‘We’re a nimble, tight-knit hospital’: Teamwork and drawing on ‘what we know’ behind success of MGH’s surgery department during pandemic

When the Ontario Ministry of Health asked hospitals across Ontario to ramp down elective surgeries in March to reserve capacity in response to COVID-19, there were two things running through Dr. Carmine Simone’s mind.

“My first reaction was an overwhelming concern for our patients,” says Dr. Simone, co-medical director of surgical services and medical lead of clinical programs at Michael Garron Hospital (MGH). “We’ve built our entire surgery program to whittle down wait times and increase access for our community and patients. But, at this time, there wasn’t much we could do.

“On the other hand, there was a sense of urgency to protect our staff,” Dr. Simone continues. “Since we didn’t know a lot about COVID-19 at the time, we didn’t want to put our staff in a position where coming to work could jeopardize their life or livelihood.”

In the days that followed the Ontario government’s directive to scale back non-essential healthcare services, MGH’s Department of Surgery came together swiftly to devise a plan that ensured the hospital could manage a potential spike in COVID-19 cases while still keeping the health and safety of its staff and existing patients in mind.

This involved building capacity by re-scheduling more than 1,000 elective surgeries between March and April. MGH’s surgical offices called patients to let them know their procedures had been postponed and stayed in contact with them throughout the next few months to keep them informed of the situation.

“Equally, if not more, important was letting our patients know when their rescheduled procedures would take place and ensuring them that these surgeries would be done in a way that would not expose them to risk,” says Dr. Simone.

The plan also involved what Dr. Desmond Lam, chief of Anesthesiology and co-medical director of surgical services, calls “building redundancy,” the process of doubling up or, in some cases, even “tripling up” MGH’s on-call schedule of surgeons, nurses, anesthesiologists and other healthcare practitioners in the event anyone fell ill or was incapacitated.

“We were preparing for the worst but, luckily, the worst never came,” Dr. Lam says. “We were never inundated with COVID-19 cases like in some jurisdictions, but it was still important that we had this plan in place.”

During this period, Dr. Simone and Dr. Lam met frequently with Jane Harwood, director of surgery, and Dr. Rajiv Singal, interim chief of MGH’s Department of Surgery, to touch base on the rapidly evolving situation. The team also held weekly town halls on Zoom where the general surgery team had the chance to ask leadership questions.

“We had to be really upfront with our staff that we were all learning together,” Jane says. “This was all new; none of us have been through a pandemic before.”

Although surgery services were considered “ramped down,” with many surgeons, nurses and anesthesiologists redeployed to other hospital areas during this time, MGH’s Department of Surgery continued performing emergency and high-priority procedures throughout the pandemic.

“We had rooms available for patients with critical issues so we continued providing that service,” Dr. Simone says.

When Toronto entered stage one of Ontario’s re-opening plan in May, allowing elective surgeries to take place again at hospitals, teamwork and a tried-and-tested system of triaging allowed the surgery team to get back on track as quickly and efficiently as possible.

The group used triage principles to determine which postponed procedures were of the highest priority. These included surgeries that, if further delayed, could adversely impact a patient’s ability to make a full recovery or affect their ability to lead a normal, functioning life.

“We make surgical triage decisions every day — even outside the pandemic — to ensure we’re using our hospital resources as best as possible,” says Dr. Singal. “So it was about drawing on our existing skillset and what we know to determine, once restrictions were lifted, which procedures needed to be done first and which ones could wait.”

The surgery team credits its close relationships with one another as well as with other hospital departments, such as the Pre-Operative Assessment Clinic (PAC), in its success in efficiently performing postponed procedures.

Since May, the Department of Surgery has completed more than 60 per cent of its backlogged cases. It hopes to reach more than 70 per cent by December.

“We’re a very nimble, tight-knit hospital,” Jane says. “It was really about the whole team — everyone on the frontlines — stepping up and coming together.”

The team also credits the leadership of MGH’s infection prevention and control (IPAC) physicians, led by Dr. Jeff Powis and Dr. Janine McCready, in helping to keep staff and patients as safe and informed as possible throughout the pandemic. “I think we have the best infectious disease consultants in the country, if not beyond that,” Dr. Simone says.

The last few months have been characterized by “never-ending change,” Dr. Lam says. But he’s confident the experience has placed MGH in a better position to manage COVID-19.

“We’re better prepared than we ever were not just for the pandemic, but from a general infection prevention and control perspective,” Dr. Lam says.

“I think the past few months have been quite inspirational,” adds Dr. Simone. “We served our patients the best we could and, as a team, we took care of one another and didn’t have any outbreaks among our staff. As a surgeon, physician and member of the healthcare community, the experience has reinforced to me that I’m in the right place and that this is what I’m meant to be doing.”