Early Experience Managing a High-volume Academic Orthopaedic Department During the Coronavirus Pandemic in New York City.

Our orthopaedic surgery department at Montefiore Medical Center and Albert Einstein College of Medicine is located within the Bronx, a borough of New York City, and serves a densely populated urban community. Since the beginning of the novel coronavirus outbreak in New York City, the medical center was forced to rapidly adapt to the projected influx of critically ill patients. The aim of this report is to outline how our large academic orthopaedic surgery department adopted changes and alternative practices in response to the most daunting challenge to public health in our region in over a century. We hope that this report provides insight for others facing similar challenges.

Overlapping and Concurrent Surgery: A Professional and Ethical Analysis.

Overlapping and concurrent surgeries form a continuum of simultaneous surgical practice in which a single surgeon has 2 or more patients in operating rooms at the same time. Undeniably, in an acute life-or-limb-threatening presentation, it may be essential for a surgeon to care for 2 individual patients simultaneously. These situations are different from scheduled elective surgery. Concurrent surgery is defined as the attending surgeon not being present for "critical and key" portions of a procedure. Billing for concurrent surgical procedures is a violation of the U.S. Centers for Medicare & Medicaid Services guidelines. The American College of Surgeons Statement of Principles (April 2016), adopted by the American Academy of Orthopaedic Surgeons, judges the practice of concurrent surgery to be "inappropriate." Overlapping surgery, although permissible under regulatory guidelines in the United States, presents substantial professional, bioethical, and legal concerns, and threatens our obligation as orthopaedic surgeons to respect the primacy of patient welfare and an individual's autonomy.

The TeamSTEPPS Approach to Safety and Quality.

Despite advances in patient safety since the landmark Institute of Medicine Report To Err is Human was published, adverse events and medical errors remain a persistent problem throughout health care. Safety experts have examined the practices in high-risk industries that maintain outstanding safety records for strategies to address the problem. Those efforts led to the development of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), a patient safety program that incorporates the principles of crew resource management and teamwork successfully used by industry into the health care setting. Evidence supports that the knowledge, skills, and attitudes, that comprise the core of TeamSTEPPS program, can improve safety and outcomes when used by members of the health care team. Successful implementation should assist the transition of health care workers from functioning as individual experts to performing as members of expert teams.

Improving outcomes: understanding the psychosocial aspects of the orthopaedic trauma patient.

The care of orthopaedic trauma patients with multiple injuries has dramatically improved in the past 25 years. The understanding of the physiology of trauma has evolved, new surgical approaches have been developed, and technologic advances have created better implants. New methods of treating fractures include fluoroscopic and computer-assisted imaging. Surgical interventions have changed from extensive and prolonged dissections to more limited and effective percutaneous and minimally invasive techniques. The lives of patients are being saved, and radiographic outcomes are improving; however, medical and surgical advances that achieve better radiographic and anatomic outcomes do not always improve functional outcomes. Understanding and optimizing the management of the psychosocial factors that affect trauma patients can improve outcomes.