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IN IT TOGETHER: Surgical team pulls together during time of change

Posted Jun 2nd, 2020

IN IT TOGETHER: Surgical team pulls together during time of change

This is part of a series of stories profiling members of the Niagara Health team and the work they are doing as part of our response to the COVID-19 pandemic. Meet Patty Welychka, Director of Clinical Services and Executive Lead and Chief Nursing Officer for the Welland and Port Colborne Sites.

During her 43 years in healthcare, Patty Welychka admits she’s never faced a bigger challenge than the response to the COVID-19 pandemic.

Patty, Niagara Health’s Director of Clinical Services and Executive Lead and Chief Nursing Officer for our Welland and Port Colborne sites, is part of the leadership team in our Surgical Program. At the beginning of the pandemic, the Provincial Government asked all hospitals to postpone elective surgeries and other non-emergent clinical activity to protect patient safety and increase capacity for healthcare workers to respond to COVID-19.

About 3,000 surgical procedures were put on hold at Niagara Health, but our team has continued to perform emergent and urgent surgeries. Each patient’s case is assessed by a medical team to determine their priority and treatment options. These decisions are reviewed on a regular basis, and if needed patient cases are reprioritized and new care plans developed.

Planning and implementing the changes were a big undertaking for Patty and the other members of the surgical program leadership — Chief of Surgery Dr. Ian Brown and Chief of Anaesthesia Dr. Don DuVall — and the front-line team.

“In all the 43 years, I’ve never been through anything like this, even though I’ve been through SARS, Ebola, H1N1 and H1N2. This is completely different,” says Patty, who worked as a Registered Nurse in various departments early in her career before moving into a leadership role. “When we went through those other times, we never had to slow down the surgical program and we didn’t see the change to this extent.”

Niagara Health recently received approval to move forward with the safe and gradual resumption of surgical, procedural and outpatient services over the coming weeks and months, using a phased approach.

The ability to proceed is dependent on hospitals meeting the criteria established by the Ontario Government for restarting. These criteria include a stable supply of personal protective equipment and medications, and maintaining 85% capacity in hospitals to ensure there is space for COVID patients.

How did you prepare to perform surgeries safely during the pandemic?

We immediately put together a team of experts to determine how we would continue emergency surgeries and time-sensitive surgeries and to develop a plan to ensure everyone was safe – patients, staff and surgeons. The first thing we did, based on evidence elsewhere, was to develop an ethical framework on how we were going to move forward with surgical procedures based on priority and need. Determining case prioritization was based on guiding principles. We had to make sure we had the right types of parameters in place with the equipment, the staff and the training, like the donning and doffing of the personal protective equipment (PPE). We also had to ensure we had the right PPE and we had to think about things like pre-screening of patients for COVID. One thing I was amazed with was the support from our surgeons and anaesthetists (doctors responsible for providing anaesthesia to patients for surgeries). They were all doing literature reviews and working with their colleagues across the country and around the world to make sure they were up to date.

What are some of the challenges and differences working during the pandemic?

Early on, something new came out on a regular basis with regard to policies and procedures because there were so many unknowns about the virus. Updates like the type of PPE our teams wear and the pre-screening of surgical patients. We had to be really resilient and flexible to make sure that as things changed across the province that we were adapting to those changes. Those changes included operating room air exchanges; we had to make sure we waited a certain amount of time in between procedures to ensure a safe environment. We also had to look at medications to make sure we had enough medication supply across the province before we could continue with anaesthesia. We were also dealing with the challenges of staff members who were worried about the unknown, and giving them the support they needed to have confidence and trust that we were prepared and keeping everybody safe.

What was key to implementing the required changes?

We were constantly talking, communicating and keeping all team members up to date on the latest information. The commitment from the team is what really made this work and the constant communication right up front, which included a virtual town hall to provide the latest information and to allow our team members to ask questions. Throughout this, people have had so many questions. Dr. Brown and Dr. DuVall have been amazing at working with Dr. Karim Ali (NH’s Director, Division of Infectious Diseases) and their colleagues in getting back to people with the information they were looking for.

Describe your team’s effort during the pandemic?

The leaders within the surgical program, the clinical managers, and their pre-op nurses and the surgeons were the people who really were the gel that pulled this off at an operational level. Myself, Dr. Brown and Dr. DuVall were there to think about the overall strategy of what we needed to do, but when you get to the front line, they are the ones who had to make it happen. They are the ones who had to support their teams and make sure operationally that everything worked. I have been very pleased about the camaraderie amongst the teams across our sites and the willingness for managers to exchange staff if they were short staff and the willingness for surgeons to go to another site where they typically would not perform surgeries. It has really pulled the entire team together. Everybody was willing to do whatever it took to do this right.

What are some of the key aspects to resuming surgeries that were postponed and the ones that had been previously scheduled for the next few months?

Our commitment to complete the postponed cases and any of the pre-scheduled surgeries that had been booked for the coming months is at the top of our priority list and they will all be prioritized based on our ethical framework. As we move forward, we want to make sure we have the capacity to do that and we need to make sure we have the teams in place and the operating room structure in place. The safety of our patients and our team is our highest priority. Our planning is based on the latest evidence and literature. We have developed a surgical and procedural oversight committee, which will meet on a weekly basis to evaluate a set of criteria before we can continue with surgery. Some examples are: we are looking to see if the community hasn’t seen a large increase in COVID cases; we’re looking at the availability of surgical inpatient and Intensive Care Unit beds and we’re making sure we have enough personal protective equipment for our team and a stable supply of medication. We’re making sure we have discharge services in the community with home and community care support. And we’re also managing our wait list to make sure we’re working through that ethical framework, which every patient’s case was put through. It’s our way of managing prioritization of the surgeries. Our Operating Room Booking Manager and the scheduling team planning and organizing the upcoming weeks’ plan of care will have a vital role in all of this. Despite there being a lot of change, what remains constant is our focus on the Niagara Health CORE values and providing extraordinary care, every person, every time. 

Click on the In It Together button below to read more stories about our team.

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