key: cord-1021023-owuvw7ij
authors: Alvarez, Ronald D.; Goff, Barbara A.; Chelmow, David; Griffin, Todd R.; Norwitz, Errol R.; Lancey, John O.DE.
title: Re-Engineering Academic Departments of Obstetrics and Gynecology to Operate in a Pandemic World and Beyond – A Joint AGOS/CUCOG Statement
date: 2020-06-17
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2020.06.024
sha: b2f0d9219e53ddffba8ab982c055365f57817e74
doc_id: 1021023
cord_uid: owuvw7ij

Abstract The COVID-19 pandemic has significantly disrupted operations in academic Departments of Obstetrics and Gynecology throughout the U.S. and will continue to impact them for the foreseeable future. It has also created an environment conducive to innovation and the accelerated implementation of new ideas. These departments will need to adapt their operations to accomodate COVID-19 and to continue to meet their tripartite mission of clinical excellence, medical education, and women’s health research. This “Call to Action” paper from leaders of AGOS and CUCOG provides a framework to help leaders of Departments of Obstetrics and Gynecology re-imagine and re-engineer their operations in light of the current COVID-19 crisis and future pandemics.

The authors report no conflict of interests. 46

The COVID-19 pandemic has significantly disrupted operations in academic 67

Departments of Obstetrics and Gynecology throughout the U.S. and will continue to 68 impact them for the foreseeable future. It has also created an environment conducive to 69 innovation and the accelerated implementation of new ideas. These departments will 70 need to adapt their operations to accomodate COVID-19 and to continue to meet their 71 tripartite mission of clinical excellence, medical education, and women's health 72

research. This "Call to Action" paper from leaders of AGOS and CUCOG provides a Departments also re-engineered outpatient scheduling. There was emerging 110 evidence even prior to COVID-19 that a prenatal schedule with fewer than the traditional 111 12-14 visits is safe for average-risk pregnant patients. 4, 5 Many Departments adopted 112 reduced schedules for average-risk pregnant patients, a strategy endorsed by ACOG. 6,7 113

An example is provided in Table 1 . 114

Telehealth implementation was also accelerated. In March 2020, CMS 116 introduced interim measures that reduced or eliminated many barriers to the 117 widespread adoption of telehealth. 8 New rules allowed providers to use telehealth for 118 new and established patients from any location and allowed patients to have a 119 telehealth visit at their homes. Licensure accommodations allowed providers to perform 120 telehealth visits across state lines. Reimbursement for telehealth visits was allowed at 121 the same rates as in-office visits. These accommodations were widely adopted by other 122 payors. The number of telehealth visits grew significantly and was well received by both 123 patients and providers. 9 124 125 Until the pandemic resolves, Departments will have to monitor COVID-19 126 infection statistics at their institutions and in their communities, continue many of these 127 safety measures, and assess the health status of their clinicians and staff. They should 128 also continue to implement innovations to maintain reduced clinic visit schedules for 129 average-risk pregnant patients and promote the use of telehealth. The future of 130 telemedicine will depend largely on the long-term policies adopted by CMS and other 131 payors to replace the current emergency regulations but we must advocate for 132 telemedicine policy changes that improve access to care and reduce the burden for 133 many patients of travel to urban ambulatory settings. 134 135

Throughout this pandemic, maternity services have been uniquely challenged to 137 maintain a safe environment for patients and health care providers. Best practices have 138 been developed and will need to continue for the foreseeable future. Several of these 139 focused on the initial evaluation of patients and support persons presenting to a 140 maternity suite. A staff member in appropriate PPE was stationed either at the hospital 141 or maternity suite entrance to triage patients and their supporters. Patients and 142 supporters were masked and screened for fever and characteristic symptoms. 10 Many 143

Departments implemented universal testing upon admission regardless of symptoms. 144

One study, in a high-prevalence, area reported that 13.7% of patients tested positive 145 upon admission to L&D, of whom 88% were asymptomatic. 11 To limit exposures, 146

patients were restricted to one support person in labor, who was required to remain 147 sequestered in the patient's room. Use of surgical simulation will become more important for trainees to maintain their skills • Virtual teaching will need to be further implemented at all levels for students, residents/fellows, faculty, and community.

• Video-conferencing capabilities will need expansion to replace in-person learning for students/residents and professional meetings Clinical research programs were placed on hold

Every member of the research team should be considered as potentially SARS-CoV2 positive

Clinical research programs need to be redesigned to limit PPE utilization and interpersonal interactions (e.g., limiting clinical research to those studies with potential benefit, enhanced utilization of remote/virtual study subject consent) •

Laboratory based research will require stricter safety and screening measures.

Standard procedures need to be put in place for safe handling of research biospecimens potentially infected with SARS-CoV2 Herd immunity is a long way off

Cannot rely on herd immunity to solve this pandemic in the next few years

The more effective we are in containing the pandemic, the longer it will take to reach the 70% SARS-CoV2positive rate in the population required for herd immunity (SARS-CoV2 positive rates are currently <20% even in highrisk Ob/Gyn populations) An effective vaccine is a long way off

Do not rely on a vaccine to solve this pandemic in the next few years • It is not clear whether antibodies are protective against reinfection

An effective vaccine is likely a viable long-term solution, but remains distant. Once developed, an extensive implementation phase will be required.

A second surge is a real possibility

As we incorporate routine/non-emergent visits and surgeries back into our practice, we need to be vigilant about a second surge • Early data from South American suggest that COVID-• COVID-19 is not going away anytime soon; collaboration with public health epidemiologists and continued tracking of rates of infection/ hospitalization/deaths necessary for the next few years • Need to be prepared to back off reactivation ("pump the brakes') if a significant uptick in infections is detected

Outpatient ambulatory care settings: Responding to community 285 transmission of COVID-19 in the United States

Accessed 5/11/20

Interim infection prevention and control recommendations for patients with 289 suspected or confirmed Coronavirus Disease 2019 (COVID-19) in healthcare settings

Oschner Health introduces new prenatal digital medicine 293 program for Gulf South

Randomized comparison of a reduced-296 visit prenatal care model enhanced with remote monitoring

COVID-19 FAQs for obstetritian-gynecologists, obstetrics

None 280