key: cord-0710214-dzb84mx4 authors: Sfez, Michel; Derichard, Alexandre; Cittanova-Pansard, Marie-Laure title: Turning a surgical unit into a COVID-19 facility: governance counts. Correspondence date: 2020-06-02 journal: Int J Surg DOI: 10.1016/j.ijsu.2020.05.080 sha: 5f7544eb3677d2f13f4ff06e396a3dc4b9a084b5 doc_id: 710214 cord_uid: dzb84mx4 nan The following additional information is required for submission. Please note that failure to respond to these questions/statements will mean your submission will be returned. If you have nothing to declare in any of these categories, then this should be stated. No author has any conflict of interest No funding has been required for this work Please state whether Ethical Approval was given, by whom and the relevant Judgement's reference number Please enter the name of the registry, the hyperlink to the registration and the unique identifying number of the study. You can register your research at http://www.researchregistry.com to obtain your UIN if you have not already registered your study. This is mandatory for human studies only. 1. Name of the registry: 2. Unique Identifying number or registration ID: 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Please specify the contribution of each author to the paper, e.g. study design, data collections, data analysis, writing. Others, who have contributed in other ways should be listed as contributors. Michel Sfez, Alexandre Derichard and Marie-Laure Cittanova-Pansard concieved the study Michel Sfez wrote the paper The Guarantor is the one or more people who accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. Please note that providing a guarantor is compulsory. Mari et al published 10 requirements to convert a surgical unit into a COVID-19 unit (1). It differs from transforming operating rooms into COVID-19 intensive care unit (ICU) (2) , so that these specific requirements are useful. Such a conversion was experienced in our institution in Paris during late March and April 2020. Although we agree with most of the aforementioned 10 steps, we would outline additional considerations. Governance is a major concern to provide adequate resources and clinical guidance. To reach both objectives, we developed a videoconferencing crisis management, by associating the institutional administrative and medical boards. This allowed us to create up to 20 post-ICU beds out of 99 surgery beds and 7 ambulatory cancer chemotherapy spaces within 24 hours, while emergency surgical capacities were maintained. In addition to the dedicated clean path for goods and staff, three independent circuits were organized, to avoid COVID-19 patients crossing paths with chemotherapy and surgery patients. The The balance between governmental instructions, resources availability and patients' care was continuously adjusted, with regard to updated scientific knowledge and pandemic evolution, by at least two weakly videoconferencing sessions: one between anesthesiologists and the other between the administrative and medical boards. From March 31 st to April 16 th , 24 COVID-19 patients were admitted; of those, 11 had transferred from an ICU, 1 came from home, and 13 arrived from a medicine or emergency department. Only one patient from a medicine department had to be retransferred to an ICU due to acute respiratory distress syndrome. No patients died. This experience underlines the pertinence of the 10-step guide of Italian colleagues along with the development of a mixed governance approach involving together the administrative and medical boards and the medical team under anesthesiologists' supervision. It allowed supportive care of patients presenting with various medical conditions in addition to the viral disease as their admission and discharge decision was a balance between healthcare needs and institutional capacities, constantly re-evaluated. A 10-step guide to convert a surgical unit into a COVID-19 unit during the COVID-19 pandemic Besoins en réanimation et réponse capacitaire. Message d'Alerte Rapide Sanitaire Provenance and peer review Not Commissioned X The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: