Editorial: Task Sharing for Neurosurgeons Amidst the COVID-19 Pandemic
Key findings
- Task sharing—having specialists collaborate with non-specialist physicians and other providers—is a health systems strategy for workforce expansion
- Task sharing is relevant in low resource settings, during disaster response and safer than task shifting, where clinical autonomy is fully transferred from highly qualified providers to those with shorter training or fewer qualifications
- Many centers are assigning "contaminated" and "clean" teams to separate wards
- Health care systems must clearly define job scope for those entering new roles, including when to seek consultation for complex cases
- If the pandemic is prolonged, neurosurgical departments may need to establish "green zones" where urgent or elective cases are performed in a separate location
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Health care systems are accustomed to reassigning staff to expand coverage in a crisis. However, the situation with COVID-19 is unique. Even experts in infectious disease and critical care are facing a learning curve in how to treat the disease, and the high risk of personal infection compounds the feelings of discomfort inherent to assuming a new role.
In an editorial in the Journal of Neurosurgery, Faith C. Robertson, MD, MSc, of the Department of Neurosurgery at Massachusetts General Hospital, and colleagues outline how health care systems can implement task sharing to strengthen their workforces during the pandemic.
Overview of Task Sharing
Research in low-resource medical and surgical settings has shown that task sharing is safer than task shifting:
- Task shifting — clinical autonomy is transferred from highly qualified health care workers to those with shorter training or fewer qualifications
- Task sharing — teams of specialists, non-specialist physicians and other health care workers share clinical responsibility, relying on iterative training and communication
If patient burden exceeds provider capacity, there will be pressure to use a task-shifting approach, but task sharing is preferred. It has three phases: training, practice and maintenance.
Training Phase
The major need is to redistribute providers in a way that minimizes things to be learned and ensures adequate reserves of those with setting-specific expertise:
- The most experienced neurosurgeons are in the most vulnerable age groups, so their efforts may best be applied to neurosurgery-specific COVID-19 cases, telemedicine encounters or guiding ethical decision-making on neurosurgical interventions
- Attending physicians with critical care experience may need to oversee medical ICU care
- Residents adept in neurocritical care and placing central lines can undergo intensive training in intubation and ventilator management
- Residents staffing neurosurgery services can work remotely when possible and serve as a buffer in case on-site residents become ill and/or require quarantine
The reduction in neurosurgical patient load permits reassignment of other faculty, residents, advanced-practice providers and, in the U.S., final-year medical students to support COVID-19–specific care. Many centers are assigning "contaminated" and "clean" teams to separate wards.
A number of medical societies have released free webinars and podcasts about COVID-19 management. Departments may also benefit from designating "coaches" to ensure proper donning, doffing and reuse of personal protective equipment (PPE).
Practice Phase
Health care systems must clearly define job scope, including when to seek consultation for complex cases. This is important for preventing "task creep" (acting beyond permissible guidelines).
When neurosurgical staff join medicine services, they will need to engage humbly in multidisciplinary teams supervised by internal medicine attendings and residents.
Maintenance Phase
Short-term priorities are to help newly trained staff thrive for as long as needed, with an adequate supply of PPE and timely dissemination of new information. It is also important to address the physical, emotional and moral stress providers feel because of isolation and care rationing.
If the virus is not seasonal and there is geographic recurrence, task sharing may have to extend into 2022, and surgeons will reassess which cases can be delayed. Departments may need to establish "green zones," as Switzerland neurosurgery is doing, where urgent or elective cases are performed in a separate location, and providers and patients require negative COVID-19 tests and chest radiographs before entering.
Prepare Now
Some cities and countries have not yet experienced the virus at its peak. Neurosurgeons in those locations can begin task sharing to strengthen their workforce, while continuing to triage operative cases and creating contingency plans in case the pandemic is prolonged.
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