage, emergent, urgent (delaying a month or two could have adverse consequences), and elective. as this point we are doing all emergent and some urgent cases based on surgeon decisionno, waiting on clearance from govenor and massachusetts dphyesalways kept available depending on patient needs, just cut back significantlyurgent issues, lacerations, abscesses, acute issues. no elective consultsyesno, we have been told cannot bill for teleheath if physician is not in office.nonon95, face shield, gown, gloveregardless of covid status everyone in room must wear n95 mask for intubation and 5 minutes afterwardnot yet, not enough testing capacity for out patient cases yet, but all inpatients are testedDepends we have different levels of testing. For ER patients 1.5 hour turn around. All others up to 3 daysnot yet, but we want to as soon as we have the capabilitynoyes - everyone in clinical areas1, restricted when they can leave and re-enter hospital to avoid trafficyes, sterisDiscussions of all, but no decision made yet. Some concerned ramp up will not be needed because even when govenor approves us elective surgery patients are scared to come to hospital, so catch up may be spread out over a long period of time.we are tentattively booking cases in late may/june, but may not be able to proceed with them if govenor and dph doesn't release restrictionsTirabassi5/11/2020
Blank Children's Hospital, Des Moines, IA1 childrenyes000nono change in schedule but only at hospital if there is active work to be donenoonly two surgeons on staff - minimizing exposure not a viable optionyes - PICU relocated to a flex ward space to open more beds for adultsnon-COVIDnoyes - children's hospital within an adult hospital so one supply systemyes - all trauma patients considered PUInononoyes - but they have now returned to normal assignments and schedulesnoyes - lasted for 6 weeks - now back to normalhalf of general surgery residents are at home self quarentined and half are at work (residents devised this plan themselves); no fellowsnonayes - combination of in person and virtual - this continues despite return to normal work schedulesnanoyes - elective cases resumed on 5/13/2020 at 1/2 normal OR capacity; as of 6/11/2020. have resumed full schedules with limitations only on the number of patients that can be admitted postoperativelycase by caseyes - govenor allowed elective cases to start on 5/6/20 - we resumed elective cases on 5/16/2020 at 1/2 OR capacity, full capacity allowed on 6/11/2020, with caveatswill prioritize cases and book within the limits of the time prvided to us by the ORyesyes - extending appointment times to limit overlapping patients in the waiting areas - also 2/3 of clinic staff were furloughed, so have to limit patient numbers on that account as well; pulling back furloughed staff as of 6/16/2020, so will be able to extend clinic hours to see more patients; still booking with extended visit timestriaging by diagnosisyes - only for routine postoperative follow upnononanoN95 with face shield or PAPR, gown, gloves.entire casenofor COVID unknown - only the anesthesiologist plus one assistant in room for intubation and extubation - 14 minute wait for all staff while room air exchangepreop COVID testing started for every patient when elective cases restarted - coincided with testing of all inpatients/admissions2-8 hoursyeswithin 48 hoursnomasks and face shields for patient care - fabric masks for administrative and support work - universal masking (for all employees, patients and caregivers) started on 5/6/2020initially only one caregiver for children - updated to two caregivers for children on 5/18/2020 - adult visitation policy remains very restrictedre-using until soiledthree phases:  first is 1/2 normal volume with a limit on the number of patients admitted postoperatively, second is full OR schedule, third is weekend elective schedule to help with backlogmany staff members were furloughed - getting them back will require demonstration of a full schedule which is difficult to accomplish with a reduced staffStephanie Kapfer6/15/20
Boston Childrens Hospital31 all childrenYesNone that I'm aware ofyesskeleton crew / if not in hospital, working from homeNo, all are strongly advised to stay home if not SOD/SOW or attending in the ICUNo; the tentative plan is the opposite for us-- we may become the regional pediatric center with kids transerred to us from surrounding adult/pedi hospitals so they can serve as dedicated COVID adult overflow centersNot that I am aware ofwe have shared some vents with local adult hospitalsOnly if they meet our criteria for PUI; however, if they come in moribund or otherwise in a state where thay cannot be asseed for COVID risk/sx, they become a PUIUntil testing done. All PUI in ED get put into a rule out area until testing performedI believe EMS still follows normal pathways as all EDs are open per usual, but inpatient (especially ICU) are mostly sent to us regionallyYes, at least from our local county/public hospital to us (both floor and ICU); other PICUs have transferred their patients to us as wellyesinitially yes, but now not as much as we expected as our census has dropped dramatically due to ceasing elective casesyesskeleton crew every day- only one fellow and one resident and a few NP's; essentially staffed like a weekend at all timesnot activelyyes, many teaching conferences have been transitioned to a zoom formatnot yet- we still provide full services to the county facility we cover when on callyes, smaller groupYesreason for need has to provided with booking and is included with the procedure in the OR case list for all to see; each surgeon must vet the case with their chief before booking not yet, current order from governor and hospital is through May 4yesurgent onlyyesyesnoNoIf COVID+ or PUI, intubated with just anesthesiologist and circulator in room; if COVID+, N95 for entire case, if PUI then N95 only for first 30 min, then can be changed to standard maskwait 30 minutes after intubation and extubation before removing N95Not yet, but actively being considered; currently we would like to do this but our daily supply of COVID testing swabs are very limited; UPDATE: started testing all nonemergent cases 4/132.5 hoursnoyes, now all people entering the hospitalyes, one caregiveryes, UV-C I believenot yet clear. currently open for business for telehealth, no elective procedures at least through may 4, no defined plan for ramp up after that as of yet-discussions have been had about weekend operating to offload built up elective case loadBiren Modi4/21/20
Children's Hospital at Providence - Anchorage, AK
Children's Hospital of Alabama3 all pedsyes1fewer than 10back to normal operating proceduresresumed normal scheduleno longernononominimize personnel for trauma; consider all PUIyesnot a problem herehave offered to other hospitalsresume normal scheduleresume normal scheduleNozoom platformnosmaller group roundno, back on scheduleresumed normal scheduleyesreview clinical situationyesyessomewould considernoN95; eye protectionwhole caseunclearN95 for anesthesia for all patients,everyone else leaves roomnotwo tests: 2 hours and 6 hours; different platformsnot for all; CV service requiring testing72 hours or so; unclear from CV servicenoinitiated 4/20; everyone2 for inpatients; 1 for surgeryyes; UV lighthaven't need to ramp up capacity; current utilization is about 75-80% of pre-covidunclearstartedMike Chen6/11/20
Children's Hospital of Michigan, Detroit 15 (all adults)1 on ventYesOnly call residents and fellows in hospital on given day. Nobody pregnant. We have offered non respiratory disease patients to adults to 21 years. No Covid19 patientsNoNominimize personnel for trauma; consider all PUIYesNoNoYesNoYesOnly one any given day. NoAll meetings suspended at this time. No zoom conferences yet. NoYes. Fewer see patient. YesYes YesNot yet. In worksNoNoN95;face sheikdStandard PPEYes. Starting tomorrow or Friday. 24-48 hours now. 1-2 hours soonStandard masks coming into and out of hospital. On at all times. N95 for all patient contact. Yes. Only parent or guardian. NoScott Langenburg 4/1/2020
Children's Hospital of Richmond, VA38 (adult)yesnot sure1 known0Returned to normaln/ayes2 >65 on home quarantinenon/anonoyesif need intubationnonot yetreturned to normalnoreturned to normalnoyes, virtualyes--phone only if no active/critical pts; yes, more virtualyesACS guidelines and surgeon preferencegradual re-opening May 1in stages with urgent/semi-elective cases firstyesurgent & semi-elective home-based surgeons are screening with telemed visits then scheduling in person visitsyesyessomenoN95/PAPR for anyone in room during intubationwhole caseyesonly anesth team in room for intubyes8 houryes, with surgeon discretion48-72 hrsno but has been discussedyesyes, only 1 caregiver per patient for <18, no visitors for >18yes; UV lightconsidering allnone so farcurrent (started 5/4)Jason Sulkowski5/22/2020
Children's Memorial Hermann Hospital, (Houston)as of 5/7 1 pedi trauma patient, one 5yo appy, one 4 wk (now d/c'd) some PUI.

39 confirmed adults currently in the adult hospital, 15 vented, 4 on ECMO
yes0 pedi, 15 adults on vent, 4 on ECMOyes4 or 3 days/nights on in a row. Work from home if not required to be at the hospitalYes>65 out of the call schedulenot yet, but there is a plan if neededn/ano, but our critcal care-trained folks are part of a surge plan (only to be activated if level 4, we are currenlty level 1)noyes, and minimizing the amount of personnel in each traumaYesNo, our children's hospital is a level 1 trauma and the COVID referral for our hospital systemNoYes, more of a skeleton crew in the hospital at all times. NoYesLess residents in hospital per day. Keeping our fellows distanced from each other.YesAttending exam only for PUI and confimed casesYes, webex for allNo, but we have canceled our outreach outpatient clinicsYes, smaller groupAs of 5/4/20, we are doing elective operations.No longer applicableyes, as of 5/4Yesas needed, many parents prefer telemedicineIf needs and in-person examinationYesYes No, using Airseal for lap casesNoN-95, face shields, gowns, glovesFull PPE for all anesthesia, regardless of COVID status. yes, all cases other than truly emergent. 12-24 standard test.
