RESUMEN
Singapore was one of the first countries to be affected by COVID-19, with the index patient diagnosed on January 23, 2020. For 2 weeks in February, we had the highest number of COVID-19 cases behind China. In this article, we summarize the key national and institutional policies that were implemented in response to COVID-19. We also describe in detail, with relevant data, how our vascular surgery practice has changed because of these policies and COVID-19. We show that with a segregated team model, the vascular surgery unit can still function while reducing risk of cross-contamination. We explain the various strategies adopted to reduce outpatient and inpatient volume. We provide a detailed breakdown of the type of vascular surgical cases that were performed during the COVID-19 pandemic and compare it with preceding months. We discuss our operating room and personal protective equipment protocols in managing a COVID-19 patient and share how we continue surgical training amid the pandemic. We also discuss the challenges we might face in the future as COVID-19 regresses.
Asunto(s)
Infecciones por Coronavirus/terapia , Prestación Integrada de Atención de Salud/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Necesidades y Demandas de Servicios de Salud/legislación & jurisprudencia , Neumonía Viral/terapia , Formulación de Políticas , Centros de Atención Terciaria/legislación & jurisprudencia , Procedimientos Quirúrgicos Vasculares/legislación & jurisprudencia , Atención Ambulatoria/legislación & jurisprudencia , Atención Ambulatoria/organización & administración , Betacoronavirus/patogenicidad , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Prestación Integrada de Atención de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/organización & administración , Departamentos de Hospitales/legislación & jurisprudencia , Departamentos de Hospitales/organización & administración , Interacciones Huésped-Patógeno , Humanos , Control de Infecciones/legislación & jurisprudencia , Control de Infecciones/organización & administración , Salud Laboral/legislación & jurisprudencia , Pandemias , Grupo de Atención al Paciente/legislación & jurisprudencia , Grupo de Atención al Paciente/organización & administración , Seguridad del Paciente/legislación & jurisprudencia , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/virología , Evaluación de Programas y Proyectos de Salud , SARS-CoV-2 , Singapur/epidemiología , Centros de Atención Terciaria/organización & administración , Carga de Trabajo/legislación & jurisprudenciaRESUMEN
The economic environment and the current health care debate have prompted a critical reevaluation of previous and current physician-hospital integration models. Even though the independent, self-employed, private practice, medical staff remains the most common model, surgical specialists such as vascular surgeons are increasingly being employed and integrated into health care delivery systems. The degree of integration varies from minimal to full integration or full employment. This review defines the forces driving these changes and analyzes the strengths and weaknesses of each employment model from the physicians' point of view. Strategies for the successful implementation of a 21st century integrative employment model are discussed.