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1 | # 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 comments | Updated by | Last updated on | |||
2 | Alberta Children's Hospital, Calgary | 1 child | yes | 0 | 1 | 0 | yes | Team A/Team B with weekend rounding | No (no comorbidities) | N/A | we have planned and agreed to it; no need yet | prefer non-Covid but possible | agreed to | not yet | universal precautions, minimizing staff | not yet | N/A | yes | no | no | yes | single fellow rounding, limit staff to weekend skeleton crew, home fellow taking part in education | no | yes - virtual | Continue to see NICU pts as needed | skeleton crew | yes | yes - ACS guidelines + case by case | not yet | yes | urgent only | yes | yes | case by case | no | N-95, face shields, gowns, gloves | Minimize staff in room during intubation; 0 droplet time for others to enter | only for those that screen positive (ILI, travel, etc) | 4-8hrs | no | yes (all healthcare workers interacting with patients; parents outside of patient room) | Yes, one caregiver | not yet | evolving, eliminate summer slowdown | Steve Lopushinsky | 4/21 | |||||||||||||
3 | Arkansas Children's Hospital | 1 child | yes | 0 | 0 | 0 | yes | skeleton weekend crew- transitioning back to a more normal staffing pattern | yes | exclude from call schedule | no | n/a | no | no | yes | no | no | no | no | n/a | yes- transitioning to normal coverage | Skeleton crew | no | n/a | yes- virtual | n/a | skeleton crew | allowing them now | case by case | yes | allowed services to ramp up in a staggered fashion | yes- but transitioning to normal | yes | case by case | yes | yes | no | n/a | no- filtering | N 95 + face shield + standard PPE | n/a | n95 if covid status unknown | yes, for ambulatory procedures | 12-24 hours | yes | 2 days | no | yes (all healthcare workers; parents outside of patient room; patients over age 2 years) | yes- 1 parent | not yet | essentially resumed pre-covid block schedule at this point | families still apprehensive | we started a more normal elective schedule June 1 | Sid Dassinger | 4/2/2020 | ||||
4 | Baystate Children's Hospital - University of Massachusetts Medical School Baystate | 11 children | yes | 2/0 | no | We have not changed our call, but we have changed clinic. No more than one surgeon present at any time. | no | yes | picu space taken over for adult icu space, primarily non-covid icu patients, picu service moved to a section of infants and childrens floor | no | BCH is within Baystate so equipement is shared | yes - all traumas are PUI, everyone wears n95 mask, gown, gloves, face shield | All 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 status | no | no | no, but within our institution some residents have been redistributed along with PA's depending on needs | no | yes, to a limited extent | on a rotation some residents are dismissed and sent home for the day | no | yes - birtual platform only | we haven't done this traditionally, but now with the roll out of telehealth we can | no | yes | three 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 decision | no, waiting on clearance from govenor and massachusetts dph | yes | always kept available depending on patient needs, just cut back significantly | urgent issues, lacerations, abscesses, acute issues. no elective consults | yes | no, we have been told cannot bill for teleheath if physician is not in office. | no | no | n95, face shield, gown, glove | regardless of covid status everyone in room must wear n95 mask for intubation and 5 minutes afterward | not yet, not enough testing capacity for out patient cases yet, but all inpatients are tested | Depends we have different levels of testing. For ER patients 1.5 hour turn around. All others up to 3 days | not yet, but we want to as soon as we have the capability | no | yes - everyone in clinical areas | 1, restricted when they can leave and re-enter hospital to avoid traffic | yes, steris | Discussions 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 restrictions | Tirabassi | 5/11/2020 | |||||||||||||
5 | Blank Children's Hospital, Des Moines, IA | 1 children | yes | 0 | 0 | 0 | no | no change in schedule but only at hospital if there is active work to be done | no | only two surgeons on staff - minimizing exposure not a viable option | yes - PICU relocated to a flex ward space to open more beds for adults | non-COVID | no | yes - children's hospital within an adult hospital so one supply system | yes - all trauma patients considered PUI | no | no | no | yes - but they have now returned to normal assignments and schedules | no | yes - lasted for 6 weeks - now back to normal | half of general surgery residents are at home self quarentined and half are at work (residents devised this plan themselves); no fellows | no | na | yes - combination of in person and virtual - this continues despite return to normal work schedules | na | no | yes - 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 postoperatively | case by case | yes - 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 caveats | will prioritize cases and book within the limits of the time prvided to us by the OR | yes | yes - 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 times | triaging by diagnosis | yes - only for routine postoperative follow up | no | no | na | no | N95 with face shield or PAPR, gown, gloves. | entire case | no | for COVID unknown - only the anesthesiologist plus one assistant in room for intubation and extubation - 14 minute wait for all staff while room air exchange | preop COVID testing started for every patient when elective cases restarted - coincided with testing of all inpatients/admissions | 2-8 hours | yes | within 48 hours | no | masks and face shields for patient care - fabric masks for administrative and support work - universal masking (for all employees, patients and caregivers) started on 5/6/2020 | initially only one caregiver for children - updated to two caregivers for children on 5/18/2020 - adult visitation policy remains very restricted | re-using until soiled | three 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 backlog | many staff members were furloughed - getting them back will require demonstration of a full schedule which is difficult to accomplish with a reduced staff | Stephanie Kapfer | 6/15/20 | ||||
6 | Boston Childrens Hospital | 31 all children | Yes | None that I'm aware of | yes | skeleton crew / if not in hospital, working from home | No, all are strongly advised to stay home if not SOD/SOW or attending in the ICU | No; 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 centers | Not that I am aware of | we have shared some vents with local adult hospitals | Only 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 PUI | Until testing done. All PUI in ED get put into a rule out area until testing performed | I believe EMS still follows normal pathways as all EDs are open per usual, but inpatient (especially ICU) are mostly sent to us regionally | Yes, at least from our local county/public hospital to us (both floor and ICU); other PICUs have transferred their patients to us as well | yes | initially yes, but now not as much as we expected as our census has dropped dramatically due to ceasing elective cases | yes | skeleton crew every day- only one fellow and one resident and a few NP's; essentially staffed like a weekend at all times | not actively | yes, many teaching conferences have been transitioned to a zoom format | not yet- we still provide full services to the county facility we cover when on call | yes, smaller group | Yes | reason 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 4 | yes | urgent only | yes | yes | no | No | If 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 mask | wait 30 minutes after intubation and extubation before removing N95 | Not 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 4/13 | 2.5 hours | no | yes, now all people entering the hospital | yes, one caregiver | yes, UV-C I believe | not 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 load | Biren Modi | 4/21/20 | |||||||||||||||||
7 | Children's Hospital at Providence - Anchorage, AK | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
8 | Children's Hospital of Alabama | 3 all peds | yes | 1 | fewer than 10 | back to normal operating procedures | resumed normal schedule | no longer | no | no | no | minimize personnel for trauma; consider all PUI | yes | not a problem here | have offered to other hospitals | resume normal schedule | resume normal schedule | No | zoom platform | no | smaller group round | no, back on schedule | resumed normal schedule | yes | review clinical situation | yes | yes | some | would consider | no | N95; eye protection | whole case | unclear | N95 for anesthesia for all patients,everyone else leaves room | no | two tests: 2 hours and 6 hours; different platforms | not for all; CV service requiring testing | 72 hours or so; unclear from CV service | no | initiated 4/20; everyone | 2 for inpatients; 1 for surgery | yes; UV light | haven't need to ramp up capacity; current utilization is about 75-80% of pre-covid | unclear | started | Mike Chen | 6/11/20 | ||||||||||||