2h for limited number of rapid tests
Yes, with 72 hour windowwith 72h windowno but has been discussedyes, all people in the hospitalone visitor per patientWe have started using the hydrogen peroxide vapor protocol developed at Duke to sterilize and allow reuse of the N-95's. They stressed the importance of people not wearning makeup, perfumes, or lotion as those are hard to remove.we are now back to our previous block times. So far, staffing and scheduling has not been a problem. Some parents are still hesitant to schedulenowWe have weekly divisional webex for covid updates. Although we are updating almost daily, it's a good summary and to provide feedback. We are reusing N95 with a sterilization process. High risk cases that violate airway are only done by attendings and fellows.Kawaguchi/Tsao5-7-2020
Children's Mercy- Kansas City15 peds, no adults15 yes200Returned to normalreturned to normalnoinformal not yetto be determinednonoyes, overall continued universal precautions yesnononon/areturned to normaln/anoonly fellow/staffyes-virtual curriculum using online teams platforma lot more telehealth. our smaller communittee outreach hospitals have been closed during the pandemic and are starting to reopen (i.e. day surgery /surgery centers)return to normalyes, as of 6/8 return to normal (with covid pre testing on all patients)Yes- ACS guideleines6/1as of 6/8 open for regular block times, all tested prior to ORnoyes, reduced with more telehealth nowif inperson neededyesyesyesnonoN95Whole caseyesyes- pre testing for COVID status, if COVID status unknown only anesthesia in room, N95 masks and eye shield wait 21 mins after intubation before others enteryes4 to 8 hours, new testing now within 2 hoursyes within 72hwith 72h windowmothers of nicu infantsyesyes- one visitoryeswe are now back to our previous block times. So far, staffing and scheduling has not been a problem. parents need time to reschedule as they now have job/child care issues to naviate or who will be home with the kidsparents cannot find caregivers/time to immediately show up for longer stay cases even though "ramp up" is in full effect.6/1daily email from institution with statsRebecca Rentea6/10/2020
Childrens Hospital of Wisconsin (Milwaukee)0 admission specifically for COVID (we have had 22 pediatric total COVID+ picked up by screening test) 1003Noyes, but have stopped doing this as we start to progress toward normal operationsyes - one in house team rounds on entire service, no housestaff "prerounds" - we see patient once. We recently went back to normal operations for attending/resident coverageomotoa;;y but went back to normal operationsmore "seasoned" staff not on call, attending staff who tested positive (now presumably immune) willing to step in and do cases for identified covid + patients - none as of yetno, but capability now exists, not necessary as of this time, but adult hospital next door (connected to us) is seeing more patients - 35 inpatients on adult siden/anonot nowminimize personnel for trauma; consider all PUI - CAPERS/N95, gown, gloves, fashshieldyeswe offered to take all peds patients currently admitted at adult hospitalsnononoinitially yes, but now resumed normal schedule team a/b alternating single teamsnoyes - virtual, zoomnoyes - see previous answeryes initially but transitioning to normal operationsyes - weekly assessment by team leaderYeswe are currently at 80% capacity and weekly adding more cases depedning on local envirnoment, PPE and COVID testing availabilityyes, but start to return to normal operationsyesbased on urgency and need to see in person vs by virtualyesyesyes - when applicableYesnot yet, but have plan in place to do so when necessaryN95; eye protectionWhole casenonot for covid-19 neg patients, all are being tested, in emergent scenario we have implemented anesthesia to intubate with CAPER, use Neg pressure OR for PUI/COVID + patientsyes, except emergent90min - 6hrsyes48hrsNoyes - all heathcare workers and staff, family and patientsyes - 1 gaurdian older than age 18Yes, UV weekly upto to 10 timessee previous answersfamily concerns regarding COVIDwill ramp up to normal by first week in JuneDavid Gourlay5/8/2020
Cohen Childrens Medical Center/ Northwell120 pediatric patients yes10-20 (most as part of MIS-C) 50-100NoYes2 teams, one night person  3 of our pediatric surgery attendings working in adult COVIDNoMore than half the childrens hospital was used for adult COVID patients although with numbers now decreasing more childrens beds are backBoth COVID + units and COVID - unitsYes- Peds ER seeing non-covid patients up to age 30; 3 pediatric surgeons attendings and one peds trauma fellow will be working in adult COVID ICU units/ administrativeYes, with the larger hospital systemNo, but this is evolvingNoNoNoyesYesYesFellows split into two teams-seperate initially. Now both fellows working. NoYes- all virtual, we just cancelled all conferences except SCORE(via Zoom)NoYes- divided crews and rounds, minimize size of each groupsYesSurgeon decision for urgent/emergent cases; approval of Surgeon in Chief needed for certain cases that need to go but arent technically urgentNoStaging cases by need level 1-4YesYesSurgeonYes YesFor about half of patientsIn some cases- has now stoppedYesN95; intubation precautionsYesUnclearMinimize staff in room during intubation; 15 minutes time for others to enterYes except for truly emergent cases45-minutes to 12 hoursYes48-72 hrsYesYesYes, one caregiverYes- sterilizingYes, staging systemNot all families are readyStarted last weekEvery day we are changing our clinical practiceSam Soffer6/11
Connecticut Children's Medical Center, Hartford CT11 (3 currently in house) plus 3 patients with post covid inflammatory syndromeyes0 (two patients previously were in PICU, one ventilated)0yeslimiting number around during day, night and weekend unchangedno one falls into those categories (but hospital is allowing this)overflow for adult hospitals if needed(does not look like that will happen)non-covid preferrednot yet, but available prnvents and feeding pumpsyesyesonly two hospitals in CT take trauma (level1)kids including uswe are pediatric only, other partner hospitals are sending all pediatric patients to us as they convert their peds beds to adultsyes (some of the "community" programs)noyestwo teams of residents/APRNs/PAs, we only have a single fellowNot applicable yetzoom platformnot applicableyes, attending of week rounds by self after discussion with housestaff. residents,PAs,APRNs, fellow round in very small group and only one person goes into roomyesACS/APSA guidelines then discuss with anesthesia and partnersyes as of last week in a slow fashionnon-aerosolizing casesonly for electives starting at our ambulatory surgery center.  20-30 min between cases in a room         This week more volume added at both OR sites (main and ambulatory)yesin next few weekshalf usual volume,  surgeon decides about in person or telehealthyesyesnowe will if this happensN95N95 for anesthesia for all patients,everyone else leaves roomthis is just starting for elective ambulatory patients as of this week12 hours (but there are some able to be done within a few hours, expecting in June that this will be most of cases)   This is slower this week because more testing done but slower to get results (Quest for outpatients)   faster for patients in ED--12 hours as done "in house"yes72hrs nownot yet (waiting for more tests to be available)yesyes, one parent onlyN95 being sterilized with hydrogen peroxide vapor as of two weeks agoslowly but plan unclear at current timestarted last week and more this weekagree with Dr Soffer's comment     we are also seeing the post covid inflammatory syndromeRichard Weiss5/18/2020
Cooper University Hospital, Camden, NJPediatric - 2 current (7 total); Adult - approximately 100 (numbers change)Yes10N/AYesOne attending in house on a given day to round and cover non-elective casesNo - not applicableN/ANot yet but there is a contingency plan for thatNon-COVID + adults would be the planNot yet but available if neededNo - adult burden is significant hereYesYesNoNoN/A - this is the home program/locationN/AYesFewer residents on service, no double scrubbing cases, no residents rounding in NICUNot applicable yetN/AYes - Virtual (WebEx, Zoom)N/AYes - Staggered rounds (attending rounds without resident); no residents rounding in NICUYes, returning to normal as of 6/1/20ACS/APSA guidelinesYesScheduling backlogged cases into our bock time, urgency determined by surgeonNo (starting to phase back in)YesSurgeon DiscretionYesYesNoN/AWill consider if it happensN95 and face shield or goggles for all cases (even if COVID negative - all patients are tested)Hasn't happened yet for Pediatric CaseUnclearOnly use negative pressure rooms or COVID + patients (have only been adults thus far)YesInpatient: 15 minute POC test (limited), 2 hr rapid PCR, 6-8 hours standard; Outpatient: 24-72 hoursYesWithin 72 hoursNoYes - All visitors and employeesOne parent; two for NICU (not at same time)Yes (hydrogen peroxide) Using local SurgiCentre for some outpatient elective cases (if COVID negative pre-op); rank system for elective cases done at main hospitalNo5/26/20 (NJ Order)Matthew Boelig6/12/20
