Experience from a Singapore tertiary hospital with restructuring of a vascular surgery practice in response to national and institutional policies during the COVID-19 pandemic

Jun Jie Ng; Tiffany R X Gan; Jen Yong Niam; Raj K Menon; Pei Ho; Rajesh B Dharmaraj; Julian C L Wong; Andrew M T L Choong

doi:10.1016/j.jvs.2020.05.026

Experience from a Singapore tertiary hospital with restructuring of a vascular surgery practice in response to national and institutional policies during the COVID-19 pandemic

J Vasc Surg. 2020 Oct;72(4):1166-1172. doi: 10.1016/j.jvs.2020.05.026. Epub 2020 May 23.

Authors

Jun Jie Ng¹, Tiffany R X Gan², Jen Yong Niam³, Raj K Menon⁴, Pei Ho⁴, Rajesh B Dharmaraj², Julian C L Wong², Andrew M T L Choong⁵

Affiliations

¹ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore; SingVaSC, Singapore Vascular Surgical Collaborative, Singapore. Electronic address: [email protected].
² Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore.
³ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁴ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore.
⁵ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore; SingVaSC, Singapore Vascular Surgical Collaborative, Singapore.

Abstract

Singapore was one of the first countries to be affected by COVID-19, with the index patient diagnosed on January 23, 2020. For 2 weeks in February, we had the highest number of COVID-19 cases behind China. In this article, we summarize the key national and institutional policies that were implemented in response to COVID-19. We also describe in detail, with relevant data, how our vascular surgery practice has changed because of these policies and COVID-19. We show that with a segregated team model, the vascular surgery unit can still function while reducing risk of cross-contamination. We explain the various strategies adopted to reduce outpatient and inpatient volume. We provide a detailed breakdown of the type of vascular surgical cases that were performed during the COVID-19 pandemic and compare it with preceding months. We discuss our operating room and personal protective equipment protocols in managing a COVID-19 patient and share how we continue surgical training amid the pandemic. We also discuss the challenges we might face in the future as COVID-19 regresses.

Keywords: COVID-19; Coronavirus disease 2019; Segregation; Surgical practice; Vascular surgery.

MeSH terms

Ambulatory Care / legislation & jurisprudence
Ambulatory Care / organization & administration
Betacoronavirus / pathogenicity
COVID-19
Coronavirus Infections / diagnosis
Coronavirus Infections / epidemiology
Coronavirus Infections / therapy*
Coronavirus Infections / virology
Delivery of Health Care, Integrated / legislation & jurisprudence*
Delivery of Health Care, Integrated / organization & administration
Health Policy / legislation & jurisprudence*
Health Services Needs and Demand / legislation & jurisprudence*
Health Services Needs and Demand / organization & administration
Hospital Departments / legislation & jurisprudence
Hospital Departments / organization & administration
Host-Pathogen Interactions
Humans
Infection Control / legislation & jurisprudence
Infection Control / organization & administration
Occupational Health / legislation & jurisprudence
Pandemics
Patient Care Team / legislation & jurisprudence
Patient Care Team / organization & administration
Patient Safety / legislation & jurisprudence
Pneumonia, Viral / diagnosis
Pneumonia, Viral / epidemiology
Pneumonia, Viral / therapy*
Pneumonia, Viral / virology
Policy Making*
Program Evaluation
SARS-CoV-2
Singapore / epidemiology
Tertiary Care Centers / legislation & jurisprudence*
Tertiary Care Centers / organization & administration
Vascular Surgical Procedures / legislation & jurisprudence*
Workload / legislation & jurisprudence