Orthopedic staff at New York City-based Mount Sinai Health System are pivoting to assist frontline healthcare workers battling a surge in COVID-19 patients across the system's emergency rooms and urgent care facilities.
"The volume of patients coming in is very, very high. It increases every day," Leesa Galatz, MD, professor and chair of the department of orthopedic surgery at Mount Sinai, told Becker's Spine Review. "We are deploying our physicians, physician assistants, medical assistants and residents into the labor pool to help out wherever they can."
"We're really trying to band together as a department and have as much of a positive impact as possible, not only in absorbing all of the musculoskeletal care but to also help our community and our hospital colleagues where they need it the most.
Orthopedic providers who aren't specifically trained in critical care are banding together to work in supporting roles with PAs and emergency physicians in the ER.
Several of the orthopedic department's anesthesia machines have been repurposed as ventilators for use in the ICU, and orthopedic surgeons are only performing urgent and emergent surgeries. It has also implemented ortho urgent care to help unload the system's ER.
"All the patients who do not have respiratory symptoms that present a musculoskeletal complaint are being directed to our ortho urgent care, where we have a physician on-call every day to see those patients," Dr. Galatz said.
For patients with urgent orthopedic problems who need surgery, "we have protocols for COVID-19 testing of all patients who are asymptomatic, to protect anesthesia and ourselves," Dr. Galatz said. "Although at this point, caution dictates that we treat everyone as if they could be positive."
"We've shifted our ambulatory practice as much as possible to telemedicine, which we were able to operationalize within a week. Now every physician is activated in our system for telemedicine so they can see patients."
The vast majority of ER visits have been respiratory-related, and orthopedic volume dropped due to most residents staying at home following the social distancing guidelines outlined by New York Gov. Andrew Cuomo.
The drop in the number of orthopedic procedures caused by the COVID-19 pandemic will have a significant impact on first- and second-quarter revenues of heath systems nationwide, but Dr. Galatz insists that their main priority is providing critical care for patients in need.
"We will have to wait until the end of the year to see what kind of a rebound we can make. An illness like this that requires so many resources is a drain on the health system, but our focus right now is providing care and saving lives, so we'll have to worry about the finances later," she said.
Orthopedic device companies are preparing for an imminent ramp up period once procedures began to be rescheduled post-coronavirus. Hospitals will likely be overwhelmed with another surge in patients — this time orthopedic — but Dr. Galatz believes surgeons will be more than happy to be back doing what they were trained to do.
"There are so many people who postponed procedures and so many who are experiencing problems and waiting to seek treatment right now," Dr. Galatz said. "Going back to business as usual is going to be all hands on deck again, but I think orthopedic surgeons are going to be really happy to be busy doing what they do best. Physicians are going to feel good about getting back to it and it will also be good for the hospital financially."
Speaking about the lack of personal protective equipment nationwide, Dr. Galatz said that the shortage caused quite a scare for frontline healthcare workers, but Mount Sinai is now getting the supplies it needs.
"The supply chains have opened up and at this point people are able to get the equipment that they need," said Dr. Galatz, while noting the projected apex of the virus in New York City in late April. "Not having PPE is a source of anxiety for providers who know that the work is risky, and making sure we have enough of what we need is really important. Because the numbers are increasing, I think you can never feel like you have enough. Right now we're okay, but we really need more."
Gov. Andrew Cuomo said during an April 2 media briefing that if the current rate of coronavirus hospitalizations continues, New York would run out of ventilators. However, the state is taking several measures to prevent that from happening, including transporting ventilators to hospitals in need from facilities where they are unused and using anesthesia machine ventilators.
"Gov. Cuomo has provided a guiding light for the state of New York and has done a lot for our city," Dr. Galatz said. "He has united hospitals in their efforts so the hospital systems are communicating with each other. Healthcare providers, hospitals and health systems, as well as citizens of New York are comforted by him providing information, because that's really what people need in a crisis — communication and information."
"It's been really great to see people step up to help when we're really needed," she added. "Our focus is on doing the right thing, getting people taken care of and getting through this."