Dhaka Shishu (Children) Hospital185 (36 Surgical)Yes721NoYes12 hours duty schedule split into two teams per 24 hours. One consulant attending per 24 hoursYesReduced the weekly attendance physically & keeping updated online on WhatsAppNoN/APediatric trauma onlyNoYesNoN/AN/AYesCertainlyYesReduced number of residents per shift; increased gap between subsequest dutiesNoN/AYes, Virtual onlineN/AYesYesYesNot yetNot decided yetN/AN/AN/ANot yetN/ANoNoYesStandard oneWhole caseYesNoYes72 hoursNoN/ANoYes, everybodyoneNoNo elective cases planned till dateStill the plateu has not reached in my country it seemsOne months from nowNothingProf. Dr. Md Ashrarur Rahman06/06/2020
Doernbecher Children's Hospital- OHSU0 surgicalYes00N/AYesone attending in house 6a-6p, usual nightly call. decreased resident/APP in houseNon/anot yet a needTBDnot yetyesyesyesn/ano non/ayesskeleton crewnot yethave not had a caseyes-virtual curriculumnoyes- only one person examines patientyesyesYes- 5/1850% daily OR closure, opening elective blocks on Saturday and SundayyesYes- 5/18surgeon preferenceyesyesnon/anot yet, but have plan in place to do so when necessaryN95n/ayesYes, wait 20 minutesYes6-24 hoursyes48 hrs (72 okay for Monday cases)noyes- everyone who comes within 6 feet of a patientyes- one parent, increased to 2 parents 5/18not yetweekend elective cases, extended weekday hours but not opening all ORs on weekdays to keep PACU/waiting room social distancing possible5/18/20Nicholas Hamilton6/8/20
East Tennessee Children's HospitalPeds 0no0nono changevolitional-as needed0nononoas neededas neededas neededno yetnoyesreduced resident work hoursnoif at greater risknonostaggered roundsyesdesignated OR management group decides5/4/203 phase approach (50%, 75%, 100%)offered virtual/phone visits vs. reschedulingyesurgent and family preferenceyesyesnonoN95 or PAPRIn OR intubation w/ surgical team out of room (length of wait depends on patient risk categoryno48hoursyes72hoursonly if screening suggests needyes, everyone1yes, H2O23 phase approach using block schedules and extended OR room operational hours M-F. No weekends yet.5/4/20Vaughan5/7/20
Emory University/Children's Healthcare of AtlantaPeds 1 (curretly 1. 8 total childrent thus far)yes13noYesnow returned to regular schedule. schedule for SOW, call, weekends all pre-COVIDyesgroup call obligations close together to minimize time in self-quarantinenon/anonoyesyesnonoresidents back to normal rotationsnoreturned to normaln/anon/ahybrid. some in person, some virtual to promote distancingn/ayes. limit large groupsno, back on schedulen/ayesextended hours and opening several OR's on Saturdaynoyestelemedicine reserved for at risk patients and families that prefer to not be seen in personyesyesnoNo, filtering both insufflation and desufflationN95 and face shieldwhole caseyesAnesthesia and single nurse only, 15 minutes wait for PUI or COVID+no, only if aerosol generating4-6 hoursnon/anoyesyes - one visitorsterilizing. UVbothpatient fear of exposurealready startedMatthew Clifton6/8/2020
Goryeb Children's Hospital Atlantic Health System Morristown New Jersey275 Adults 9 childrenyes100 Adults 3 childrenYesTeam A/Team BYesOver 70, not taking callyesCOVID+Yesnoroutine trauma PPENo but in negative flow roomsnonoNA (we are the home program and we have not pulled back)noyes1/3 of residents off for 5 days to insure healthy reservenoyes - virtualtelehealth and increased inbound transfersroom entry only when absolute, split teamsYESSurgeon in chief in consultation with division chiefsNow, in MayAcuity and case level prioritiesyesyes in MayWhere hands are needed--tube care, stomas, wound issues. Virtually all post-ops are done virtuallyyesyesno--this prolongs hospitalization in some patientsnoN95 and face shieldIntubation box; we have not instituted the time delayYES2-3 days (down from 7!)yes48 hours to 7 days max and attest to quarantinenoyes--everyonekids--one only and no tag outyes UVAll of the abovepatient barrier--they are afraid5/18Lazar5-15-2020
Hasbro Children's Hospital Providence, RIPeds 4 (total)yes05noYesSkeleton week and weekend crew, minimal junior resident coverage; attendings first call for PICU/NICU - ended on 5/22/2020 - return to normal scheduleYes (pregnancy, age >65)2 pregnant HCW in ped surg and 1 >65 y/o, limited to telehealth and 1st call beeper (incl. at night) - ended 5/22/2020 for older HCW. Pregnant HCW remain off clinical dutyYes - partiallyAdult COVID-neg oncology patientsReady as part of next tier, but ultimately not required (curve flattened)No - prepared to do so, but not needed in the endYesNoNononoyes - return to normal schedule 5/22/2020fellow and senior Gen Surg resident alternating weeks in-hospital, except for index cases (when the fellow comes in, even during "off" weeks (ended 5/22/2020)noyes. Zoom for non-PHI conferences, Skype for Business for QI, M&M, tumor board and other PHI conferencesyes - telehealth as much as possible, including monitored simple procedures like G-tube changesSmaller teams - until 5/22/2020, when return to normal schedulelate in the process, but yes. Now (5/11/2020) slowly restarting electives, outpatients only for now. By 6/1/2020, return to 50-75% electivesguidelines based on ACS and CDC, adapted on a case-by-case basis. Priority to cancer, cardiac and children (for entire hospital system)yes, starting May 11tier 1: 25%; tier 2:50%, with kill-switch if spike occurs - not needed (yet?)maximize tele-health (first line are the staff (attendings and APP) who are highre risk (pregnancy, age)have remained open to all visits not appropriate for tele-healthif not appropriate for tele-healthyesyesready to - but have not (yet)noNo, but clear institution-wide guidelines (keeping it a closed system with modified insufflation, deflation, suction, flow/pressure rates, specimen retrieval, etc.)N95 + face shieldFor ALL patients (even COVID-negative: N95+Face shield for AGP (incl intubation); then, 15 min air exchange before start of operation with regular masks. If case <1 h - option to forego 15 min wait and perform surgery with N95no, but smoke/CO23 aspiration via N95-grade filterYes. COVID negs: limited personnel with N95/face shield, clear plastic cover over patient's head; 15 min wait while droplets are gone (HEPA air recirc.), before full OR personnel in. No N95 required after that. At extubation, same (reverse) process. For COVID+ and symptomatic PUIs, intubation in dedicated neg pressure room, then to ORYesrapid test: 45-90 min (but limited supply). Roche test takes few hours, batched 4 times/dayyes48 h norm, but up to 96 h to accommodate (long) weekendsonly symptomaticyes. All hospital personnel mandatory since March13. All patients and families since April 291 (up to 2 caregivers can visit/stay, but only one at a time; exchange must occur outside the hospital)Yes. H2O2, Battelle as of 5/1 3 tiers planned; 25% of capacity to start 5/11. Contemplating, but not yet implementing Saturdays. Plan for 12-hour OR daysNot really - but prioritizing to avoid long-term postop stay for now, if possible. As of 6/11/2020, only 15% of ICU/vent resources used for COVID (down from a maximum of 40%)5/11/2020Francois Luks6/11/2020
IWK Health Centre, Dalhousie University, Halifax0NO00n/ayesskeleton w/e crewn/ayes in principle, but hasn't happened yetn/ayes - one peds surgeon covering adult traumanot yetyesn/an/an/anonoyessingle fellow program, 2nd year fellow covering as junior staff to minimize exposuren/ayes virtual - microsoft teamsn/ayes, minimizing rounds in large groupsyesyesyesprioritization system standardized across surgeonsyesyescombination of type of case and time waitingyesyesnon/anoN95 and face shieldn/anoyes, as abovenot yet, but has been discussed6 hoursthere are screening criteria24-48hnoyes, for all healthcare workers at the hospitalyes, only one caregiver per patientnono weekend or extended hours for nowexisitng nursing staff limitations, nothing newcurrently at 80% capacityRodrigo Romao6/11/2020
Johns Hopkins All Childrens Hospital, St. Petersburg, FL8yes010YesTeam A/Team B. When we resumed elective cases (mid-May), team members who were not on, came in for clinics and OR. UPDATE: However, as of June, we are back to our regular schedule.NoNoNoNoYes, considering all PUI, until 3 screening questions are answered. All patients are getting tested regardless.Yesn/an/aNoYes
one fellow rounds/covers cases per week, during the day, except if there's an index case. Fellows alternate night call. Residents are divided as well (morning resident, day resident, late resident). UPDATE: Back to "normal" (non-Covid) schedule as of June.