9 | Children's Hospital of Michigan, Detroit | 15 (all adults) | 1 on vent | Yes | Only 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 patients | No | No | minimize personnel for trauma; consider all PUI | Yes | No | No | Yes | No | Yes | Only one any given day. | No | All meetings suspended at this time. No zoom conferences yet. | No | Yes. Fewer see patient. | Yes | Yes | Yes | Not yet. In works | No | No | N95;face sheikd | Standard PPE | Yes. Starting tomorrow or Friday. | 24-48 hours now. 1-2 hours soon | Standard masks coming into and out of hospital. On at all times. N95 for all patient contact. | Yes. Only parent or guardian. | No | Scott Langenburg | 4/1/2020 | ||||||||||||||||||||||
10 | Children's Hospital of Richmond, VA | 38 (adult) | yes | not sure | 1 known | 0 | Returned to normal | n/a | yes | 2 >65 on home quarantine | no | n/a | no | no | yes | if need intubation | no | not yet | returned to normal | no | returned to normal | no | yes, virtual | yes--phone only if no active/critical pts; | yes, more virtual | yes | ACS guidelines and surgeon preference | gradual re-opening May 1 | in stages with urgent/semi-elective cases first | yes | urgent & semi-elective | home-based surgeons are screening with telemed visits then scheduling in person visits | yes | yes | some | no | N95/PAPR for anyone in room during intubation | whole case | yes | only anesth team in room for intub | yes | 8 hour | yes, with surgeon discretion | 48-72 hrs | no but has been discussed | yes | yes, only 1 caregiver per patient for <18, no visitors for >18 | yes; UV light | considering all | none so far | current (started 5/4) | Jason Sulkowski | 5/22/2020 | ||||||
11 | 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 | yes | 0 pedi, 15 adults on vent, 4 on ECMO | yes | 4 or 3 days/nights on in a row. Work from home if not required to be at the hospital | Yes | >65 out of the call schedule | not yet, but there is a plan if needed | n/a | no, but our critcal care-trained folks are part of a surge plan (only to be activated if level 4, we are currenlty level 1) | no | yes, and minimizing the amount of personnel in each trauma | Yes | No, our children's hospital is a level 1 trauma and the COVID referral for our hospital system | No | Yes, more of a skeleton crew in the hospital at all times. | No | Yes | Less residents in hospital per day. Keeping our fellows distanced from each other. | Yes | Attending exam only for PUI and confimed cases | Yes, webex for all | No, but we have canceled our outreach outpatient clinics | Yes, smaller group | As of 5/4/20, we are doing elective operations. | No longer applicable | yes, as of 5/4 | Yes | as needed, many parents prefer telemedicine | If needs and in-person examination | Yes | Yes | No, using Airseal for lap cases | No | N-95, face shields, gowns, gloves | Full 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 window | with 72h window | no but has been discussed | yes, all people in the hospital | one visitor per patient | We 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 schedule | now | We 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/Tsao | 5-7-2020 | |||||||||
12 | Children's Mercy- Kansas City | 15 peds, no adults | 15 yes | 2 | 0 | 0 | Returned to normal | returned to normal | no | informal | not yet | to be determined | no | no | yes, overall continued universal precautions | yes | no | no | no | n/a | returned to normal | n/a | no | only fellow/staff | yes-virtual curriculum using online teams platform | a 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 normal | yes, as of 6/8 return to normal (with covid pre testing on all patients) | Yes- ACS guideleines | 6/1 | as of 6/8 open for regular block times, all tested prior to OR | no | yes, reduced with more telehealth now | if inperson needed | yes | yes | yes | no | no | N95 | Whole case | yes | yes- 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 enter | yes | 4 to 8 hours, new testing now within 2 hours | yes within 72h | with 72h window | mothers of nicu infants | yes | yes- one visitor | yes | we 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 kids | parents cannot find caregivers/time to immediately show up for longer stay cases even though "ramp up" is in full effect. | 6/1 | daily email from institution with stats | Rebecca Rentea | 6/10/2020 | ||
13 | Childrens Hospital of Wisconsin (Milwaukee) | 0 admission specifically for COVID (we have had 22 pediatric total COVID+ picked up by screening test) | 10 | 0 | 3 | No | yes, but have stopped doing this as we start to progress toward normal operations | yes - 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 coverage | omotoa;;y but went back to normal operations | more "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 yet | no, 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 side | n/a | no | not now | minimize personnel for trauma; consider all PUI - CAPERS/N95, gown, gloves, fashshield | yes | we offered to take all peds patients currently admitted at adult hospitals | no | no | no | initially yes, but now resumed normal schedule | team a/b alternating single teams | no | yes - virtual, zoom | no | yes - see previous answer | yes initially but transitioning to normal operations | yes - weekly assessment by team leader | Yes | we are currently at 80% capacity and weekly adding more cases depedning on local envirnoment, PPE and COVID testing availability | yes, but start to return to normal operations | yes | based on urgency and need to see in person vs by virtual | yes | yes | yes - when applicable | Yes | not yet, but have plan in place to do so when necessary | N95; eye protection | Whole case | no | not 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 + patients | yes, except emergent | 90min - 6hrs | yes | 48hrs | No | yes - all heathcare workers and staff, family and patients | yes - 1 gaurdian older than age 18 | Yes, UV weekly upto to 10 times | see previous answers | family concerns regarding COVID | will ramp up to normal by first week in June | David Gourlay | 5/8/2020 | ||||
14 | Cohen Childrens Medical Center/ Northwell | 120 pediatric patients | yes | 10-20 (most as part of MIS-C) | 50-100 | No | Yes | 2 teams, one night person 3 of our pediatric surgery attendings working in adult COVID | No | More than half the childrens hospital was used for adult COVID patients although with numbers now decreasing more childrens beds are back | Both COVID + units and COVID - units | Yes- 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/ administrative | Yes, with the larger hospital system | No, but this is evolving | No | No | No | yes | Yes | Yes | Fellows split into two teams-seperate initially. Now both fellows working. | No | Yes- all virtual, we just cancelled all conferences except SCORE(via Zoom) | No | Yes- divided crews and rounds, minimize size of each groups | Yes | Surgeon decision for urgent/emergent cases; approval of Surgeon in Chief needed for certain cases that need to go but arent technically urgent | No | Staging cases by need level 1-4 | Yes | Yes | Surgeon | Yes | Yes | For about half of patients | In some cases- has now stopped | Yes | N95; intubation precautions | Yes | Unclear | Minimize staff in room during intubation; 15 minutes time for others to enter | Yes except for truly emergent cases | 45-minutes to 12 hours | Yes | 48-72 hrs | Yes | Yes | Yes, one caregiver | Yes- sterilizing | Yes, staging system | Not all families are ready | Started last week | Every day we are changing our clinical practice | Sam Soffer | 6/11 | ||||
15 | Connecticut Children's Medical Center, Hartford CT | 11 (3 currently in house) plus 3 patients with post covid inflammatory syndrome | yes | 0 (two patients previously were in PICU, one ventilated) | 0 | yes | limiting number around during day, night and weekend unchanged | no 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 preferred | not yet, but available prn | vents and feeding pumps | yes | yes | only two hospitals in CT take trauma (level1)kids including us | we are pediatric only, other partner hospitals are sending all pediatric patients to us as they convert their peds beds to adults | yes (some of the "community" programs) | no | yes | two teams of residents/APRNs/PAs, we only have a single fellow | Not applicable yet | zoom platform | not applicable | yes, 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 room | yes | ACS/APSA guidelines then discuss with anesthesia and partners | yes as of last week in a slow fashion | non-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) | yes | in next few weeks | half usual volume, surgeon decides about in person or telehealth | yes | yes | no | we will if this happens | N95 | N95 for anesthesia for all patients,everyone else leaves room | this is just starting for elective ambulatory patients as of this week | 12 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" | yes | 72hrs now | not yet (waiting for more tests to be available) | yes | yes, one parent only | N95 being sterilized with hydrogen peroxide vapor as of two weeks ago | slowly but plan unclear at current time | started last week and more this week | agree with Dr Soffer's comment we are also seeing the post covid inflammatory syndrome | Richard Weiss | 5/18/2020 | |||||||||
