Otolaryngology Resident Practices and Perceptions in the Initial Phase of the U.S. COVID-19 Pandemic

Otolaryngology Resident Practices and Perceptions in the Initial Phase of the U.S. COVID-19 Pandemic

The coronavirus 2019 (COVID19) pandemic has had widespread implications on clinical practice at United States (U.S.) hospitals. These changes are particularly relevant to otolaryngology – head and neck surgery (OHNS) residents, as reports suggest an increased risk of contracting COVID19 for otolaryngologists.

The objectives of this study were to evaluate OHNS residency program practice changes and characterize resident perceptions during the initial phase of the pandemic.A cross-sectional survey of U.S. OHNS residents at 81 programs was conducted between March 23-29, 2020.82 residents from 51 institutions (63% of invited programs) responded. At time of survey, 98% of programs had enacted policy changes to minimize COVID19 spread.

These included filtered respirator use for aerosol-generating procedures even in COVID19-negative patients (85%), decreased resident staffing of surgeries (70%), and reduced frequency of tracheotomy care (61%). The majority of residents (66%) perceived that residents were at higher risk of contracting COVID19 compared to attendings. Residents were most concerned about protective equipment shortage (93%) and transmitting COVID19 to patients (90%).

 Otolaryngology Resident Practices and Perceptions in the Initial Phase of the U.S. COVID-19 Pandemic
Otolaryngology Resident Practices and Perceptions in the Initial Phase of the U.S. COVID-19 Pandemic

The majority of residents (73%) were satisfied with their department’s COVID19 response. Resident satisfaction correlated with comfort level in discussing concerns with attendings (r=0.72, p<0.00001) and inversely correlated with perceptions of increased risk compared to attendings (r=-0.52, p < 0.00001).U.S.

OHNS residency programs implemented policy changes quickly in response to the COVID19 pandemic. Sources of resident anxieties demonstrate the importance of open communication and an integrated team approach to facilitate optimal patient and provider care during this unprecedented crisis.

Utility of Tracheostomy in Patients with COVID-19 and Other Special Considerations

Patients who become severely ill from COVID19 have a high likelihood of needing prolonged intubation, making tracheostomy a likely consideration. The infectious nature of COVID19 poses an additional risk of transmission to healthcare workers that should be taken into consideration.

We explore current literature and recommendations for tracheostomy in patients with COVID19, and look back at previous data from SARS-CoV-1, the virus responsible for the SARS outbreak of 2003.

Given the severity and clinical uncertainty of patients with COVID19 and the increased risk of transmission to clinicians, careful consideration should be taken prior to performing tracheostomy. If tracheostomy is performed, we recommend a bedside approach to limit exposure time and number of exposed personnel.

Bronchoscopy use with a percutaneous approach should be limited in order to decrease viral exposure. Thorough preprocedural planning, use of experienced personnel, enhanced PPE where available, and a thoughtful anesthesia approach are instrumental in maximizing positive patient outcomes while successfully protecting the safety of healthcare personnel.

Patients who become severely ill from COVID19 have a high likelihood of needing prolonged intubation, making tracheostomy a likely consideration.

The infectious nature of COVID19 poses an additional risk of transmission to healthcare workers that should be taken into consideration. We explore current literature and recommendations for tracheostomy in patients with COVID19, and look back at previous data from SARS-CoV-1, the virus responsible for the SARS outbreak of 2003.

Given the severity and clinical uncertainty of patients with COVID19 and the increased risk of transmission to clinicians, careful consideration should be taken prior to performing tracheostomy. If tracheostomy is performed, we recommend a bedside approach to limit exposure time and number of exposed personnel.

Bronchoscopy use with a percutaneous approach should be limited in order to decrease viral exposure.

Thorough preprocedural planning, use of experienced personnel, enhanced PPE where available, and a thoughtful anesthesia approach are instrumental in maximizing positive patient outcomes while successfully protecting the safety of healthcare personnel.

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