YesOnly attending/fellow seeing patients COVID+ or PUI, to preserve PPEYes, virtual platform and in person. In person: conference room is marked with red tape to ensure 6 feet of distance). UPDATE (June): Keeping this platform, although we have resumed our normal schedule to ensure social distancing.n/aStaggered rounds: Morning rounds: overnight person, one fellow, one resident, and the surgeon of the week round at 6am. Afternoon/Evening rounds: one fellow, on call APP, evening resident. UPDATE (as of June): the attending decides whether or not to do 6am rounds with the team. However, if not rounding at 6am, only the attending enters the room during mid-rounds, and rounds with an APP and/or fellow. Resumed on 5/4/20Institutional spreadsheet of what is urgent, if surgeon disagrees, a triage committee decides. No longer being used since start of elective cases. UPDATE (June): no longer applicableYes, 5/4/20Backlog speadsheet has been prioritized (1: urgent, 2: 1 month, 3: > 1monthNo, using a combination of telehealth, telephone and in person visits. UPDATE (June): Mostly in person and telehealth visits.Patients deemed to need an in-person visit, were still being scheduled for one before reopening on 5/4. UPDATE: Most patients are being scheduled for an in-person visit, except some post-ops, and some who live at a distanceSurgeon decidesyesYes. UPDATE (June): NoNoNoNoN95/Face Mask + GogglesOnly during intubationYesN95/Face Shield or PAPR our anesthesia collegues, everyone else leaves room or stands > than 6 feet awayYes, since reopening for electives-all patients get tested. UPDATE (June): ambulatory surgery and all admitted patients are being tested1 hr rapid test (only for ER urgent cases). Four hour turnaround for the remaining cases. Batched twice/day. Discussion on an evening batch. UPDATE (June): 1 hr rapid test for urgent cases (the test takes more than an hour). Four hour turn around for the remaining cases, batched three x/day. The last one is at 3:30p, and is not resulted until the next morning. Yes72 hoursNoYes, everyone older than 2 years old. As of 4/24/20.yes, one parent onlyyes, wear regular mask over N95, and a faceshield. If N95 not soiled after use, store in brown bag in well ventilated place for re-use. Started electives on 5/4 with a lower capacity. This week we are scheduling as we usually do. Discussing performing electives on Memorial Day and Independence Day (observed). UPDATE (June): Did not operate during Memorial Day. Normal scheduling. No extended hours.Staffing is always a barrier, we now have a few traveling nurses ans scrubs, as well as new hires in the OR.5/4/20Raquel Gonzalez6/8/20
Le Bonheur Children's Hospital, MemphisPeds 0 Peds 0yesTeam A/Team B (includes attendings, fellows, residents, NPs), 5 days in hospital/5 days out of hospitalYes, most senior surgeonRemote assignments and non-clinical worknot yet, plan in placenon-COVID, start with young adultnonot yetNot specifically. But standard precautions. Definitely N95 and eye shield if intubating.nonot that I am aware ofnot that I am aware ofnon/ayesTeam A/Team Bnot yet since we have not had any inptyes - virtual platform onlyn/ayes, Team A/Team Byespre-set metrics yesyesnonono, but starting to filter desufflationN95, eye shieldanesthesia only in room, N95 masks and eye shieldno48 hrs, hopefully, shorter soonyes - all heathcare workers and staffyes, 2 visitors only and they cannot change during the hospitalizationyes, wear regular mask over N95, if N95 not soiled after use, store in brown bag in well ventilated place for re-usedaily incident command mtgs; every 5 days whole team does patient pass ons using zoom and, at that time, talk about changes in division processesEunice Huang4/1/2020
Lucile Packard Childrens Hospital - Stanford1 ped 7 adult0yesweekend/holiday type of coverage, rounder of the week with a back up surgeon scheduleyes, no patient contact for >60 year old surgeonsyes, no patient contact for >60 year old surgeonsPlan in place to do son/anot yetnot yetyesyesnononon/ayesskeleton crewnot yetn/ayes, virtualyes, skeleton crew, favor geographics fro surgeon coverageyesyesACSyesyesyesnofilteringN95yes, only anesthesia in the room, N95not yet12-24 hrsnoyesN95Matias Bruzoni4/2/2020
Lucile Packard Childrens Hospital - Stanford (Peds only)1 Ped0Yesweekend- holiday like coverage w/3 teams; Individual faculty covering 24/7 for 5-7 days then 10-14 days off, back up faculty scheduleYes (age >65 and comorbidities)No clinical exposure (only telehealth)Not yet, but certainly a considerationlikely non-covidNot yetNot at this timeYesSeparated currentlyNoNot at this timeNot strictly, but emphasis for all providers to limit time in hospital as possibleNoYescompletely separate teams working alternating days; single team members are caring for pts by specific units; minimize in person group rounds by facilitating conference call, attending is the only one physically rounding on every pt for the service along with specific resident/fellow/NP caring for pt; currently mask used for all inpatient encounters and minimal # providers used for examyesminimize exposure unless clinically necessaryyes - virtual platform onlyNo, -same inpatient hospital care as needed for outside hospitals at current time. Contingency plan to pull back in patient care and transferring pts to the peds only hospital depending upon attrition of faculty in workforce if necessary. Postponed non-urgent outpt issues, telehealth for vast majority that can be; strict criteria / attending approval for in-person clinic eval for those sites (similar as to main peds hospital)Yes- divided teams on different days and minimize group rounds of those teamsyesHospital criteria based on CDC & ACS guidelines, but surgeon / anesthesia decision to make when needed case by caseyes, started 5/4/2020short transition period for semi-urgent elective, then open up to backlog of cases based on each division prioritizing caseyesmid May, started to offer in-person visits, but with preference toward tele-healthPhysician decision ahead of clinic dates and coorination with family and staffyesvariable capability to do from homecase by casenocase by casefull PPE with N95, shields, only critical anesthesia personnel in room for intubationyes - wearing throughout case for those aerosolizing higher risk proceduresInsufflation use - all airway and GI endoscopy and laparoscopylimit to critical anesthesia provider in OR during intubation with those providers in N95 & shields for all pt casesnot for all pts currently, but going to available rapid test (< 1hr) by April 2, 2020currently16-24 hrs, but rapid test (<1 hr) available April 2, 2020yes - elective require non rapid tests performed within 72 hrs, urgent/emergent cases get rapid testing performed and results <1 hr72hrsHighly encouraged by institution for global testing (using nasal swab PCR and serology IgM & IgG) of all providers starting in April 20, 2020 - for self interest as well as confirm to patients/families that providers had been checked as well. By May 1, 2020, >11,000 faculty/staff had been testedyes, all providers and staffyes - always evolving. Currently: limit of only 1 specific parent or family member to visit for the entire hospital admission (cannot have different parent visitors at different times)Re-sterilizing N95 in Sterrad sterilization systemNo extra hours/days planned...just booking as can based on priority. Still finding that some families are wishing to delay operations furtherNone at current time5/18/2020 is normalization of standard OR block times as prior to COVID and moving forwardMany of these processes have gone thru rapid changes, hard to capture in just a couple short time frames of data collection (3-30-2020, 6-5-2020). Data on total number of COVID + patients treated is incompleteStephen ShewJune 5, 2020
Lurie Children's Hospital (Chicago)Tested 5632 pts with 527 positive; currently 5 current inpatients positive (79 total hospitalized); 1 pt with MIS-C (was in ICU for 1 day)79 total<10 (not sure exact number)unkownnot that I know aboutThe column to the right describes our changes from mid-March until end of April. As of May 1 we have returned to normal call scheduleCohorted into teams of ~3 attendings. 1 covers Floor/PICU, 1 covers NICU and backs up other, 1 additional to help take call during week and cover weekend. This cohort of 3 attendings switches out weekly.Non/aNo. We will be central referral for all pediatric care/transfers to increase capacity at other hospitals in Chicago to focus on adultsn/aNoYes, Lurie sent ~20 vents to NorthwesternYesYesYes (we now accept up to age 25)YesNon/aInitiallly yes but now back to normal coveragesplit NICU and PICU/floor, stagger presence of clinical fellows, brought research residnets in to help with coverageYtrying to limit exams to attending only, as of 4/14 this is being liberalizedYes, Virtual platform onlyNoYes, split teams as noted intially & Now back to normal rounding practicesYesNo - we made it upYesLimited block times right now as we ramp upYes but now back to normalyesSurgeon pref for telehealth but mostly back to normalAvailable in hospital as of ~4/7, as of 6/6/20 still do not have ability to do this from homeNoNoNoYes, N95 then regualr surgical mask over the top, eye protection requiredwhole caseNoNo clear policy until 4/13, post 4/13 we are testing all pts and all staff wear N95Started 4/13. We have a rapid that takes 1-2 hours, regular takes 48 hY48-72hnoYes - care providers only (not families), policy changed around 4/3 to where universal masks used (still not using N95 for PUIs)1noSaturdays were offered for elective block time/catch up but very few surgeons used this block time to my knowledgestaff furloghs due to financial impacts of COVID are limiting OR availablityalready startednoneMehul Raval4/15/20