16 | Cooper University Hospital, Camden, NJ | Pediatric - 2 current (7 total); Adult - approximately 100 (numbers change) | Yes | 1 | 0 | N/A | Yes | One attending in house on a given day to round and cover non-elective cases | No - not applicable | N/A | Not yet but there is a contingency plan for that | Non-COVID + adults would be the plan | Not yet but available if needed | No - adult burden is significant here | Yes | Yes | No | No | N/A - this is the home program/location | N/A | Yes | Fewer residents on service, no double scrubbing cases, no residents rounding in NICU | Not applicable yet | N/A | Yes - Virtual (WebEx, Zoom) | N/A | Yes - Staggered rounds (attending rounds without resident); no residents rounding in NICU | Yes, returning to normal as of 6/1/20 | ACS/APSA guidelines | Yes | Scheduling backlogged cases into our bock time, urgency determined by surgeon | No (starting to phase back in) | Yes | Surgeon Discretion | Yes | Yes | No | N/A | Will consider if it happens | N95 and face shield or goggles for all cases (even if COVID negative - all patients are tested) | Hasn't happened yet for Pediatric Case | Unclear | Only use negative pressure rooms or COVID + patients (have only been adults thus far) | Yes | Inpatient: 15 minute POC test (limited), 2 hr rapid PCR, 6-8 hours standard; Outpatient: 24-72 hours | Yes | Within 72 hours | No | Yes - All visitors and employees | One 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 hospital | No | 5/26/20 (NJ Order) | Matthew Boelig | 6/12/20 | |||
17 | Dhaka Shishu (Children) Hospital | 185 (36 Surgical) | Yes | 7 | 21 | No | Yes | 12 hours duty schedule split into two teams per 24 hours. One consulant attending per 24 hours | Yes | Reduced the weekly attendance physically & keeping updated online on WhatsApp | No | N/A | Pediatric trauma only | No | Yes | No | N/A | N/A | Yes | Certainly | Yes | Reduced number of residents per shift; increased gap between subsequest duties | No | N/A | Yes, Virtual online | N/A | Yes | Yes | Yes | Not yet | Not decided yet | N/A | N/A | N/A | Not yet | N/A | No | No | Yes | Standard one | Whole case | Yes | No | Yes | 72 hours | No | N/A | No | Yes, everybody | one | No | No elective cases planned till date | Still the plateu has not reached in my country it seems | One months from now | Nothing | Prof. Dr. Md Ashrarur Rahman | 06/06/2020 | ||
18 | Doernbecher Children's Hospital- OHSU | 0 surgical | Yes | 0 | 0 | N/A | Yes | one attending in house 6a-6p, usual nightly call. decreased resident/APP in house | No | n/a | not yet a need | TBD | not yet | yes | yes | yes | n/a | no | no | n/a | yes | skeleton crew | not yet | have not had a case | yes-virtual curriculum | no | yes- only one person examines patient | yes | yes | Yes- 5/18 | 50% daily OR closure, opening elective blocks on Saturday and Sunday | yes | Yes- 5/18 | surgeon preference | yes | yes | no | n/a | not yet, but have plan in place to do so when necessary | N95 | n/a | yes | Yes, wait 20 minutes | Yes | 6-24 hours | yes | 48 hrs (72 okay for Monday cases) | no | yes- everyone who comes within 6 feet of a patient | yes- one parent, increased to 2 parents 5/18 | not yet | weekend elective cases, extended weekday hours but not opening all ORs on weekdays to keep PACU/waiting room social distancing possible | 5/18/20 | Nicholas Hamilton | 6/8/20 | ||||
19 | East Tennessee Children's Hospital | Peds 0 | no | 0 | no | no change | volitional | - | as needed | 0 | no | no | no | as needed | as needed | as needed | no yet | no | yes | reduced resident work hours | no | if at greater risk | no | no | staggered rounds | yes | designated OR management group decides | 5/4/20 | 3 phase approach (50%, 75%, 100%) | offered virtual/phone visits vs. rescheduling | yes | urgent and family preference | yes | yes | no | no | N95 or PAPR | In OR intubation w/ surgical team out of room (length of wait depends on patient risk category | no | 48hours | yes | 72hours | only if screening suggests need | yes, everyone | 1 | yes, H2O2 | 3 phase approach using block schedules and extended OR room operational hours M-F. No weekends yet. | 5/4/20 | Vaughan | 5/7/20 | |||||||||
20 | Emory University/Children's Healthcare of Atlanta | Peds 1 (curretly 1. 8 total childrent thus far) | yes | 1 | 3 | no | Yes | now returned to regular schedule. schedule for SOW, call, weekends all pre-COVID | yes | group call obligations close together to minimize time in self-quarantine | no | n/a | no | no | yes | yes | no | no | residents back to normal rotations | no | returned to normal | n/a | no | n/a | hybrid. some in person, some virtual to promote distancing | n/a | yes. limit large groups | no, back on schedule | n/a | yes | extended hours and opening several OR's on Saturday | no | yes | telemedicine reserved for at risk patients and families that prefer to not be seen in person | yes | yes | no | No, filtering both insufflation and desufflation | N95 and face shield | whole case | yes | Anesthesia and single nurse only, 15 minutes wait for PUI or COVID+ | no, only if aerosol generating | 4-6 hours | no | n/a | no | yes | yes - one visitor | sterilizing. UV | both | patient fear of exposure | already started | Matthew Clifton | 6/8/2020 | ||||
21 | Goryeb Children's Hospital Atlantic Health System Morristown New Jersey | 275 Adults 9 children | yes | 100 Adults 3 children | Yes | Team A/Team B | Yes | Over 70, not taking call | yes | COVID+ | Yes | no | routine trauma PPE | No but in negative flow rooms | no | no | NA (we are the home program and we have not pulled back) | no | yes | 1/3 of residents off for 5 days to insure healthy reserve | no | yes - virtual | telehealth and increased inbound transfers | room entry only when absolute, split teams | YES | Surgeon in chief in consultation with division chiefs | Now, in May | Acuity and case level priorities | yes | yes in May | Where hands are needed--tube care, stomas, wound issues. Virtually all post-ops are done virtually | yes | yes | no--this prolongs hospitalization in some patients | no | N95 and face shield | Intubation box; we have not instituted the time delay | YES | 2-3 days (down from 7!) | yes | 48 hours to 7 days max and attest to quarantine | no | yes--everyone | kids--one only and no tag out | yes UV | All of the above | patient barrier--they are afraid | 5/18 | Lazar | 5-15-2020 | |||||||||
22 | Hasbro Children's Hospital Providence, RI | Peds 4 (total) | yes | 0 | 5 | no | Yes | Skeleton week and weekend crew, minimal junior resident coverage; attendings first call for PICU/NICU - ended on 5/22/2020 - return to normal schedule | Yes (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 duty | Yes - partially | Adult COVID-neg oncology patients | Ready as part of next tier, but ultimately not required (curve flattened) | No - prepared to do so, but not needed in the end | Yes | No | No | no | no | yes - return to normal schedule 5/22/2020 | fellow 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) | no | yes. Zoom for non-PHI conferences, Skype for Business for QI, M&M, tumor board and other PHI conferences | yes - telehealth as much as possible, including monitored simple procedures like G-tube changes | Smaller teams - until 5/22/2020, when return to normal schedule | late in the process, but yes. Now (5/11/2020) slowly restarting electives, outpatients only for now. By 6/1/2020, return to 50-75% electives | guidelines 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 11 | tier 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-health | if not appropriate for tele-health | yes | yes | ready to - but have not (yet) | no | No, but clear institution-wide guidelines (keeping it a closed system with modified insufflation, deflation, suction, flow/pressure rates, specimen retrieval, etc.) | N95 + face shield | For 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 N95 | no, but smoke/CO23 aspiration via N95-grade filter | Yes. 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 OR | Yes | rapid test: 45-90 min (but limited supply). Roche test takes few hours, batched 4 times/day | yes | 48 h norm, but up to 96 h to accommodate (long) weekends | only symptomatic | yes. All hospital personnel mandatory since March13. All patients and families since April 29 | 1 (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 days | Not 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%) | 5/11/2020 | Francois Luks | 6/11/2020 | |||||
23 | IWK Health Centre, Dalhousie University, Halifax | 0 | NO | 0 | 0 | n/a | yes | skeleton w/e crew | n/a | yes in principle, but hasn't happened yet | n/a | yes - one peds surgeon covering adult trauma | not yet | yes | n/a | n/a | n/a | no | no | yes | single fellow program, 2nd year fellow covering as junior staff to minimize exposure | n/a | yes virtual - microsoft teams | n/a | yes, minimizing rounds in large groups | yes | yes | yes | prioritization system standardized across surgeons | yes | yes | combination of type of case and time waiting | yes | yes | no | n/a | no | N95 and face shield | n/a | no | yes, as above | not yet, but has been discussed | 6 hours | there are screening criteria | 24-48h | no | yes, for all healthcare workers at the hospital | yes, only one caregiver per patient | no | no weekend or extended hours for now | exisitng nursing staff limitations, nothing new | currently at 80% capacity | Rodrigo Romao | 6/11/2020 | |||||
