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Re-engineering and Transforming Care on the COVID-19 Front Lines

Amy J. Goldberg, MD, FACS
American Board of Surgery
Specialty: Surgery
Subspecialty: Surgical Critical Care

As the Coronavirus Disease 2019 (COVID-19) virus began to overwhelm hospitals in Seattle and New York, the team at the Temple University Health System (TUHS) started planning for the surge that was surely heading to Philadelphia.

“Fortunately, our Thoracic Medicine and Surgery Chairman, Gerard J. Criner, MD, had been in contact with a pulmonologist in Wuhan, China, the epicenter of the COVID-19 outbreak,” said Amy J. Goldberg, MD, Surgeon-in-Chief at TUHS. His advice? Place all patients with COVID-19 in a dedicated building to help the health care team provide the most consistent, up-to-date care and help contain the spread of the virus.

Physical Transformation
Almost immediately, Dr. Goldberg and Claire Raab, MD, Temple’s Associate Chief Medical Officer, set their sights on Temple’s Esther K. Boyer Pavilion. The nine-story building, a former pediatric hospital, housed 85 doctors’ offices over three floors and several inpatient floors. Centrally located, it is linked to the main hospital building by a covered bridge, which would make patient transfers easier.

Drs. Goldberg and Raab led a complex effort to safely re-engineer and transform the building to care for patients with COVID-19, including emptying spaces, moving furniture and equipment, hanging plastic sheeting, and stocking medical supplies. A 100-bed medical/surgical area and a 100-bed intensive care unit area were created. Every square foot was utilized, with two to four COVID-19 patients sharing a room to maximize the number of patients who had access to ventilators. With the help of a plastic-sheeting partition, the lobby of the building was transformed into an open-floor unit for 21 patients who were the most healthy and able to breathe on their own. Without wired call buttons available, each patient was given a cell phone that was programmed with nurses’ phone numbers. Opened in early March, this temporary hospital successfully housed 190 patients at its peak. By early June, as the COVID-19 surge waned, that number decreased to an average of 70 to 80 patients per day.

Care Transformation
Perhaps the most significant change was in the way care was provided to patients. According to Dr. Goldberg, “It was not unusual to look over and see the Orthopaedics Chair working elbow-to-elbow with an ophthalmologist at a patient’s bedside. All of the ‘silos’ between the specialties disappeared so that we could all just do what was best for our patients. All of us—no matter our training—took our lead from Dr. Criner and his team, who kept abreast of the very latest developments in this evolving pandemic.” Dr. Criner conducted daily rounds of all patients, set care plans, and determined who may be a good match for a clinical trial. In addition, to minimize exposure and reduce the use of valuable personal protective equipment, care was “clustered,” with staff providing as much care as possible each time they entered a room, including medications and temperature checks.

The Aftermath
Now on the other side of the COVID-19 curve, Dr. Goldberg is feeling optimistic. “I was absolutely humbled and re-invigorated by this experience. Seeing the entire Temple community come together to turn what was essentially an office building into a critical care hospital and take care of our community’s very sickest patients was incredible. Unfortunately, more surges are in our future, but I feel that we are better equipped to deal with them now.”

When asked if there was a particular patient with COVID-19 who affected her, she said that every patient was inspiring and humbling. “In less than ideal circumstances, with many of them sharing rooms, sleeping on cots, and unable to see their loved ones, these very sick and scared patients spent some of their limited energy thanking us for our efforts,” stated Dr. Goldberg.

Certified by the American Board of Surgery (ABS), Dr. Goldberg serves as Surgeon-in-Chief at Temple University Health System, a Philadelphia-based academic health system that is driving medical advances through clinical innovation, pioneering research, and world-class education. She serves on the Board of Directors for the ABS.

(Published: June 15, 2020)

Read more stories from the COVID-19 front lines.

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