Maimonides Children's Hospital, Brooklyn NY1895 adult, 49 pedsyes7 peds vents overall, 140 peak ICU beds, 180 peak vents<10none knownyespediatric surgery attendings were repurposed to floor and ICU COVID teamsnothe issue has not arisen within pediatric sugery but has within other divisions and has been addressed to minimize exposure for those individualsyesbothyesyesyesyesnononon/ayesresidents are covering multiple COVID units in 12 hour shifts for 3 days in a row and then rest for several days, surgical services have been combined into a single resident rotationyesas much as possible exposure is limited to the fewest necessary physicians, in the case of tracheostomies the procedure is performed by a single attendinginitially yes but due to the rapid increase in patient volume education has been significantly curtailed rounds are conducted daily by a single surgeon and nurse practitioner, no residents are available for clinical care except for operartive cases and overnight coverageyesyesno, only scheduling urgent cases at presentgradual opening of ORs starting with urgent casesyesyespatients who are eligible for surgery in the upcoming weeks as the ORs reopen or who have symptomatic issues that can not be delayedas much as possiblenoyesyes prior to the availability of rapid diagnostic screeningnofull PPE with N95, shieldswhole caseyesonly anesthesia in OR for intubation, routinely using glide scope, wait 15 minyes, all patients admitted from the ER with the expectation of surgery are rapid testedrapid - 1 hour, standard - 1 dayyesup to 72 hoursnoyes, everyoneno visitors for adult patients, 1 visitor for pedsnogradual increase in OR volume with extended hours / weekends to be determinedthe ability to start elective surgery is dependent on a 30% bed capacity (which we never had pre-COVID) according to NY state guidlines, the ability to perform ICU requiring procedures is not possible presentlyJune 1stDan Hechtman6/12/20
Maynard Children's Hospital at Vidant Medical Center - East Carolina University69 adult, 2 pedsyes1900yesyes. set rounding day with OR and all inpatient coverage. set clinic day.; other days at homeyessurgeons over 60 not in hospital. pregnant residents in outpatient clinic only (lower risk population). Cormorbidities treated as disability with accomodationsnon/ano, but offered to do so. no surge here yetnoyes - all traumas are PUI, everyone wears n95 mask, gown, gloves, face shieldyesnononon/ayes fewer residents covering more services with 5 day blocks at homeyesmust have direct attending oversight at all timesyes - Webex. Virtual onlyno changeyes - smaller groups, one attendingyes for 8 weeks, now resumedsimilar to acs system. panel review of all cases to ensure meet criteriayesurgency followed by duration of waitfor 7 weeks, now resumedyes all new patients, needed followups, acute concernslimitednonon/anon95, face shield, gown, glovewhole caseyesMinimize personnel in room, wait 10 minutes to enteryesvaries 90 min to 24 hrs, variable reagent availabilityyes72 hrs (change from 48 hrs firs 6 weeks)noall clinical staff1sterilizing with H2)2, but have not reused yetNo extra hours/days planned...just booking as can based on priority. Still finding that some families are wishing to delay operations furthertesting, state policy5/26 restartWalsh6/11/20
MGHfC, Boston22 adult, 2 child at MGHfC (225 adults at MGH proper)yesyesSOW + backup only in house unless in ORyesno SOW call for >65yesbothyesyes, MGH. Vents, staffyesnowe did, no longerwe did, no longernonoyesresidents redeployed to cover COVID ICU and floor patietns so those on surgery covering multiple servicesnoyes, virtual. there is much more now actuallyonly urgent in person, otherwise all virtualyes, minimize people who enter room, team is small already due to resident, NP, PA redeploymentyesyes, initially chief decided, last few weeks OR leadership didno, only those delayed but still urgent like low grade cancer, nothine elective like Nuss. still being worked outyesnot yetyesyesno noN95 or PAPRall team wears N95 or only anesthesia in room and then wait 30 min. 30 min delay for room cleaning team. only those getting admitted now<12 hrsyes48hrnoyes1yes, H202Starting 'urgent' delayed cases, the rest still in the planning phase mostly because of capacity in the hospital. Many of our PACUs are still ICUs full of adult COVID patients. unknownwe have seen a serious cardiomyopathy and Kowasaki like lillness in 3 pedi patients with COVID Casey Kelleher5/7/20
Minnesota Children'syesyesyes
Mott Children's Hospital University of Michigan, Ann Arbor, MichiganPresently <20 adults, 1 peds. Over total 600 treated Yes?<5NoYes, but back to normal nowTeam A/Team Bnot age, but pregnant, we have no comorbiditiesPregnant staff do not care for CoVid + or suspected pts.Our negative pressure ward became the RICU where ventilated CoVid pts are housed primarily. The other adult ICU's were then filled. Since we now only have <20 Covid pts., the RICU has been dismantled and the negative pressure ward will return to a normal peds floor.CoVid +Our critical care certified pediatric surgery staff manned the adult Covid ICU's along with adult ICU and anesthesia staff during the peak. They are not longer needed in that capacity. Others were on a "line team, but minimally utilized.not that I know ofWe are considering all level 1 trauma pts PUI due to the high risk for intubation. We are using normal precautions for level 2 and belowyesnonot yet, plans are being made -- this was not necessary in the endnonoyesfellows on 5 days then alternate, resident schedule more detailed, but attempting to keep only those needed, also doing this for PA's - three teams alternatingYesOne provider at a time - virtual rounds at the room door, exam only as neededyes - virtualYes, doing as much via virtual or phone as possible. Traveling to operate.Yes, minimizing size of team, special precautions for PUI and CoVid pts.YesUp to surgeon, but using guidelines set by institution and ACSYeswe ramped up over a 2 week period to full schedulesYesyes, still attempting to make as many visitis as feasable virtual visitsSurgeon screeningYesWill have ability soon - still hopingYes, protocolized it so we are all treating pts similarlyyesNo, but now filtering insuflation gasN95/PAPR Whole caseyesFor all pts, only 2 anesthesia personnel in room, all others wait 20 minutes, then do case, then only 2 anesthesia personnel in room for extubation, then wait 20 minutes to go to PACU. For CoVid + or PUI, everyone in room with N95/PAPR for the entire caseBegining today6-8 hours I am toldyes48-72 hoursnoYes, all hospital personnel wear a mask. Patients and parents are issued a mask and encouraged to wear them, but they do not always do that2Yes, not sure the techniqueWe have kept our usual schedule so far during the ramp up. Up to surgeons to manage thier individual schedulesNot yet
Adult patients: One adult visitor.
• Pediatric and newborn patients:
Two visitors, but only parents or guardians.
No siblings or extended family.
• Obstetric patients: Two adult visitors
at a time for mothers in labor and delivery.
No siblings of newborn.
• No visitors with flu-like or cold symptoms.
• No children under 16 will be allowed
to visit, except under exceptional circumstances.
• In Ambulatory Care Clinics visitors
are limited to one visitor/companion who is
providing transportation to the patient receiving care.

Steven Bruch6/12/20
Nationwide Children's Hospital3 children0YesSkeleton weekend crewYesNo clinical duties if pegnant or immunosuppressednot yetn/anot yetnot yetyesnon/an/ayesnoyesteam A/Team ByesAttending only for high risk / confirmed non-emergent cases, if possibleyes- virtual curriculumn/asmaller group- minimal room entries and number of people examining patientyesyesyesyesyesyesnon95intubate in OR, others leave room 30 minyes6-8 hrs, test run twice per dayyes, everyoneyes-one visitoryes, Battele hydrogen peroxideBen Nwomeh4/9/2020
Nemours-AI duPont Hospital for Children4 pedsyes - 18 cumulative hospitalizations03noyesskeleton crewnowe created capacity for 38 adult pts plus a MICU but it has not been used yetnon-covid nonoregular mask, eye shield, gownyesnononowe did , now back to normalnow back to normalyesonly if essential help necessaryyes, virtuallimited in person eval, encourage transfer of allyes, virtual rounding using vidyo. No more than 2-3 rounding together, only one person goes in roomrestarted nowup to surgeonyes all cases being scheduled as ablenot anymoreyes up to surgeonyesyesonly some surgeons, only for COVID +some surgeons are, no uniform policynoN95/PAPR for anyone in room during intubationjust intubationnoOnly anesthesia team in OR for intubationyes1.5 to 2h for urgent cases, 48h for outptsyes48hnoyes, everyoneyes - one healthy parentstarting to, outsourcing to a company to do this (Battelle)extended OR hours to 7pm parents saying no. trying to preserve social distancing in OR workspaces (eg preop holding) so limiting number of rooms running at a timewe are calling cases "time sensitive" rather than elective but have essentially started doing all cases againLoren Berman5/21/20
Nemours-Jacksonville, Wolfosns Chidlren1 childno0yesSkeleton weekend crewnonononoregular mask, eye shield, gownnonononon/an/ayes, virtuallimited in person eval, encourage transfer of all, telehealth yes2 person roundsyesyes but up to surgeonnoyesnoyesyesnonoN95 and goggles N95 and goggles if in roomnorapid test, within 1 hrnonoyes-one visitorYes - UV sterilizationAll of the above are planned options, havent decided yetGustavo Villalona4/201/2020
Norton Children's Hospital, Louisville0 (ped only)7None currently, previously 1None to my knowledgeNoNon/aNon/aNot yet - contingency plan in place but not neededn/aNot yetpart of a hospital systemYesYesn/an/aNon/aYesSend home ASAPNon/aYes - virtualn/aYes - minimize team sizeYesSurgeon with Chief approvalYes, elective cases starting 5/6/20Using cases from depot (previously scheduled) and reviewing priority of case with surgeonYesYes as of 5/6/20Review with individual surgeon to determine need to see in person vs. telehealth vs. deferredYesDeveloping processNoNot yet needed but would be consideredNo - using smoke evacuator and N95 for laparoscopyN95 and goggles n/aYes based on SAGES publicationN95 and Goggles, no waitYes starting with elective operations 5/6/2024-72 hours, rapid tests available when neededOnly for elective scheduled cases72-96 hoursNot routineYes as of 3/30Yes - two visitors, must remain the same two people, and all are screenedYes - UV sterilizationConsidering weekends, longer weekday hours, maximizing use of outpatient surgery centerFollowed state guidelinesElective cases started 5/6/20Cindy Downard6/5/2020
NYP-Morgan Stanley Children's Hospital - Columbia University690 (adults) - 70 (children)yes6>20noyespediatric surgery attendings took many call shifts in the adult hospital ICU and on SWAT teamsyes
Reducing exposure in pregnant and over 65 years of age
yesBothyesyesyesyesyes, all pediatric care in our health system limited to the Children's Hospital
yes, all pediatric care in our health system limited to the Children's Hospital