24 | Johns Hopkins All Childrens Hospital, St. Petersburg, FL | 8 | yes | 0 | 1 | 0 | Yes | Team 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. | No | No | No | No | Yes, considering all PUI, until 3 screening questions are answered. All patients are getting tested regardless. | Yes | n/a | n/a | No | Yes | 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. | Yes | Only attending/fellow seeing patients COVID+ or PUI, to preserve PPE | Yes, 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/a | Staggered 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 5/4/20 | Institutional 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 applicable | Yes, 5/4/20 | Backlog speadsheet has been prioritized (1: urgent, 2: 1 month, 3: > 1month | No, 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 distance | Surgeon decides | yes | Yes. UPDATE (June): No | No | No | No | N95/Face Mask + Goggles | Only during intubation | Yes | N95/Face Shield or PAPR our anesthesia collegues, everyone else leaves room or stands > than 6 feet away | Yes, since reopening for electives-all patients get tested. UPDATE (June): ambulatory surgery and all admitted patients are being tested | 1 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. | Yes | 72 hours | No | Yes, everyone older than 2 years old. As of 4/24/20. | yes, one parent only | yes, 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. | 5/4/20 | Raquel Gonzalez | 6/8/20 | ||||||
25 | Le Bonheur Children's Hospital, Memphis | Peds 0 | Peds 0 | yes | Team A/Team B (includes attendings, fellows, residents, NPs), 5 days in hospital/5 days out of hospital | Yes, most senior surgeon | Remote assignments and non-clinical work | not yet, plan in place | non-COVID, start with young adult | no | not yet | Not specifically. But standard precautions. Definitely N95 and eye shield if intubating. | no | not that I am aware of | not that I am aware of | no | n/a | yes | Team A/Team B | not yet since we have not had any inpt | yes - virtual platform only | n/a | yes, Team A/Team B | yes | pre-set metrics | yes | yes | no | no | no, but starting to filter desufflation | N95, eye shield | anesthesia only in room, N95 masks and eye shield | no | 48 hrs, hopefully, shorter soon | yes - all heathcare workers and staff | yes, 2 visitors only and they cannot change during the hospitalization | yes, wear regular mask over N95, if N95 not soiled after use, store in brown bag in well ventilated place for re-use | daily incident command mtgs; every 5 days whole team does patient pass ons using zoom and, at that time, talk about changes in division processes | Eunice Huang | 4/1/2020 | |||||||||||||||||||
26 | Lucile Packard Childrens Hospital - Stanford | 1 ped 7 adult | 0 | yes | weekend/holiday type of coverage, rounder of the week with a back up surgeon schedule | yes, no patient contact for >60 year old surgeons | yes, no patient contact for >60 year old surgeons | Plan in place to do so | n/a | not yet | not yet | yes | yes | no | no | no | n/a | yes | skeleton crew | not yet | n/a | yes, virtual | yes, skeleton crew, favor geographics fro surgeon coverage | yes | yes | ACS | yes | yes | yes | no | filtering | N95 | yes, only anesthesia in the room, N95 | not yet | 12-24 hrs | no | yes | N95 | Matias Bruzoni | 4/2/2020 | |||||||||||||||||||
27 | Lucile Packard Childrens Hospital - Stanford (Peds only) | 1 Ped | 0 | Yes | weekend- holiday like coverage w/3 teams; Individual faculty covering 24/7 for 5-7 days then 10-14 days off, back up faculty schedule | Yes (age >65 and comorbidities) | No clinical exposure (only telehealth) | Not yet, but certainly a consideration | likely non-covid | Not yet | Not at this time | Yes | Separated currently | No | Not at this time | Not strictly, but emphasis for all providers to limit time in hospital as possible | No | Yes | completely 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 exam | yes | minimize exposure unless clinically necessary | yes - virtual platform only | No, -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 teams | yes | Hospital criteria based on CDC & ACS guidelines, but surgeon / anesthesia decision to make when needed case by case | yes, started 5/4/2020 | short transition period for semi-urgent elective, then open up to backlog of cases based on each division prioritizing case | yes | mid May, started to offer in-person visits, but with preference toward tele-health | Physician decision ahead of clinic dates and coorination with family and staff | yes | variable capability to do from home | case by case | no | case by case | full PPE with N95, shields, only critical anesthesia personnel in room for intubation | yes - wearing throughout case for those aerosolizing higher risk procedures | Insufflation use - all airway and GI endoscopy and laparoscopy | limit to critical anesthesia provider in OR during intubation with those providers in N95 & shields for all pt cases | not for all pts currently, but going to available rapid test (< 1hr) by April 2, 2020 | currently16-24 hrs, but rapid test (<1 hr) available April 2, 2020 | yes - elective require non rapid tests performed within 72 hrs, urgent/emergent cases get rapid testing performed and results <1 hr | 72hrs | Highly 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 tested | yes, all providers and staff | yes - 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 system | No extra hours/days planned...just booking as can based on priority. Still finding that some families are wishing to delay operations further | None at current time | 5/18/2020 is normalization of standard OR block times as prior to COVID and moving forward | Many 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 incomplete | Stephen Shew | June 5, 2020 | |||||
28 | 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) | unkown | not that I know about | The column to the right describes our changes from mid-March until end of April. As of May 1 we have returned to normal call schedule | Cohorted 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. | No | n/a | No. We will be central referral for all pediatric care/transfers to increase capacity at other hospitals in Chicago to focus on adults | n/a | No | Yes, Lurie sent ~20 vents to Northwestern | Yes | Yes | Yes (we now accept up to age 25) | Yes | No | n/a | Initiallly yes but now back to normal coverage | split NICU and PICU/floor, stagger presence of clinical fellows, brought research residnets in to help with coverage | Y | trying to limit exams to attending only, as of 4/14 this is being liberalized | Yes, Virtual platform only | No | Yes, split teams as noted intially & Now back to normal rounding practices | Yes | No - we made it up | Yes | Limited block times right now as we ramp up | Yes but now back to normal | yes | Surgeon pref for telehealth but mostly back to normal | Available in hospital as of ~4/7, as of 6/6/20 still do not have ability to do this from home | No | No | No | Yes, N95 then regualr surgical mask over the top, eye protection required | whole case | No | No clear policy until 4/13, post 4/13 we are testing all pts and all staff wear N95 | Started 4/13. | We have a rapid that takes 1-2 hours, regular takes 48 h | Y | 48-72h | no | Yes - care providers only (not families), policy changed around 4/3 to where universal masks used (still not using N95 for PUIs) | 1 | no | Saturdays were offered for elective block time/catch up but very few surgeons used this block time to my knowledge | staff furloghs due to financial impacts of COVID are limiting OR availablity | already started | none | Mehul Raval | 4/15/20 6/6/20 | |||
29 | Maimonides Children's Hospital, Brooklyn NY | 1895 adult, 49 peds | yes | 7 peds vents overall, 140 peak ICU beds, 180 peak vents | <10 | none known | yes | pediatric surgery attendings were repurposed to floor and ICU COVID teams | no | the issue has not arisen within pediatric sugery but has within other divisions and has been addressed to minimize exposure for those individuals | yes | both | yes | yes | yes | yes | no | no | no | n/a | yes | residents 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 rotation | yes | as much as possible exposure is limited to the fewest necessary physicians, in the case of tracheostomies the procedure is performed by a single attending | initially 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 coverage | yes | yes | no, only scheduling urgent cases at present | gradual opening of ORs starting with urgent cases | yes | yes | patients who are eligible for surgery in the upcoming weeks as the ORs reopen or who have symptomatic issues that can not be delayed | as much as possible | no | yes | yes prior to the availability of rapid diagnostic screening | no | full PPE with N95, shields | whole case | yes | only anesthesia in OR for intubation, routinely using glide scope, wait 15 min | yes, all patients admitted from the ER with the expectation of surgery are rapid tested | rapid - 1 hour, standard - 1 day | yes | up to 72 hours | no | yes, everyone | no visitors for adult patients, 1 visitor for peds | no | gradual increase in OR volume with extended hours / weekends to be determined | the 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 presently | June 1st | Dan Hechtman | 6/12/20 | ||||
