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06 april 2020

Emergency Restructuring of a General Surgery Residency Program During the Coronavirus Disease 2019 Pandemic. The University of Washington Experience - JAMA Surgery

6-4-2020; doi:10.1001/jamasurg.2020.1219
By: Nassar, et al.

Aim: Describe the University of Washington experience with restructuring the surgical department in reaction to COVID-19

Keys: Essential restructuring of surgical department consists of physical distancing and re-evaluate team structure in order to continue to provide safe and efficient care. 


  • Anticipation on surgical staff affected by COVID-19 is necessary. Restructuring of the general surgical team is needed. 
  • Minimize exposure of surgical staff to COVID-19


    • Limit the number of residents with direct patient contact
    • Create independent resident-physician teams that are isolated from other teams
  • Essentials for successful restructuring:


    • Physical distancing (interteam distancing, intrateam distancing, handsoff communication (virtual), assigned bedside rounds


      • The senior resident on this service leads virtual rounds using medical record reviews of the patients and then assigns team members for bedside rounds based on clinical scenario. This minimizes the number of clinicians entering each patient room and eliminates groups of residents rounding in the traditional model
      • Create specific working spaces for individual residents, 1,5m apart 
    • Team structure (functionally independent teams, capability to withstand member loss, residents of all levels per team)
    • Macrostructure (supplement affected clinicians with research residents, include at-home residents in workforce)
    • Conceptual points (resident and faculty buy-in, quick conception and assembly, committee for the triaging and implementation of revisions)