yesnoyesevery other day physical presence in the hospitalnoyesyes, limited on-site presence for NICU consultations. No clinic or elective surgerysmaller teams and onlyone member of team exams patientyesyesno, only those delayed but still semi-urgent and time sensitivesemi-urgent only scheduled into limited OR blocksyesyestelevisit is first choice. Lesions/conditions that need hands-on are scheduled for in-person office visityesyesyesno, using AirsSeal smoke evacuator on all laparoscopy casesfull PPE with N95, shields, only critical anesthesia personnel in room for intubationwhole caseYes based on SAGES publicationwait 20 minutes after intubation. Aerosol generating procedures done in negative pressure OR.yesone hourno, done in pre-op area on day of surgerymust be within 48 hoursnoyes, everyoneone, used to be twoyessemi-urgent only; weekend block schedule offeredNY State regulations with ban on elective surgeryJune 1Steven Stylianos6/8/20
Oishei Childrens/Univ at Buffalo1 peds100n/ayesone attending in house 6a-6p plus usual call; decreased resident/APP pool, single fellow gets one day off a week for respite/home help; restarted block time 6/8 so we're basically back to usual careyesover 60 not allowed to take clinicalk callhave an empty 20-bed surge ICU area but no longer anticipate need; THIS WAS CLOSED end of Mayn/aslated to run surge ICU but no longer anticipate neednot yetall considered PUI, keeping minimal provider rules (one resident unless more needed)not yetnonoyesnoyeslimit to least necessary, single fellow being given one weekday respite for homenot yetyes - virtualn/askeleton crew; single provider sees patient and is dictating exam that APP transcribes in her officeyes; ELECTIVE SCHEDULE RESTARTED 6/8yes  -- APSA reference and common senselikely mid-May; now scheduling "time sensitive" things that can't wait 4 weeks; AS OF 6/8 BACK TO NORMALasked all surgeons to prioritize cases and have a vetting committee (OR nurse managers, two surgeons, anesthesia); opening slots for ~5 cases/.day as a startyes; NOT ANY MOREonly urgent visits; 6/8 FULL CLINICSindividual surgeons vet requests from APPsyesyesnononoN95whole caseYes based on SAGES publicationonly essential people in room for intubation. phase 1 PACU recovery done in OR; no negative rooms available; use plexiglass shield box to intubateyes24-48 hours for nowyes72noyes... everybody in building wears a procedural maskone at a time, two total allowedstarting to; hydrogen peroxideboth but have to work out union rules regarding nursing staff and private anesthesia group isn't sure it can staff a huge amount of extra timestaff limits6/8· Obstetric patients: Two adult visitors at a time for mothers in labor and delivery. No siblings of newborn.David Rothstein6/8
Oklahoma Children's Hospital 4 peds, adult positive rate approx 1.5 %40 peds00back to normal operating proceduresback to normalyes for pregnant or co-morbidities, have not for > 60n/a yetnowill plan on non Covidnot at this timenouniversal not N95yesientsnononon/aback to normal callwe will if neededfaculty and fellows, no residentsyes virtual 100%, using zoomyes, are transfering pediatric patients to Children'syesback to normal scheduleback to normal5/4/2020normalyesweek of 5/4yesyesnoyesN95intubation and extubation room, anesthesia wearing N95in house testing4 to 12 hoursyes24-48 hoursnoyes, visitors and non clinical admin wearing masks made by a large mattress manufacturing company in town, made to specifications from ID, testing to see if their eficacy is equal to surgical mask, all clinical personnel wear surgical masks or N95yes, now 2 parents, no childrenlooking at various methods to steralizealready donenone now5/4Cameron Mantor/ Catherine Hunter6/8/2020
Penn State Children's HospitalPeds 1. Adults 14 1 death: ICU 6 IMC 2 Floor 1 PUI: ICU 2 IMC 2yes: Day team/Night teamYes2 man team for daytime activities, 12 hour shifts. One person is the rounder for the weel and the second is the operator for the week. Activities are on 2 week blocks. Daytime team does not take evening call but are back up emergency call people for children who need attenting evaluations or level 1 traumas. Night team take phone calls in the evening, 12 hour shifts. /weekend call covered by daytime team. Night team to exposure for 2 weeks or automatic quarantine for 2 weeks following clinical activities.not yetN/Anot yet, but it is a possibilityNoNot yet, but still use universal precautionsNoNoYesYesYesYesThey are on their holiday coverage schedule, Team A and Team ByesResidents/fellows do not evaluate or round on sus[pected or confirmed positive patientsYes, virtualNoYesYesACS guidelines and surgeon preferenceYesYesYesnot yet but being consideredNo, but now filtering insuflation gasN95 N95 mask, induction in negative pressure room with patient and anesthia present onlyNo, only only those recommended by ID. Not enought tests2-3 hrsYes - everyoneYes, no visitorsYes>. Level 1 mask to be worn at all times and stored in a dry place and reused for 1 week. N95 Mask for OR, resuse same method. Droplet isolation patient, maks not reused.Dorothy Rocourt4/1/2010
Phoenix Children's Hospital 00YesA/B/C 4 surgeons per weekN/aIncreased to 21y by GovernorN/aNot at this time Not yetNon/an/aNoYes No Yes One fellow on per weekYesNo residents allowed. Fellows may participate. Yes virtual - zoomIn person is for untransferable emergency coverage only. Yes. Small rounding a group. yesyesNo. Zoom. yesyesNot because of COVID n/aN95 and goggles During intubation, anesthesia only in room, N95 masks and eye shieldNot yet (pending availability) 24 for staff, unclear for patients. Noyes, only one caregiver per patientNot yetDavid Notrica4/1
Rainbow Babies & Children's Hospital0yes0non/an/an/ayesnonot at this timenoyes, treat trauma pts as PUIyesnonoyesnoyesminimal resident coverageyesno residents unless absolutely nessicaryyes, virtualn/ayesyesyesyesslowlyyes, many moved to telehealthyesyesyesnonoN95During intubation, anesthesia only in room, N95 masks and eye shieldyes2 hrsyes48 hrsnoyes1yes, Battele hydrogen peroxideMichael Dingeldein5/9
Riley, Indiana UniversityYes8 total PICUMore than 1, but don't know the reports of thatYesskeleton weekend crewYes (comorbidities)Not in call poolNo, but it has been discussedBoth have been discussedNot at this timeYes, vents with adult facilitiesYes. Full COVID PPE used for new trauma patientsYesN/AYes, general pediatric patients being sent away from mixed center to the children's hospitalNon/ayesskeleton weekend crewYes. Only the minimum personnel needed for consults or operations on these patients. No double scrubbing.Yes - all virtualUsing Telehealth whenever possibleYes. Limited residents/fellows on roundsYesyes - ACS guidelines + case by caseYes. June for semi-urgent and July for elective cases.In discussion. Possible weekend elective cases.YesSome patients.Starting with those who need in-person exams - wounds and gtube issues.YesYesOnly for early appendicitis patients who wish to pursue non-op managementNo. Exhaust CO2 scrubbers in use.N95, masks, face sheildswhole caseNo. Mild risk.Minimize staff in room during intubation; 0 droplet time for others to enterNodon't knowNon/anoYes. All providers and staff wear a mask. Patients/families only wear masks they bring or is symptomatic.Yes, one caregiverYesStarting at 25% volume and increasing volume of elective cases each week. No weekend cases planned. Week day mornings are starting earlier, but we have not extended evening hours.nursing staff limitsstarting nowFeeder/Grower NICU babies from mixed adult/peds hospital in the system being sent to children's hospital.Brian Gray4/21
San Diego Rady Children'sc. 3Yes0at least 1no reports of thatyesskeleton w/eNodiscussions if needed in future; likely not to happenlikely young adult non covid trauma and other illnessesnot yet, but possiblyyes offering some testing for EMSYes. full COVID PPE for trauma activations. admission are tested and PPE scaled back as appropriateYESNoNoyesno as elective case load is downyesW/E skeleton crew; parallell teams to keep same team exposures; minimize team member contact while on ie social distancing; wk of 5/18 back to regular resident scheduleyesattending only for most traumas; would limit res/fellow involvement in COVID+ ptsyes virtualn/ayes - changed team structure; minimize people in the room; singout virutallyyes; elective surgery resumed mid may wiht some limitations based on decreased staff. by memorial day will be up to full scheduleYes set cases; if outside the guidelines need approval from one of 5 members of MD OR leaderhship can clearYes beginning of May for cases that cannot wait longer than 90 days. scaled up so that after memorial day will be 100%starting at a lower than usual volume but resuming some sort of block time by serviceinitially yes but now converting as much as possible to telemedicine; still using telemed mixed with in person for pts who need examinationhave always kept in person visits as neededwound and reuqired examsyesyeshave agreed to do so; no covid pos appy pt yetlikely not, filtering gassesN95 and face shieldwould to N95 for whole casehospital does not seem to but some surgeon s doAnesthesia and single nurse only, enter room after connected to circuit; now testing all pts preop; many anesthesiologists confident and using nl practice; some maybe 1/2 still using N95 and face shiled for intubation testing day before surgery or day of surgery if pt home distance precludes coming in the day before2 hoursyesup to 48 hoursNOuniversal masking; surgical mask in patient care; home made or other mask for non clinicalone caregiver; no childrenreusing- UV sterilizationstarting back lower volume but opening up OR and recaliming OR staff from float pool work; now including cases that cannot wait longer than 90 days; full schedule as of memorial day; considering late OR and w/e OR in summer when fully operationallimited staff as the usuall hiring increase in spring was put on hold and some staff out caring for relatives5/27Karen Kling as of 6/116/11/2020
Sanford Children's Hospital, Sioux Falls, SD23 adults/0 childrenyes00yesThree attendings. One on inpatient, one outpatient, one off. Now back to normal schedule and rounding habits.NAyes, but never needed to happennon-COVID adultsnoPPE, Vents (adult and children's hospital on same campus)Facemasks, but not N95 or PAPRyesnonoyesnoyestwo teams. one week on, one week off. Now back to regular schedulenoyes, in person and virtualyes. only one inpatient surgeon rounds. Now back to team rounding.yesACS guidelines. Exceptions approved by division chief. Back to full OR since 6/1yesphased approach. back to full schedule since 6/1nonever stoppedyesyesnonoN95 or PAPRN/A. would wear N95 if positiveyesAnesthesia intubates with rest of team out of room until air exhange (4 minutes)yesinpatient 1-2hrs, outpatient 8hrsyes72hrsnoyes - everyone2 adult visitors allowed. 1 parent only in clinicnoconsidering weekendsnostarted 5/11. Back to regular schedule as of 6/1Ryckman6/5/2020
