NewYork-Presbyterian Morgan Stanley Children’s Hospital Reports on Perioperative Services Response to COVID-19

Prestigious journal, Annals of Surgery, publishes surgical perspective

Jun 1, 2020

New York, NY

Dr. Steven Stylianos

During the peak of the New York City coronavirus pandemic, NewYork-Presbyterian Morgan Stanley Children’s Hospital supplied equipment, redeployed personnel, and rapidly transformed their operating rooms (OR) to assist NewYork-Presbyterian’s system-wide response to the massive influx of critically-ill adult patients with COVID-19.

At the same time, NewYork-Presbyterian Morgan Stanley Children’s Hospital took admitted pediatric patients from NewYork-Presbyterian’s other hospitals, continuing to serve as a full-service children’s hospital and performing emergency and urgent pediatric surgeries.

These efforts, detailed in a report titled “The Perioperative Services Response at a Major Children’s Hospital During the Peak of the COVID-19 Pandemic in New York City,” were published online in the journal Annals of Surgery.

“This was a tremendous effort that would not have been possible without the exemplary work of our skilled and dedicated teams across our enterprise,” said Dr. Craig Albanese, senior vice president and chief operating officer at NewYork-Presbyterian Morgan Stanley Children’s Hospital and an author of the report. “Due to our swift collaboration, we worked to provide the very best care for both our adult and pediatric patients during this unprecedented time. I am proud of the immense perseverance of our staff and what we were able to accomplish.”

The report outlines the strategies and steps taken by perioperative leadership between March 17 and May 8 to best utilize the children’s ORs in NewYork-Presbyterian’s system to meet the influx of critically-ill COVID-19 patients.

“The overwhelming drive was to free beds and provide personnel and equipment to help care for the surge of COVID-19 adult patients, while still functioning as a full-service children’s hospital,” said Dr. Steven Stylianos, surgeon-in-chief at NewYork-Presbyterian Morgan Stanley Children’s Hospital, the Rudolph N. Schullinger Professor of Surgery and chief of the Division of Pediatric Surgery at Columbia University Vagelos College of Physicians and Surgeons, and the lead author of the report. “Helping our fellow health care workers take care of COVID patients, while continuing to provide our pediatric patients and their families with the best care possible was a delicate balance that we needed to strike. This was truly a multidisciplinary effort that touched every aspect of the hospital.”

Beginning in March, hospital leadership from surgery, anesthesiology, obstetrics, and pediatrics quickly developed protocols and processes to facilitate expansion of OR activities in the children’s hospital.

“The speed with which the surge was occurring, we had to be equally fast and nimble to keep up with it,” said Dr. Stylianos. “That motivated us to take these actions and to do them as promptly as we could.”

The report details the following strategies plus others that were employed:

  • Redeployed personnel (faculty, residents, nurses, and staff) and equipment (anesthesia machines) to other NewYork-Presbyterian campuses to care for critically-ill adult COVID-19 patients;
  • Formed a 24/7 airway management team dedicated to performing intubations for COVID-19-positive pediatric and adult patients;
  • Implemented same-day COVID-19 testing in the perioperative area, to maximize safety and reduce patient and family stress;
  • Redesigned perioperative services, which included converting several ORs—one into a COVID-19 dedicated OR for pediatric patients who needed major surgeries and another into a negative pressure room for patients getting aerosol generating procedures (which can spread the coronavirus in the air) such as a tracheostomy. A third pediatric OR was converted for caesarean sections because pregnant women and newborns were transferred to the children’s hospital from nearby NewYork-Presbyterian Allen Hospital to make room for its high volume of adult COVID-19 patients.

During these seven weeks, NewYork-Presbyterian Morgan Stanley Children’s Hospital performed 303 subspecialty surgical procedures, including 40 cardiac repair surgeries (22 of them performed on newborns), two heart transplants, and a liver transplant. In addition, pediatric patients in need of admission from other NewYork-Presbyterian campuses were brought to NewYork-Presbyterian Morgan Stanley Children’s Hospital to free up space for COVID-19-positive adult patients.

As the number of COVID-19 infections declined in New York City, NewYork-Presbyterian Morgan Stanley Children’s Hospital slowly began to expand OR services to perform semi-urgent pediatric procedures, with each individual patient case assessed by a perioperative leadership group. The hospital also began treating children with the COVID-19-related Multisystem Inflammatory Syndrome in Children. In addition, it is planning the hospital’s return to normal activities.

“This was a true crisis on many fronts—for the patients who were afflicted with COVID-19 and for the hospital to match the acuity and the surge aspect of this,” said Dr. Stylianos. “But from those crises was born an esprit de corps and a problem-solving mentality that was unbelievable and second to none. I have such tremendous pride to be part of NewYork-Presbyterian’s many campuses that came together to fight this battle.”

The link to the full report can be found here.

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