30 | Maynard Children's Hospital at Vidant Medical Center - East Carolina University | 69 adult, 2 peds | yes | 19 | 0 | 0 | yes | yes. set rounding day with OR and all inpatient coverage. set clinic day.; other days at home | yes | surgeons over 60 not in hospital. pregnant residents in outpatient clinic only (lower risk population). Cormorbidities treated as disability with accomodations | no | n/a | no, but offered to do so. no surge here yet | no | yes - all traumas are PUI, everyone wears n95 mask, gown, gloves, face shield | yes | no | no | no | n/a | yes | fewer residents covering more services with 5 day blocks at home | yes | must have direct attending oversight at all times | yes - Webex. Virtual only | no change | yes - smaller groups, one attending | yes for 8 weeks, now resumed | similar to acs system. panel review of all cases to ensure meet criteria | yes | urgency followed by duration of wait | for 7 weeks, now resumed | yes | all new patients, needed followups, acute concerns | limited | no | no | n/a | no | n95, face shield, gown, glove | whole case | yes | Minimize personnel in room, wait 10 minutes to enter | yes | varies 90 min to 24 hrs, variable reagent availability | yes | 72 hrs (change from 48 hrs firs 6 weeks) | no | all clinical staff | 1 | sterilizing with H2)2, but have not reused yet | No extra hours/days planned...just booking as can based on priority. Still finding that some families are wishing to delay operations further | testing, state policy | 5/26 restart | Walsh | 6/11/20 | |||
31 | MGHfC, Boston | 22 adult, 2 child at MGHfC (225 adults at MGH proper) | yes | yes | SOW + backup only in house unless in OR | yes | no SOW call for >65 | yes | both | yes | yes, MGH. Vents, staff | yes | no | we did, no longer | we did, no longer | no | no | yes | residents redeployed to cover COVID ICU and floor patietns so those on surgery covering multiple services | no | yes, virtual. there is much more now actually | only urgent in person, otherwise all virtual | yes, minimize people who enter room, team is small already due to resident, NP, PA redeployment | yes | yes, initially chief decided, last few weeks OR leadership did | no, only those delayed but still urgent like low grade cancer, nothine elective like Nuss. | still being worked out | yes | not yet | yes | yes | no | no | N95 or PAPR | all 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 hrs | yes | 48hr | no | yes | 1 | yes, H202 | Starting '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. | unknown | we have seen a serious cardiomyopathy and Kowasaki like lillness in 3 pedi patients with COVID | Casey Kelleher | 5/7/20 | |||||||||||
32 | Minnesota Children's | yes | yes | yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
33 | Mott Children's Hospital University of Michigan, Ann Arbor, Michigan | Presently <20 adults, 1 peds. Over total 600 treated | Yes | ? | <5 | No | Yes, but back to normal now | Team A/Team B | not age, but pregnant, we have no comorbidities | Pregnant 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 of | We are considering all level 1 trauma pts PUI due to the high risk for intubation. We are using normal precautions for level 2 and below | yes | no | not yet, plans are being made -- this was not necessary in the end | no | no | yes | fellows on 5 days then alternate, resident schedule more detailed, but attempting to keep only those needed, also doing this for PA's - three teams alternating | Yes | One provider at a time - virtual rounds at the room door, exam only as needed | yes - virtual | Yes, doing as much via virtual or phone as possible. Traveling to operate. | Yes, minimizing size of team, special precautions for PUI and CoVid pts. | Yes | Up to surgeon, but using guidelines set by institution and ACS | Yes | we ramped up over a 2 week period to full schedules | Yes | yes, still attempting to make as many visitis as feasable virtual visits | Surgeon screening | Yes | Will have ability soon - still hoping | Yes, protocolized it so we are all treating pts similarly | yes | No, but now filtering insuflation gas | N95/PAPR | Whole case | yes | For 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 case | Begining today | 6-8 hours I am told | yes | 48-72 hours | no | Yes, all hospital personnel wear a mask. Patients and parents are issued a mask and encouraged to wear them, but they do not always do that | 2 | Yes, not sure the technique | We have kept our usual schedule so far during the ramp up. Up to surgeons to manage thier individual schedules | Not 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 Bruch | 6/12/20 | |||
34 | Nationwide Children's Hospital | 3 children | 0 | Yes | Skeleton weekend crew | Yes | No clinical duties if pegnant or immunosuppressed | not yet | n/a | not yet | not yet | yes | no | n/a | n/a | yes | no | yes | team A/Team B | yes | Attending only for high risk / confirmed non-emergent cases, if possible | yes- virtual curriculum | n/a | smaller group- minimal room entries and number of people examining patient | yes | yes | yes | yes | yes | yes | no | n95 | intubate in OR, others leave room 30 min | yes | 6-8 hrs, test run twice per day | yes, everyone | yes-one visitor | yes, Battele hydrogen peroxide | Ben Nwomeh | 4/9/2020 | |||||||||||||||||||
35 | Nemours-AI duPont Hospital for Children | 4 peds | yes - 18 cumulative hospitalizations | 0 | 3 | no | yes | skeleton crew | no | we created capacity for 38 adult pts plus a MICU but it has not been used yet | non-covid | no | no | regular mask, eye shield, gown | yes | no | no | no | we did , now back to normal | now back to normal | yes | only if essential help necessary | yes, virtual | limited in person eval, encourage transfer of all | yes, virtual rounding using vidyo. No more than 2-3 rounding together, only one person goes in room | restarted now | up to surgeon | yes | all cases being scheduled as able | not anymore | yes | up to surgeon | yes | yes | only some surgeons, only for COVID + | some surgeons are, no uniform policy | no | N95/PAPR for anyone in room during intubation | just intubation | no | Only anesthesia team in OR for intubation | yes | 1.5 to 2h for urgent cases, 48h for outpts | yes | 48h | no | yes, everyone | yes - one healthy parent | starting 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 time | we are calling cases "time sensitive" rather than elective but have essentially started doing all cases again | Loren Berman | 5/21/20 | |||||
36 | Nemours-Jacksonville, Wolfosns Chidlren | 1 child | no | 0 | yes | Skeleton weekend crew | no | no | no | no | regular mask, eye shield, gown | no | no | no | no | n/a | n/a | yes, virtual | limited in person eval, encourage transfer of all, telehealth yes | 2 person rounds | yes | yes but up to surgeon | no | yes | no | yes | yes | no | no | N95 and goggles | N95 and goggles if in room | no | rapid test, within 1 hr | no | no | yes-one visitor | Yes - UV sterilization | All of the above are planned options, havent decided yet | Gustavo Villalona | 4/201/2020 | |||||||||||||||||||
37 | Norton Children's Hospital, Louisville | 0 (ped only) | 7 | None currently, previously 1 | None to my knowledge | No | No | n/a | No | n/a | Not yet - contingency plan in place but not needed | n/a | Not yet | part of a hospital system | Yes | Yes | n/a | n/a | No | n/a | Yes | Send home ASAP | No | n/a | Yes - virtual | n/a | Yes - minimize team size | Yes | Surgeon with Chief approval | Yes, elective cases starting 5/6/20 | Using cases from depot (previously scheduled) and reviewing priority of case with surgeon | Yes | Yes as of 5/6/20 | Review with individual surgeon to determine need to see in person vs. telehealth vs. deferred | Yes | Developing process | No | Not yet needed but would be considered | No - using smoke evacuator and N95 for laparoscopy | N95 and goggles | n/a | Yes based on SAGES publication | N95 and Goggles, no wait | Yes starting with elective operations 5/6/20 | 24-72 hours, rapid tests available when needed | Only for elective scheduled cases | 72-96 hours | Not routine | Yes as of 3/30 | Yes - two visitors, must remain the same two people, and all are screened | Yes - UV sterilization | Considering weekends, longer weekday hours, maximizing use of outpatient surgery center | Followed state guidelines | Elective cases started 5/6/20 | Cindy Downard | 6/5/2020 | |||
38 | NYP-Morgan Stanley Children's Hospital - Columbia University | 690 (adults) - 70 (children) | yes | 6 | >20 | no | yes | pediatric surgery attendings took many call shifts in the adult hospital ICU and on SWAT teams | yes | Reducing exposure in pregnant and over 65 years of age | yes | Both | yes | yes | yes | yes | yes, 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 | yes | no | yes | every other day physical presence in the hospital | no | yes | yes, limited on-site presence for NICU consultations. No clinic or elective surgery | smaller teams and onlyone member of team exams patient | yes | yes | no, only those delayed but still semi-urgent and time sensitive | semi-urgent only scheduled into limited OR blocks | yes | yes | televisit is first choice. Lesions/conditions that need hands-on are scheduled for in-person office visit | yes | yes | yes | no, using AirsSeal smoke evacuator on all laparoscopy cases | full PPE with N95, shields, only critical anesthesia personnel in room for intubation | whole case | Yes based on SAGES publication | wait 20 minutes after intubation. Aerosol generating procedures done in negative pressure OR. | yes | one hour | no, done in pre-op area on day of surgery | must be within 48 hours | no | yes, everyone | one, used to be two | yes | semi-urgent only; weekend block schedule offered | NY State regulations with ban on elective surgery | June 1 | Steven Stylianos | 6/8/20 | |||||