St. Christopher's Hospital for Children5 childrenyes3/0yesDays are like weekend days (the on call attending comes in and does cases as well as clinic as both are relatively light-back up attending always available)NoYesBothNoYes (vents)YesYesN/AN/ANoYesLike attendings days are covered by the two on call members of the resident teamNoYes-virtual by ZoomN/ANoYesNoYesStarting to schedule cases felt to be "time sensitive."Yesyes All new patients that aren't purely elective and follow ups that need to be seen.YesNoNoNoN95, eye shield, gloves, gownsWait 15 minutesYes75-90 minutesYes48 hrsNoYes-everyone1YesDoing time sensitive cases in addition to emergencies. Using telemedicineThis week (week of 5/11/20)
St. Louis Children's Hosp/WashU0yes0Yesback to normalyesinstitution guidelinesyesbothnoyesyesyesnononon/aback to normal calln/ayesattending onlyyes- virtual curriculumback to normalcombo of smaller group and viirtual roundsyesYes- ACS guideleinesyesstarting to schedule all casesyesyesall patients allowed nowyesyesnono- using smoke filtration sytemn95, face shield, gown, gloveentire caseyesanesthesia only in room, N95 masks and eye shieldyes few hoursyes48-72 hrsnoyes - everyoneyes-one visitoryesno special strategystaff limited6/1Patrick Dillon05/07/2020
Stony Brook Chidren's; SBUH435 Adults / 33 Kidsyes230 adult vents, 17 PICU2 (pos, but asymptomatic)none to my knowledgeYes2 teams, day-night, telemedicine, goal is to keep protected read for redployment, work from homenot yetyes, ED upto 30, Cancer center cleared, Hem-Onc cleared, Peds helping with adultsBoth Ready to Cover Adult COVID or SICU, Trauma, ACS as neededYes, with the larger hospital systemYES, Everyone is considered posisive, PPE like universal precautionsyes, TESTING remains a critical issueNo, our children's hospital is a level 1 trauma we (all NY) increased capacity >50%NoyesnoyesFellows were emergency credentialed as attendings to aid in Gen Surg, Trauma, ACS careNo; Residents initally redepolyed and then redeployed again. 1/3 of COVID+ patients are currently being cared for by surgeons and surgery residentsMinmal, Zoom conferences. Now we are bask to MS Teams, ans Zoom Resident Education, Score etc. Resumed a Zooom Department M+M as well.Telehealth is fully functional and appreciated by families; other surgeons have had to streamline or pull back depending upon daily updateyes. Doc of the week shifts, BID Video call with MS Teams (HIPPA compliant)YEsHospital decided. ACS COVID repsonse and then surgeon input. Each day Hosp team looks at the next days cases to review appropriateness based on resourcesYes50% alternating blocks. Now bcak to full OR capacity based on NYS DOH regsyesSimple and necessary on case-by-case basisyesyesOnly if mandated. At the moment, still cen get simple Appy in and outNoConsidered, but no. Exhaust CO2 scrubbers in place. Data for laparotmy is simialr for laparoscopy, its just that there are many more studies on laparoscopyN95, masks, face sheildsEntire caseyesno induction room-intubation team in COVID+ deignated ORNo24-48 hrsyes48-72hrsYes, now being implementedyes... everybody in building wears a procedural maskyes, one caregiver for kids; ow NO visitors, no vendors etcYes, re-using, extended use, sterilizingRe-open Ambi surg center as clean, COVID free site. Extensive testing for all outpat, and elective OR casesNYS DOH regs prior to June 1. Now, none, we're backJune 1Our Ambi surg center and cancer center were converted into hospital beds for increased capacity. · No children under 16 will be allowed to visit, except under exceptional circumstances. · In Ambulatory Care Clinics visitors are limited to one visitor/companion who is providing transportation to the patient receiving care.Chris Muratore6/12/2020
Strong Memorial Hospital, University of Rochester, NYNumbers have been decresing for weeks. Peak was in early May. In adults, I understand we had low 40s on a vent at one time during the peak. ~ 40 was our max, so we got just to the tipping point and then cases fortunately declined. Yes. Overall, very few children. At most we have 2 at one time. We have had a couple of children with COVID-associated multisystem organ dysfunction. All rcovered. No deaths in children to my knowledge. One was seen by Peds Surg service. Had abdominal pain and CT scan done elsewhere showed a normal appendix with an appendicolith. He also had very large intra-abdominal lymph nodes.35-40 (all adult) at peak. Currently much fewer. ~ 10 I believe1 to my knowledge. Was assymptomatic. Urgent procedure and COVID test had not resulted yet. No symptomatic patients to my knowledgeNone to my knowledgeYesskeleton crew / if not in hospital, working from home. Pretty much back to normal. Still working from home at times, though we are quite busy now and we usually need to be at work.Kind of.This is mainly N/A, but we have a senior surgeon who works every other month who is not coming to work (mainly due to quarantine restrictions). He has now returned, so pretty much back to normal in that regardNo. Though the children's ED and hospital have agreed to take older patients as needed in order to offload the adult side COVID - onlyNo. We were not neededYes, with the larger hospital system, nut we are a children's hospital within a much larger hospital system, so there isn't anything particularly uniqu about thisYesYesNoNoYesYesYesmasive residency workforce reallignment. Our residents are now on a shared service with 3 other adult services. They work 1 week on and 1 week off. The Pediatric surgery service is probably the busiest service now given that we still do acute care surgery. Transplant is also busy as NYC is not doing as many transplants due to the crisis there. Back to normal as of mid-MayNoN/AYes. We are doing virtual education with the Zoom platformN/AYes. smaller group. Back to normal as of mid MayYes.pre-determined metrics. some case by case (requires discussion with surgeon-in-chief)YesFluid situation, Balance of staffing and cases. Trickiest part was maintaining social distancing for fmailies and staff on breaks. We relatively quickly ramped up to normal capacity at the end of May YesYesOnly those needing in person exam/ drain removal, dilations, button problemsYesYesNoN/ANoMost patients, regular precautions (eye protection, mask, gown, gloves); known COVID + or test pending N95 / PAPRN/A. THough personally, I would wear the whole caseNoWe have 1 negative pressure OR. For COVID - patients, intubation as usual. For COVID unknown, anesthesia present only with N95 or PPAR. wait 10 minutes (more than 3 air cycles for our ORs), then enterYes. Unless emergency case and then we will proceed with test pending8-12 hoursYes72 hours for those coming from outside hospital. If patient has been in hospital, 7 daysNoYes. ALL staff. family member, patient if ableYes. adults - no visitors for most. Laboring women can have 1 visitor. Dying adults can have a visitor at the end of life. Children get 1 guardian. Children with special needs may have 2 on a case by case basisYes - vaporized hydrogen peroxideWe have ramped up. No extra hours, but we hve returned to normal OR volumes on adult and Peds sides.Mid MayDerek Wakeman6/12/20
Texas Children's Hospital741 detected casesYes05- general surgeryNot to my knowledgeyesteam A/team ByesNo clinical duties for >70 yo, pregnant. also offered to >60 yo w comorbiditiesnonononot yetyesyes, separate areas in ED, Special Isolation Unit for all positive casesnonoyesnoyesresidents/fellows on weekend/skeleton coverage, work from home if possible (phone calls/care coordination/communicatoin)YesEssential care team members onlyyes- virtualn/ayes, skeleton crew/smaller groupyesyes- hospital based guidelines and clearance by dept chairYesFluid situation, Balance of staffing and casestransition to phone/video visitsYesNo restriction other than volume to adhere to physical distancing and staffing constraints yesyesNoNo- but protocol available case by case basisNo- smoke evacuator N95, eye protectionFor the entire caseYesintubate in OR- single anesthesia provider, others >6 ft awayyes2 hours rapid test, others 6-8 hrsYes48 hrsNoyes - everyone yes- one > 18 yo and healthyRe-usingBoth being planned, limited by staffing Staffing, social distancing in common spaces, patient concerns4/22Seeing rapid increase in cases and hospitalizations since reopening. Things changing quickly over last week.M.Lopez06/20
The Hospital for Sick Children, Toronto3 inpatient children and 16 positive detected overall (13 outpatients - ED)yes000YesRounder and call person on, protected vulnerable staffYesMinimizing people present, offering vulnerable colleauges not to be on call, virtual clinicsNoNANo, but availableNot yet, PPE could be shared throughout hospitals in GTAYesYesNA, we are the only pediatric trauma center in townNoNoNAYesHalf fellow team on and alternatingResidents yesNot coming to OR if concernsYes, virtuallyOnly virtual consultations at OSHYes, one staff (SOW) seeing all patientsYesyes - no elective cases, and then concensus to identify urgent - time sensitive cases, and all emergent neonates, appendicitis, tumorsStarted 5/11 - for time senstiive and more urgent cases, ramping upStep wise, time sensitive cases firstVirutal or phoneOnly urgent or one who need physical exams - dilations or imaging and time sensitive. Clinical judgement and physical requiredYesyesNoNo - using smoke evacuator and N95 for laparoscopyN95 and minimizing personel in OR during intubation and extubationWearing N95 during all OR cases (we did not have COVID+ patients yet. Potentially yes, using smoke evacuator. Minimize staff in room during intubation; 0 droplet time for others to enterYes, for all elective and urgent cases, not for emergent cases12 hours - 4 cycles per dayyes24-48 hoursnoYes for all clinical interactionsyes, one visitor per patientNot yet, but collecting N95 masks for re-use. Optimizing technique for resterilization, currently under investigationSlowly ramp up, currently no plan for elective cases on week-end, but has been discussed. Will likely need to extend hoursNo5/11Ramping up more room in a gradual fashion, with creating priority lists, reviewed by surgical teams. R. Baertschiger6/6/2020
