Pediatric otolaryngology workflow changes in a community hospital setting to decrease exposure to novel coronavirus

Abstract

Objectives: To develop a workflow algorithm for physicians and staff to decrease cross contamination and minimize exposure to Coronavirus Disease -19 (COVID-19) in pediatric otolaryngology at a community pediatric hospital.

Methods: PubMed and Google Scholar searches were carried out using the keywords. Pertinent clinical information related to pediatric otolaryngology was reviewed from journals, Texas Medical Board guidelines as well as institutional guidelines. Updated information from the Centers for Disease Control through social media was identified via Google search.

Study design: Safety measures and clinical work-flow protocols were developed to protect patients, families, and staff. Protocols included a rotation schedule for providers and ancillary staff, guidelines for in-clinic visits and alteration to surgical block and surgical case cadence to minimize exposure of providers and staff to COVID-19. Algorithms and guidelines were reviewed and revisions made at each phase of the pandemic related to in-clinic visits, telemedicine visits, and surgical cases.

Conclusion: In the era of the COVID-19 pandemic, otolaryngologists and pediatric otolaryngologists are amongst sub-specialties with an increased risk of exposure. It is imperative that a modification in clinical workflow is created to minimize the risk of exposure to providers and staff while continuing to provide care to patients.

Practice implications: The COVID-19 pandemic continues to evolve and change rapidly. The described guidelines and workflow algorithm serve as tools to help pediatric otolaryngologists protect themselves and their staff and patients during this global crisis.

Keywords: COVID-19; Otolaryngology; Patient safety; Physicians.

Fig. 1

Algorithm for physician rotation and responsibilities.

Fig. 2

Comparison of turnover times between surgeries before and during COVID-19 PE: Pressure Equalization, T&A: Tonsillectomy and Adenoidectomy, A: Adenoidectomy, DLB, diag: Direct Laryngoscopy and Bronchoscopy, diagnostic.

Fig. 3

Covid-19 positive results notification process-Surgery.

Fig. 4

Personal Protective Equipment (PPE) guidelines currently in place.