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Health Care Delivery Models

Blueprint for Restructuring a Department of Surgery in Concert With the Health Care System During a PandemicThe University of Wisconsin Experience

Educational Objective
To understand how to restructure health systems in response to COVID-19

1 Credit CME

JAMA Surgery

Published Online: April 14, 2020

Special Communication

Article Information and Disclosures

Ben L. Zarzaur, MD, MPH¹;

Christopher C. Stahl, MD¹;

Jacob A. Greenberg, MD, EdM¹;

Stephanie A. Savage, MD, MS¹;

Rebecca M. Minter, MD¹

Author Affiliations

¹Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison

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Abstract

The current health care environment is complex. Systems often cross US state boundaries to provide care to patients with a wide variety of medical needs. The coronavirus disease 2019 pandemic is challenging health care systems across the globe. Systems face varying levels of complexity as they adapt to the new reality. This pandemic continues to escalate in hot spots nationally and internationally, and the worst strain on health care systems may be yet to come. The purpose of this article is to provide a road map developed from lessons learned from the experience in the Department of Surgery at the University of Wisconsin School of Medicine and Public Health and University of Wisconsin Health, based on past experience with incident command structures in military combat operations and Federal Emergency Management Agency responses. We will discuss administrative restructuring leveraging a team-of-teams approach, provide a framework for deploying the workforce needed to deliver all necessary urgent health care and critical care to patients in the system, and consider implications for the future.

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Article Information

Accepted for Publication: April 3, 2020.

Corresponding Author: Ben L. Zarzaur, MD, MPH, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Clinical Science Center, G5/335, Madison, WI 53792 (zarzaur@surgery.wisc.edu).

Published Online: April 14, 2020. doi:10.1001/jamasurg.2020.1386

Correction: This article was corrected on June 17, 2020, to add the names of Andrew T. Braun, MD, MHS, Rima Rahal, MD, and Joshua M. Glazer, MD, to the Additional Contributions section along with additional information on their involvement with the manuscript.

Author Contributions: Dr Zarzaur had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Zarzaur, Stahl, Greenberg, Minter.

Acquisition, analysis, or interpretation of data: Savage, Minter.

Drafting of the manuscript: Zarzaur, Stahl, Greenberg, Minter.

Critical revision of the manuscript for important intellectual content: Zarzaur, Stahl, Savage, Minter.

Administrative, technical, or material support: Zarzaur, Minter.

Supervision: Zarzaur, Savage, Minter.

Conflict of Interest Disclosures: Dr Greenberg reported grants from BD Interventional, grants from Medtronic, and other support from Intuitive outside the submitted work. No other disclosures were reported.

Additional Contributions: The authors wish to acknowledge the following colleagues at University of Wisconsin School of Medicine and Public Health: Anupama T. Joseph, MD, for assistance with language editing and proofreading, Karen L. Williams, BS, for assistance with figure illustration, and Marylou Hagen, PA-C, and Scot Johnson, NP, for assistance with development of the department of surgery response plan. We also wish to acknowledge Hee Soo Jung, MD, Andrew T. Braun, MD, MHS, Rima Rahal, MD, and Joshua M. Glazer, MD, who all assisted with creation of content included in tables and figures as well as the guiding principles developed as part of the intensive care unit response plan described in the manuscript. They were not compensated for their contributions.

References

McChrystal S . Team of Teams: New Rules of Engagement for a Complex World. Penguin Publishing Group; 2015.

Society of Critical Care Medicine. United States resource availability for COVID-19. Published March 19, 2020. Accessed March 26, 2020. https://sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19

Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19). Published February 11, 2020. Accessed April 1, 2020.https://www.cdc.gov/coronavirus/2019-ncov/faq.html

Guan W-J , Ni Z-Y , Hu Y , et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. Published February 19, 2020. doi:10.1056/NEJMoa2002032 PubMed Google Scholar

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.