PECULIAR FEATURES OF THE ORGANIZATION OF SURGICAL CARE IN A MULTIDISCIPLINARY HOSPITAL REPURPOSED TO PROVIDE CARE TO COVID-19 PATIENTS: THE STRUCTURE OF THE INCOMING FLOW AND THE METHODOLOGY OF SURGICAL WORK IN PANDEMIC

Abstract

The spread of a new coronavirus infection (NQVI) in St. Petersburg required the inclusion of the City Mariinsky Hospital in the system of care for infectious patients from April 2020. Once completely, twice partially, the hospital was repurposed into an infectious diseases hospital. In the new mode of operation, all patients with acute surgical diseases were provided with specialized emergency surgical care. The development of new management decisions was based on the structure of the incoming flow of surgical patients with COVID-19 and the «infectious» features of the course of surgical complications and diseases. The organization of the surgical care was influenced by a key factors: the need for long-term work of personnel in personal protective equipment (PPE), high temperatures in the premises, the difficulties of using means of communication, the peculiarities of medical document management, changes in the logistics of movement and the rules for processing surgical instruments, modes of operation of operating units, a special schedule for the work of surgical teams. The structure of diseases in patients with COVID-19 was dominated by acute surgical diseases of the abdominal organs, complications of the postoperative period requiring surgical correction (34–37%), lung and pleural injuries, including purulent, acute respiratory failure, in which a tracheostomy was required (25–35%). During the periods of repurposing, 801 operations were performed for current diseases and complications of NSVI. As a result of the adoption of thoughtful management decisions, correction of the staffing table of the surgical service, support units, the implementation of a set of anti-epidemic measures, it was possible to provide effective surgical care to all patients with NKIV who need it, reduce the incidence of medical personnel, and gain and analyze the experience of surgical work in difficult epidemic conditions.