39 | Oishei Childrens/Univ at Buffalo | 1 peds | 1 | 0 | 0 | n/a | yes | one 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 care | yes | over 60 not allowed to take clinicalk call | have an empty 20-bed surge ICU area but no longer anticipate need; THIS WAS CLOSED end of May | n/a | slated to run surge ICU but no longer anticipate need | not yet | all considered PUI, keeping minimal provider rules (one resident unless more needed) | not yet | no | no | yes | no | yes | limit to least necessary, single fellow being given one weekday respite for home | not yet | yes - virtual | n/a | skeleton crew; single provider sees patient and is dictating exam that APP transcribes in her office | yes; ELECTIVE SCHEDULE RESTARTED 6/8 | yes -- APSA reference and common sense | likely mid-May; now scheduling "time sensitive" things that can't wait 4 weeks; AS OF 6/8 BACK TO NORMAL | asked all surgeons to prioritize cases and have a vetting committee (OR nurse managers, two surgeons, anesthesia); opening slots for ~5 cases/.day as a start | yes; NOT ANY MORE | only urgent visits; 6/8 FULL CLINICS | individual surgeons vet requests from APPs | yes | yes | no | no | no | N95 | whole case | Yes based on SAGES publication | only essential people in room for intubation. phase 1 PACU recovery done in OR; no negative rooms available; use plexiglass shield box to intubate | yes | 24-48 hours for now | yes | 72 | no | yes... everybody in building wears a procedural mask | one at a time, two total allowed | starting to; hydrogen peroxide | both 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 time | staff limits | 6/8 | · Obstetric patients: Two adult visitors at a time for mothers in labor and delivery. No siblings of newborn. | David Rothstein | 6/8 | |||
40 | Oklahoma Children's Hospital | 4 peds, adult positive rate approx 1.5 % | 4 | 0 peds | 0 | 0 | back to normal operating procedures | back to normal | yes for pregnant or co-morbidities, have not for > 60 | n/a yet | no | will plan on non Covid | not at this time | no | universal not N95 | yesients | no | no | no | n/a | back to normal call | we will if needed | faculty and fellows, no residents | yes virtual 100%, using zoom | yes, are transfering pediatric patients to Children's | yes | back to normal schedule | back to normal | 5/4/2020 | normal | yes | week of 5/4 | yes | yes | no | yes | N95 | intubation and extubation room, anesthesia wearing N95 | in house testing | 4 to 12 hours | yes | 24-48 hours | no | yes, 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 N95 | yes, now 2 parents, no children | looking at various methods to steralize | already done | none now | 5/4 | Cameron Mantor/ Catherine Hunter | 6/8/2020 | ||||||||
41 | Penn State Children's Hospital | Peds 1. Adults 14 | 1 death: ICU 6 IMC 2 Floor 1 PUI: ICU 2 IMC 2 | yes: | Day team/Night team | Yes | 2 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 yet | N/A | not yet, but it is a possibility | No | Not yet, but still use universal precautions | No | No | Yes | Yes | Yes | Yes | They are on their holiday coverage schedule, Team A and Team B | yes | Residents/fellows do not evaluate or round on sus[pected or confirmed positive patients | Yes, virtual | No | Yes | Yes | ACS guidelines and surgeon preference | Yes | Yes | Yes | not yet but being considered | No, but now filtering insuflation gas | N95 | N95 mask, induction in negative pressure room with patient and anesthia present only | No, only only those recommended by ID. Not enought tests | 2-3 hrs | Yes - everyone | Yes, no visitors | Yes>. 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 Rocourt | 4/1/2010 | |||||||||||||||||||
42 | Phoenix Children's Hospital | 0 | 0 | Yes | A/B/C 4 surgeons per week | N/a | Increased to 21y by Governor | N/a | Not at this time | Not yet | No | n/a | n/a | No | Yes | No | Yes | One fellow on per week | Yes | No residents allowed. Fellows may participate. | Yes virtual - zoom | In person is for untransferable emergency coverage only. | Yes. Small rounding a group. | yes | yes | No. Zoom. | yes | yes | Not because of COVID | n/a | N95 and goggles | During intubation, anesthesia only in room, N95 masks and eye shield | Not yet (pending availability) | 24 for staff, unclear for patients. | No | yes, only one caregiver per patient | Not yet | David Notrica | 4/1 | ||||||||||||||||||||
43 | Rainbow Babies & Children's Hospital | 0 | yes | 0 | no | n/a | n/a | n/a | yes | no | not at this time | no | yes, treat trauma pts as PUI | yes | no | no | yes | no | yes | minimal resident coverage | yes | no residents unless absolutely nessicary | yes, virtual | n/a | yes | yes | yes | yes | slowly | yes, many moved to telehealth | yes | yes | yes | no | no | N95 | During intubation, anesthesia only in room, N95 masks and eye shield | yes | 2 hrs | yes | 48 hrs | no | yes | 1 | yes, Battele hydrogen peroxide | Michael Dingeldein | 5/9 | ||||||||||||
44 | Riley, Indiana University | Yes | 8 total PICU | More than 1, but don't know the total. | no reports of that | Yes | skeleton weekend crew | Yes (comorbidities) | Not in call pool | No, but it has been discussed | Both have been discussed | Not at this time | Yes, vents with adult facilities | Yes. Full COVID PPE used for new trauma patients | Yes | N/A | Yes, general pediatric patients being sent away from mixed center to the children's hospital | No | n/a | yes | skeleton weekend crew | Yes. | Only the minimum personnel needed for consults or operations on these patients. No double scrubbing. | Yes - all virtual | Using Telehealth whenever possible | Yes. Limited residents/fellows on rounds | Yes | yes - ACS guidelines + case by case | Yes. June for semi-urgent and July for elective cases. | In discussion. Possible weekend elective cases. | Yes | Some patients. | Starting with those who need in-person exams - wounds and gtube issues. | Yes | Yes | Only for early appendicitis patients who wish to pursue non-op management | No. Exhaust CO2 scrubbers in use. | N95, masks, face sheilds | whole case | No. Mild risk. | Minimize staff in room during intubation; 0 droplet time for others to enter | No | don't know | No | n/a | no | Yes. All providers and staff wear a mask. Patients/families only wear masks they bring or is symptomatic. | Yes, one caregiver | Yes | Starting 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 limits | starting now | Feeder/Grower NICU babies from mixed adult/peds hospital in the system being sent to children's hospital. | Brian Gray | 4/21 | ||||
45 | San Diego Rady Children's | c. 3 | Yes | 0 | at least 1 | no reports of that | yes | skeleton w/e | No | discussions if needed in future; likely not to happen | likely young adult non covid trauma and other illnesses | not yet, but possibly | yes offering some testing for EMS | Yes. full COVID PPE for trauma activations. admission are tested and PPE scaled back as appropriate | YES | No | No | yes | no as elective case load is down | yes | W/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 schedule | yes | attending only for most traumas; would limit res/fellow involvement in COVID+ pts | yes virtual | n/a | yes - changed team structure; minimize people in the room; singout virutally | yes; elective surgery resumed mid may wiht some limitations based on decreased staff. by memorial day will be up to full schedule | Yes set cases; if outside the guidelines need approval from one of 5 members of MD OR leaderhship can clear | Yes 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 service | initially yes but now converting as much as possible to telemedicine; still using telemed mixed with in person for pts who need examination | have always kept in person visits as needed | wound and reuqired exams | yes | yes | have agreed to do so; no covid pos appy pt yet | likely not, filtering gasses | N95 and face shield | would to N95 for whole case | hospital does not seem to but some surgeon s do | Anesthesia 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 before | 2 hours | yes | up to 48 hours | NO | universal masking; surgical mask in patient care; home made or other mask for non clinical | one caregiver; no children | reusing- UV sterilization | starting 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 operational | limited staff as the usuall hiring increase in spring was put on hold and some staff out caring for relatives | 5/27 | Karen Kling as of 6/11 | 6/11/2020 | |||||
46 | Sanford Children's Hospital, Sioux Falls, SD | 23 adults/0 children | yes | 0 | 0 | yes | Three attendings. One on inpatient, one outpatient, one off. Now back to normal schedule and rounding habits. | NA | yes, but never needed to happen | non-COVID adults | no | PPE, Vents (adult and children's hospital on same campus) | Facemasks, but not N95 or PAPR | yes | no | no | yes | no | yes | two teams. one week on, one week off. Now back to regular schedule | no | yes, in person and virtual | yes. only one inpatient surgeon rounds. Now back to team rounding. | yes | ACS guidelines. Exceptions approved by division chief. Back to full OR since 6/1 | yes | phased approach. back to full schedule since 6/1 | no | never stopped | yes | yes | no | no | N95 or PAPR | N/A. would wear N95 if positive | yes | Anesthesia intubates with rest of team out of room until air exhange (4 minutes) | yes | inpatient 1-2hrs, outpatient 8hrs | yes | 72hrs | no | yes - everyone | 2 adult visitors allowed. 1 parent only in clinic | no | considering weekends | no | started 5/11. Back to regular schedule as of 6/1 | Ryckman | 6/5/2020 | |||||||||