UCSF Benioff Children's Hospital SF0 children0yesweekend schedulesnononoyesno traumayesn/anonoyesweekend crewyesattending onlyyes zoomnoyes virtual roundsyesyes ACSyesyesyesnonoN05yes, leave 15 minutesno not enough tests6-24hrsyes everyoneyes one visitorreusingHanmin Lee4/4/2020
UCSF Benioff Childrens Hospital Oakland0Yes03noneyesTeam A/Team BYesMinimize shifts as possibleHas remained an option if needed (never used)n/anoyes (PPE with community practices)yesnonoyesnon/ayesteam A/Team ByesAttending only for high risk / confirmed non-emergent casesyes - virtualn/ayes, weekly zoom sign outs and skeleton crew for bedside rounds.yesYes - ACS guidelinesYes- scheduling all casesStep wise approach - time sensistive casses first.yesyesn/ayesyesyes - case by case decisionyesno (using air filtering)N95 / PAPRwhole caseYesAnesthesia and single nurse only, 15 minutes wait.yes - except for emergent cases6-24 hrsYes4 daysnoYes - everyoneyes - one visitornot yetPlan for optimization of current block times and some extended daysSpcae limitations to maitain distancing while increasing volume. Pre-op clinic and Pre-op testing coordination with the day of the procedure.May 11evening and weekend OR expansion is planned to be used on an as needed basisChris Newton05/08
University of Chicago Comer Children'sPeds 1 - 83 adults in adult hospital1 peds on vent, 12 adultsYesMinimized on-site, remote team taking consults/calls at night to protect on-site teamsYes (formal process by our institution)Remote assigment for CLD, immunosuppressed, cardiac risk, pregnancyPlans in place to do sonon-COVID, <25, short projected LOSnot yet, but it is a possibilityNot yetYesNoNoNoNon/aYesSkeleton crewNot yetYes, moved curriculum to virtual Yes, virtual, transferring children with need for hands-on surgical care to one of two primary sitesYes - one person from each team examines patient; only two co-roundersYesSurgeon in chief clearsYesYesYesYesNo, filtering both insufflation and desufflationN95Anesthesiologist only in the room, with CRNA or resident/fellowNo - not enough tests12-24 hoursYes - everyoneNo visitorsN95Jessica Kandel4/1/2020
University of Florida19 adults (6 in MICU); 2 childrenYes6, all adultyesTeam A/Team BNANAnot yet, but is part of plan if neededCOVID+not yet, but are in the line-up. adult non-trauma attendings currently enough to cover.noyesyesnonononayesTeam A/Team B in 2 week cycled blocks, shared amongst all services that have been cohorted into 3 groupsnoyes - virtualyes - telehealth or in-person for specific casesyes, skeleton crew and fewer team members in room with patientsyesyesYes - now scheduling all cases that are willing to be operated onWas step wise - one week increase followed by full operations based on Governor's clearanceyesyes needing interventions doneyesyescase by casenoN95 with surgical mask overAnesthesia and circulator in room during intubation/extubation, no entry for 18 minutes after intubation/extubationno2-4 hoursyes24-72 hrsnoyes - everyoneyes - one dedicated visitor per pediatric patient, may only switch out after 7 days. No one allowed in <18 years. All visitors screened upon with sterilization for up to 4 times. technique has been published but I can't find it in the billion emails that have been sent out.elective cases on weekends and alteration of blocksMay 4Saleem Islam5/7/20
University of Iowa Stead Family Children's Hospital4 children, 121 adultsyes1 pediatric ptno chagne in call, we have attending of the week that takes call and a back attending. The remaining faculty are off service and do not have to come in. Team A/ Team BNAOffering limitted time in hospital and covering clinical responsiblilities. But currently no faculty is over 60 years old or pregnant. Still trying to limit exposure.yes in principle, but hasn't happened yetbothWe are in the line-up but not required to date.yesyesyes - PUI and COVID + are separated from other patients in ED and on floor (floor and OR in negative pressure rooms)We are accepting all pediatric trauma patients. We do not have mixed floorsAccepting all pediatric patients. No mixed floorsyesnoyesplatooning, Team A/Bnoyes, virtualNAyes, minimize number of trainees on roundsyesyes, great leeway to surgeonyes as of April 28thStaged based on community new case rate, hospital/PPE available, and testing available. Goal ramp up gradually based on level of acuity, time in queue, family preferences, and surgical resource availabilityyes - some delayed, some virtual, some in person yes Patient needs for physical exam after video telehealth visit. Taking patient preference into account.yesyes, but prefer to do it from office or clinicnoyesN95, shield, gown, hat, glovesNegative pressure OR rooms. Anesthesia and circulator in room during intubation/extubation, no entry for 20-30 minutes after intubation/extubation. When possible extubate in recovery room (all private rooms, some negative pressure) or ICU. ICU has negative pressure rooms. yesScreening 3-4 hours. Transplant 1-2 hours.noyes, everyoneyes-only one visitor per 24 hoursyes, re-using if Covid negative, hydrogen peroxide vapor treatmentMaximizing block utilization and accomodating patients during week Joel Shilyansky4/30/20
University of MassachusettsyesTeam A/Team B - skeleton crewyesNo hospital/patient rounds if over 60 or immunosusppressedYesnon-COVID adultsnot yetYes.  There is a field hopital for COVID patients that serves all hospitals in our community and has support of the National GuardYes.  Also keeping trauma supplies out of the bay.  One person responsible for moving supllies into room at request by walkie talkieNoNoMost surgery residents are redeployed to non surgeical teams.  Many COVID unitsNoyesVery complicated coverage schedule but most COVID teams are one week on and one week off at a timeno...only if immunosuppresssed or otherwise at riskyes..virtualtelehealth onlyyes...attending rounds without residentsyesDivision chief responsible for decision but we are in line with ACS guidelinesyes 5/18 when state opensyesnot elective visitsurgent issues onlyyesyesno...have not changed management of appendicitisnoN95 and PAPROnly anesthesia team in OR for intubationyes10 hoursyes48 hrsnoyes-everyone1yes..UVweekends and extending block timne hours later in day5/18Aidlen5/7/2020
University of Michigan290 adults 3 childrenyes200 plus adults1noyeslombardi 2 weeks on 1 week offnonayesCOVID+yesyesyesyesN/AN/Ayesnoyesone fellow 5 days on then 5 days offnoyes virtualyes virtual for most still going to do cases those yes and only rounfds onceyesyesyes as of May 1day by day yesslowlynew patients only and urgent complicated patientsyesyescase bycasenonoN95 and shieldswhole caseyesitnubation only anesthesia and a circulatero then wait 20 minutes not yet not enough tests we have a alogorythm24 hoursyes48noyes everyoneyes singler parent onlyyes laser and vaporday by day peds cases firstgovernment edits5/28peter f ehrlich 5/22/2020
University of North Carolina Children's Hospital4 children; 37 adultsyes0yesBack-up call for faculty and NPsyessurgeon over 65 years old not expected to operate on COVID19 positive patientsYesNon COVID+ adults to age 35nonoYesNo but in negative flow roomsnonoyesNo, they take consolidated shifts to minimize resident exposureyesThey take consolidated shifts to minimize resident exposure; ie one senior resident instead of 2 on the daily serviceYesThey are able to do the case but the attending goes inthe room daily for rounds.yesyes, mostly telehealth and video clinic visitsnoyesYesyesRisk based scale to schedule casesyesyes If we need to do a hands on physical exam; ie DRE or stoma careYesyesnonoN95/PAPR gown double gloves face sheild Yes wait 21 minutes after intubation and extubation if COVID19 positiveYes24 hoursYes48 hoursnoYes, everyonefor children 1 parent; for adutls noneyes, UVExtended OR hoursNone yetHayes-Jordan5/8/20
University of Texas, Children's Health Dallaschanged every day; always < 10 and usually < 1; to date have tested 1987 and had 48+ including testing for asymptomaticyes1/0 (child)0noyesTeam A/Team B (day team, night team with reserve attending at home unless needed; outside hospital attending day and night with reserve attending home unless needed; then a few attendings at home in case any of the above teams were to get sick/exposed - rotation changes each week)Yes (formal process by our hospital and formal process from our University)No patient care if provider >65, immunosuppresed, or pregnantyes for a brief period of timeup to age 21 and up to 35 if have pediatric type disease (CF, cong heart, sickle cell, etc...)noyes (PPE to adult hospital with whom we are partners)no - routine trauma PPEyes - PUI and COVID + are separated from other patients in ED and on floorinitially yes (for a week) but adult side has noted to have plenty of capacity so now back down to previous agenoyesnoyesteam A/ Team B - each with day team or night team; residency program also created a reserve pool of residents for anyone with daily screen positive or known COVID exposure; 1 week on and 1 week off changing on different days then attendingsyesattending only yea - virtual onlyyes - changed criteria for in person evals (emergency that cannot be transported due to instability) - otherwise transfer to primary childrens hospitalstaggered roundsyessurgeon make decision that has to be approved by SICbegining of maystaged based on community new case rate, hospital/PPE available, and testing available. Goal ramp up gradually based on level of acuityyes - some delayed, some virtual, some in person only if urgent/time sensitive (like rectal dilations)slowly in Maynew patien evals, those needing physical exam, virtual for others those with respiratory symptoms or PUI - virtualyesyesnonoN95/PAPR + standardanesthesia and nures only, 15 minutes and wait; have just changed now to anesthesia and nurse only for intubation and extubation (not longer 15 min wait)elective yes if family willing; urgent emergent nousually 2-24 hours though for transplant patients/pui/or special circumstances there is a 2 hour testpreferred not requiredno more than 72 hoursnoyes - everyone over 2 yoyes- first was 2 specified care givers (no children <18, no other caregivers); as of second week of April - one caregiver; no can have 2 designated but only one at a time with patientyes - UVchanging OR assignments from surgeon block time to division block time to try to optimize OR utilitzation; extending hourswe have many support staff who cannot come back because they are high risk so limits staffing optionsMay 11Diesen5/21/2020