Zach Ferraro and Evan Tannenbaum, residents in obstetrics and gynaecology, describe how their hospital has established new workflows that have allowed them to resume practice with something like normality

In mid-March we began hearing word that the seriousness of covid-19 would warrant near complete social and economic closures. Soon, concerts were cancelled, flights grounded, businesses forced to lock their doors, and international borders blockaded. Clinics and operating rooms were no exception to the altered workflow. Life was changing right before our eyes in a way that our generation of trainees had never seen before.

As hospitals and clinics prepared to combat the virus, and social distancing measures continued, it was uncertain when some semblance of normalcy would return. This uncertainty was compounded with cancelled exams, workforce redeployments, and hospital protocols that seemed to change daily, as new research about the virus emerged. It was a tense time for everyone.

People cope with uncertainty and stress differently; there’s no question about that. From our view, team morale has benefited greatly from “checking in” on one another. A simple, “How are you?” or, “Is everything alright?” really does wonders when asked frequently, acknowledges your concern, and comes from a genuine place. We are so fortunate to be blessed with friends, families, and colleagues who continually remind us that we’re all in this together.

While we are uncertain if these gestures have a direct, measurable impact on patient outcomes, one thing is clear: they work towards fostering a sense of trust and a feeling of relief between patients and physicians—a small reminder that we are not alone. 

As residents in obstetrics and gynaecology (OB/GYN), our widespread and collective efforts seek to ensure both the safety of healthcare providers and the delivery of competent and compassionate care for mothers and their newborns. The achievement of these goals is dependent on effective communication and teamwork, especially in these trying and uncertain times.

A decision was made to relocate most of our workforce to labour and delivery. Senior residents agreed to take on more call to help reduce the workload of the team should any of our colleagues be forced to take time off due to signs, symptoms, or a diagnosis of covid-19. We received daily departmental updates about both the current census of COVID+ cases and persons under investigation, informing us of their clinical status. Weekly “code” simulations on the labour floor continue to help instil confidence, improve workflow efficiencies, and ensure proper donning and doffing of personal protective equipment (PPE).

These skills were again reinforced at the hospital level. A dedicated departmental committee on covid-19 disseminates new information as it becomes available and informs us about changes to care pathway logistics and resource allocation. We all participate in frequent virtual update meetings and weekly Zoom town halls as another way to check in with each other, share a concern, a laugh, and occasionally a lead on a new craft brewery with contactless delivery.

Our resident leaders, site chiefs, clinical staff, and administration have all fought tirelessly to secure necessary PPE and to ensure their proper use. Despite the extra precautions, we are still able to communicate and connect with patients and colleagues in a meaningful way. To us, that has been the most profound change (or lack thereof). 

While the halls and rooms of labour and delivery remain largely unchanged—with the exception of newly required PPE, new signage, and the occasional COVID+ (or “under investigation”) patients—the floor still has the same Groundhog Day ambiance: will the patient in 6 deliver or are we heading for C-section? In triage (labour assessment), have the patient’s water broken? Which patient should take priority? And, so on.

Does this routine mean we are winning the fight against covid-19? Perhaps the absence of significant palpable change is a testament to the emotional and physical sacrifices of those that work to update every single aspect of patient flow and the provision of care in the era of covid-19. Whether it be spending an extra minute with a family to answer their questions related to covid-19 or heading to the OR for an emergency cesarean in full PPE, we are prepared. We are ready. It is starting to feel “normal.” 

Witnessing the variety of initiatives underway seeking to inspire change and foster hope is truly a privilege: photo diaries that praise the unsung heroes of healthcare; the senior colleague who reminds us that it is “okay” to not have all the answers; and the establishment of the COVID-19 Women’s Initiative, an innovative public health platform that provides real time maps of reproductive health services available to women. For these efforts, and the many, many more, we are here to say, thank you. We thank those who work to make the growing pains associated with our new reality a little bit easier to bear. Because of you, we can continue caring for our patients safely, effectively, and with the same standard of compassion and humility to which we are accustomed.

In the words of Canadian physician Sir William Osler: “the best preparation for tomorrow is to do today’s work extremely well.” His words resonate now more than ever before as we fight—one day at a time—against covid-19 together. In a high stakes area of medicine where acuity is omnipresent, we think we are doing today’s work extremely well.

Zach Ferraro is a first year OB/GYN resident at the University of Toronto and former CIHR research fellow in human development and child health. @DrFerraro 

Conflicts of Interest: none declared. 

 

 

Evan Tannenbaum is a fifth year OB/GYN resident at the University of Toronto. @TannenbaumEvan

Conflicts of Interest: none declared.