47 | St. Christopher's Hospital for Children | 5 children | yes | 3/0 | yes | Days 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) | No | Yes | Both | No | Yes (vents) | Yes | Yes | N/A | N/A | No | Yes | Like attendings days are covered by the two on call members of the resident team | No | Yes-virtual by Zoom | N/A | No | Yes | No | Yes | Starting to schedule cases felt to be "time sensitive." | Yes | yes | All new patients that aren't purely elective and follow ups that need to be seen. | Yes | No | No | No | N95, eye shield, gloves, gowns | Wait 15 minutes | Yes | 75-90 minutes | Yes | 48 hrs | No | Yes-everyone | 1 | Yes | Doing time sensitive cases in addition to emergencies. Using telemedicine | This week (week of 5/11/20) | ||||||||||||||
48 | St. Louis Children's Hosp/WashU | 0 | yes | 0 | Yes | back to normal | yes | institution guidelines | yes | both | no | yes | yes | yes | no | no | no | n/a | back to normal call | n/a | yes | attending only | yes- virtual curriculum | back to normal | combo of smaller group and viirtual rounds | yes | Yes- ACS guideleines | yes | starting to schedule all cases | yes | yes | all patients allowed now | yes | yes | no | no- using smoke filtration sytem | n95, face shield, gown, glove | entire case | yes | anesthesia only in room, N95 masks and eye shield | yes | few hours | yes | 48-72 hrs | no | yes - everyone | yes-one visitor | yes | no special strategy | staff limited | 6/1 | Patrick Dillon | 05/07/2020 | ||||||
49 | Stony Brook Chidren's; SBUH | 435 Adults / 33 Kids | yes | 230 adult vents, 17 PICU | 2 (pos, but asymptomatic) | none to my knowledge | Yes | 2 teams, day-night, telemedicine, goal is to keep protected read for redployment, work from home | not yet | yes, ED upto 30, Cancer center cleared, Hem-Onc cleared, Peds helping with adults | Both | Ready to Cover Adult COVID or SICU, Trauma, ACS as needed | Yes, with the larger hospital system | YES, Everyone is considered posisive, PPE like universal precautions | yes, TESTING remains a critical issue | No, our children's hospital is a level 1 trauma we (all NY) increased capacity >50% | No | yes | no | yes | Fellows were emergency credentialed as attendings to aid in Gen Surg, Trauma, ACS care | No; Residents initally redepolyed and then redeployed again. 1/3 of COVID+ patients are currently being cared for by surgeons and surgery residents | Minmal, 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 update | yes. Doc of the week shifts, BID Video call with MS Teams (HIPPA compliant) | YEs | Hospital decided. ACS COVID repsonse and then surgeon input. Each day Hosp team looks at the next days cases to review appropriateness based on resources | Yes | 50% alternating blocks. Now bcak to full OR capacity based on NYS DOH regs | yes | Simple and necessary on case-by-case basis | yes | yes | Only if mandated. At the moment, still cen get simple Appy in and out | No | Considered, but no. Exhaust CO2 scrubbers in place. Data for laparotmy is simialr for laparoscopy, its just that there are many more studies on laparoscopy | N95, masks, face sheilds | Entire case | yes | no induction room-intubation team in COVID+ deignated OR | No | 24-48 hrs | yes | 48-72hrs | Yes, now being implemented | yes... everybody in building wears a procedural mask | yes, one caregiver for kids; ow NO visitors, no vendors etc | Yes, re-using, extended use, sterilizing | Re-open Ambi surg center as clean, COVID free site. Extensive testing for all outpat, and elective OR cases | NYS DOH regs prior to June 1. Now, none, we're back | June 1 | Our 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 Muratore | 6/12/2020 | |||||
50 | Strong Memorial Hospital, University of Rochester, NY | Numbers 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 believe | 1 to my knowledge. Was assymptomatic. Urgent procedure and COVID test had not resulted yet. No symptomatic patients to my knowledge | None to my knowledge | Yes | skeleton 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 regard | No. Though the children's ED and hospital have agreed to take older patients as needed in order to offload the adult side | COVID - only | No. We were not needed | Yes, 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 this | Yes | Yes | No | No | Yes | Yes | Yes | masive 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-May | No | N/A | Yes. We are doing virtual education with the Zoom platform | N/A | Yes. smaller group. Back to normal as of mid May | Yes. | pre-determined metrics. some case by case (requires discussion with surgeon-in-chief) | Yes | Fluid 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 | Yes | Yes | Only those needing in person exam/ drain removal, dilations, button problems | Yes | Yes | No | N/A | No | Most patients, regular precautions (eye protection, mask, gown, gloves); known COVID + or test pending N95 / PAPR | N/A. THough personally, I would wear the whole case | No | We 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 enter | Yes. Unless emergency case and then we will proceed with test pending | 8-12 hours | Yes | 72 hours for those coming from outside hospital. If patient has been in hospital, 7 days | No | Yes. ALL staff. family member, patient if able | Yes. 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 basis | Yes - vaporized hydrogen peroxide | We have ramped up. No extra hours, but we hve returned to normal OR volumes on adult and Peds sides. | Mid May | Derek Wakeman | 6/12/20 | ||||
51 | Texas Children's Hospital | 741 detected cases | Yes | 0 | 5- general surgery | Not to my knowledge | yes | team A/team B | yes | No clinical duties for >70 yo, pregnant. also offered to >60 yo w comorbidities | no | no | no | not yet | yes | yes, separate areas in ED, Special Isolation Unit for all positive cases | no | no | yes | no | yes | residents/fellows on weekend/skeleton coverage, work from home if possible (phone calls/care coordination/communicatoin) | Yes | Essential care team members only | yes- virtual | n/a | yes, skeleton crew/smaller group | yes | yes- hospital based guidelines and clearance by dept chair | Yes | Fluid situation, Balance of staffing and cases | transition to phone/video visits | Yes | No restriction other than volume to adhere to physical distancing and staffing constraints | yes | yes | No | No- but protocol available case by case basis | No- smoke evacuator | N95, eye protection | For the entire case | Yes | intubate in OR- single anesthesia provider, others >6 ft away | yes | 2 hours rapid test, others 6-8 hrs | Yes | 48 hrs | No | yes - everyone | yes- one > 18 yo and healthy | Re-using | Both being planned, limited by staffing | Staffing, social distancing in common spaces, patient concerns | 4/22 | Seeing rapid increase in cases and hospitalizations since reopening. Things changing quickly over last week. | M.Lopez | 06/20 | ||
52 | The Hospital for Sick Children, Toronto | 3 inpatient children and 16 positive detected overall (13 outpatients - ED) | yes | 0 | 0 | 0 | Yes | Rounder and call person on, protected vulnerable staff | Yes | Minimizing people present, offering vulnerable colleauges not to be on call, virtual clinics | No | NA | No, but available | Not yet, PPE could be shared throughout hospitals in GTA | Yes | Yes | NA, we are the only pediatric trauma center in town | No | No | NA | Yes | Half fellow team on and alternating | Residents yes | Not coming to OR if concerns | Yes, virtually | Only virtual consultations at OSH | Yes, one staff (SOW) seeing all patients | Yes | yes - no elective cases, and then concensus to identify urgent - time sensitive cases, and all emergent neonates, appendicitis, tumors | Started 5/11 - for time senstiive and more urgent cases, ramping up | Step wise, time sensitive cases first | Virutal or phone | Only urgent or one who need physical exams - dilations or imaging and time sensitive. | Clinical judgement and physical required | Yes | yes | No | No - using smoke evacuator and N95 for laparoscopy | N95 and minimizing personel in OR during intubation and extubation | Wearing 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 enter | Yes, for all elective and urgent cases, not for emergent cases | 12 hours - 4 cycles per day | yes | 24-48 hours | no | Yes for all clinical interactions | yes, one visitor per patient | Not yet, but collecting N95 masks for re-use. Optimizing technique for resterilization, currently under investigation | Slowly ramp up, currently no plan for elective cases on week-end, but has been discussed. Will likely need to extend hours | No | 5/11 | Ramping up more room in a gradual fashion, with creating priority lists, reviewed by surgical teams. | R. Baertschiger | 6/6/2020 | |||
53 | UCSF Benioff Children's Hospital SF | 0 children | 0 | yes | weekend schedules | no | no | no | yes | no trauma | yes | n/a | no | no | yes | weekend crew | yes | attending only | yes zoom | no | yes virtual rounds | yes | yes ACS | yes | yes | yes | no | no | N05 | yes, leave 15 minutes | no not enough tests | 6-24hrs | yes everyone | yes one visitor | reusing | Hanmin Lee | 4/4/2020 | ||||||||||||||||||||||
54 | UCSF Benioff Childrens Hospital Oakland | 0 | Yes | 0 | 3 | none | yes | Team A/Team B | Yes | Minimize shifts as possible | Has remained an option if needed (never used) | n/a | no | yes (PPE with community practices) | yes | no | no | yes | no | n/a | yes | team A/Team B | yes | Attending only for high risk / confirmed non-emergent cases | yes - virtual | n/a | yes, weekly zoom sign outs and skeleton crew for bedside rounds. | yes | Yes - ACS guidelines | Yes- scheduling all cases | Step wise approach - time sensistive casses first. | yes | yes | n/a | yes | yes | yes - case by case decision | yes | no (using air filtering) | N95 / PAPR | whole case | Yes | Anesthesia and single nurse only, 15 minutes wait. | yes - except for emergent cases | 6-24 hrs | Yes | 4 days | no | Yes - everyone | yes - one visitor | not yet | Plan for optimization of current block times and some extended days | Spcae limitations to maitain distancing while increasing volume. Pre-op clinic and Pre-op testing coordination with the day of the procedure. | May 11 | evening and weekend OR expansion is planned to be used on an as needed basis | Chris Newton | 05/08 | ||
55 | University of Chicago Comer Children's | Peds 1 - 83 adults in adult hospital | 1 peds on vent, 12 adults | Yes | Minimized on-site, remote team taking consults/calls at night to protect on-site teams | Yes (formal process by our institution) | Remote assigment for CLD, immunosuppressed, cardiac risk, pregnancy | Plans in place to do so | non-COVID, <25, short projected LOS | not yet, but it is a possibility | Not yet | Yes | No | No | No | No | n/a | Yes | Skeleton crew | Not yet | Yes, moved curriculum to virtual | Yes, virtual, transferring children with need for hands-on surgical care to one of two primary sites | Yes - one person from each team examines patient; only two co-rounders | Yes | Surgeon in chief clears | Yes | Yes | Yes | Yes | No, filtering both insufflation and desufflation | N95 | Anesthesiologist only in the room, with CRNA or resident/fellow | No - not enough tests | 12-24 hours | Yes - everyone | No visitors | N95 | Jessica Kandel | 4/1/2020 | ||||||||||||||||||||
56 | University of Florida | 19 adults (6 in MICU); 2 children | Yes | 6, all adult | yes | Team A/Team B | NA | NA | not yet, but is part of plan if needed | COVID+ | not yet, but are in the line-up. adult non-trauma attendings currently enough to cover. | no | yes | yes | no | no | no | na | yes | Team A/Team B in 2 week cycled blocks, shared amongst all services that have been cohorted into 3 groups | no | yes - virtual | yes - telehealth or in-person for specific cases | yes, skeleton crew and fewer team members in room with patients | yes | yes | Yes - now scheduling all cases that are willing to be operated on | Was step wise - one week increase followed by full operations based on Governor's clearance | yes | yes | needing interventions done | yes | yes | case by case | no | N95 with surgical mask over | Anesthesia and circulator in room during intubation/extubation, no entry for 18 minutes after intubation/extubation | no | 2-4 hours | yes | 24-72 hrs | no | yes - everyone | yes - one dedicated visitor per pediatric patient, may only switch out after 7 days. No one allowed in <18 years. All visitors screened upon entry. | re-using 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 blocks | May 4 | Saleem Islam | 5/7/20 | ||||||||||
57 | University of Iowa Stead Family Children's Hospital | 4 children, 121 adults | yes | 1 pediatric pt | no 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 B | NA | Offering 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 yet | both | We are in the line-up but not required to date. | yes | yes | yes - 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 floors | Accepting all pediatric patients. No mixed floors | yes | no | yes | platooning, Team A/B | no | yes, virtual | NA | yes, minimize number of trainees on rounds | yes | yes, great leeway to surgeon | yes as of April 28th | Staged 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 availability | yes - some delayed, some virtual, some in person | yes | Patient needs for physical exam after video telehealth visit. Taking patient preference into account. | yes | yes, but prefer to do it from office or clinic | no | yes | N95, shield, gown, hat, gloves | Negative 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. | yes | Screening 3-4 hours. Transplant 1-2 hours. | no | yes, everyone | yes-only one visitor per 24 hours | yes, re-using if Covid negative, hydrogen peroxide vapor treatment | Maximizing block utilization and accomodating patients during week | Joel Shilyansky | 4/30/20 | |||||||||||||
58 | University of Massachusetts | yes | Team A/Team B - skeleton crew | yes | No hospital/patient rounds if over 60 or immunosusppressed | Yes | non-COVID adults | not yet | Yes. There is a field hopital for COVID patients that serves all hospitals in our community and has support of the National Guard | Yes. Also keeping trauma supplies out of the bay. One person responsible for moving supllies into room at request by walkie talkie | No | No | Most surgery residents are redeployed to non surgeical teams. Many COVID units | No | yes | Very complicated coverage schedule but most COVID teams are one week on and one week off at a time | no...only if immunosuppresssed or otherwise at risk | yes..virtual | telehealth only | yes...attending rounds without residents | yes | Division chief responsible for decision but we are in line with ACS guidelines | yes 5/18 when state opens | yes | not elective visits | urgent issues only | yes | yes | no...have not changed management of appendicitis | no | N95 and PAPR | Only anesthesia team in OR for intubation | yes | 10 hours | yes | 48 hrs | no | yes-everyone | 1 | yes..UV | weekends and extending block timne hours later in day | 5/18 | Aidlen | 5/7/2020 | |||||||||||||||
59 | University of Michigan | 290 adults 3 children | yes | 200 plus adults | 1 | no | yes | lombardi 2 weeks on 1 week off | no | na | yes | COVID+ | yes | yes | yes | yes | N/A | N/A | yes | no | yes | one fellow 5 days on then 5 days off | no | yes virtual | yes virtual for most still going to do cases those | yes and only rounfds once | yes | yes | yes as of May 1 | day by day | yes | slowly | new patients only and urgent complicated patients | yes | yes | case bycase | no | no | N95 and shields | whole case | yes | itnubation only anesthesia and a circulatero then wait 20 minutes | not yet not enough tests we have a alogorythm | 24 hours | yes | 48 | no | yes everyone | yes singler parent only | yes laser and vapor | day by day peds cases first | government edits | 5/28 | peter f ehrlich | 5/22/2020 | ||||
60 | University of North Carolina Children's Hospital | 4 children; 37 adults | yes | 0 | yes | Back-up call for faculty and NPs | yes | surgeon over 65 years old not expected to operate on COVID19 positive patients | Yes | Non COVID+ adults to age 35 | no | no | Yes | No but in negative flow rooms | no | no | yes | No, they take consolidated shifts to minimize resident exposure | yes | They take consolidated shifts to minimize resident exposure; ie one senior resident instead of 2 on the daily service | Yes | They are able to do the case but the attending goes inthe room daily for rounds. | yes | yes, mostly telehealth and video clinic visits | no | yes | Yes | yes | Risk based scale to schedule cases | yes | yes | If we need to do a hands on physical exam; ie DRE or stoma care | Yes | yes | no | no | N95/PAPR gown double gloves face sheild | Yes wait 21 minutes after intubation and extubation if COVID19 positive | Yes | 24 hours | Yes | 48 hours | no | Yes, everyone | for children 1 parent; for adutls none | yes, UV | Extended OR hours | None yet | Hayes-Jordan | 5/8/20 | |||||||||
61 | University of Texas, Children's Health Dallas | changed every day; always < 10 and usually < 1; to date have tested 1987 and had 48+ including testing for asymptomatic | yes | 1/0 (child) | 0 | no | yes | Team 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 pregnant | yes for a brief period of time | up to age 21 and up to 35 if have pediatric type disease (CF, cong heart, sickle cell, etc...) | no | yes (PPE to adult hospital with whom we are partners) | no - routine trauma PPE | yes - PUI and COVID + are separated from other patients in ED and on floor | initially yes (for a week) but adult side has noted to have plenty of capacity so now back down to previous age | no | yes | no | yes | team 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 attendings | yes | attending only | yea - virtual only | yes - changed criteria for in person evals (emergency that cannot be transported due to instability) - otherwise transfer to primary childrens hospital | staggered rounds | yes | surgeon make decision that has to be approved by SIC | begining of may | staged based on community new case rate, hospital/PPE available, and testing available. Goal ramp up gradually based on level of acuity | yes - some delayed, some virtual, some in person only if urgent/time sensitive (like rectal dilations) | slowly in May | new patien evals, those needing physical exam, virtual for others those with respiratory symptoms or PUI - virtual | yes | yes | no | no | N95/PAPR + standard | anesthesia 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 no | usually 2-24 hours though for transplant patients/pui/or special circumstances there is a 2 hour test | preferred not required | no more than 72 hours | no | yes - everyone over 2 yo | yes- 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 patient | yes - UV | changing OR assignments from surgeon block time to division block time to try to optimize OR utilitzation; extending hours | we have many support staff who cannot come back because they are high risk so limits staffing options | May 11 | Diesen | 5/21/2020 | ||||||
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