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March 31, 2020: Gyn Oncology Reassignment during the COVID-19 Pandemic
Given the rising burden of COVID-19 on institutions throughout the country, many hospitals are adapting with the reassignment of both medical and administrative staff members. We offer the following guidance and opinion to our members in order to help them discuss their potential reassignment outside the practice of Obstetrics and Gynecology, with their respective leadership. This document may require modification as the COVID-19 pandemic evolves and further resource stratification needs to be revisited.
Gynecologic Oncology Inpatient and Outpatient Need:
As outlined in a previous SGO communication about the ongoing care of gynecologic oncology patients, gynecologic oncologists have the following ongoing responsibilities that should preclude their reassignment:
- Continued obligation to see new urgent and emergent cancer cases
- Continued obligation to oversee ongoing chemotherapy and radiation of patients and support medical oncology providers, as needed
- Continued obligation to operate on urgent and emergent cancer cases and to help gynecology colleagues with select gynecologic surgical emergencies
Gynecologic Oncology Coverage:
At most centers throughout the country, gynecologic oncologists provide back-up and support for obstetrical hemorrhage, gynecologic hemorrhage, and complicated benign pelvic pathology. Additionally, at many hospitals, the number of active gynecologic oncologists is limited in number. During the current crisis, given the need for efficient use of medical and surgical staff, gynecologic oncologists can be used to provide the following services to Obstetrics and Gynecology Departments on a 24-hour, 7 day-a-week basis:
- Obstetrical hemorrhage support
- Urgent and emergent benign surgery
- Urgent and emergent cancer surgery
- Urgent and emergent surgical consults by other hospital services
- Cesarean delivery support
The SGO hopes that the information provided will help each of our members discuss the efficient use of their medical and surgical expertise with their hospital’s leadership during the COVID-19 pandemic.
April 14, 2020, ADDENDUM: Palliative Care (for the Non-Palliative Care Specialist):
Due to the COVID-19 crisis there is a sudden increase in critically ill patients who need to have their goals of care and code status clarified. Many of these conversations need to take place with patients who are actively in distress and/or with family members who are unable to visit their sick loved ones. Gynecologic oncologists, whether or not they have palliative care fellowship training, have advanced communication skills and experience conducting difficult goals of care conversations. In institutions where the volume is more than can be handled by the Palliative Care Team, gynecologic oncologists can be used to provide the following services to off-load that burden:
- Conduct goals of care conversations with families of intubated patients via telemedicine
- Conduct goals of care conversations with patients in the ER, on the floor and in the ICU prior to intubation. Emphasis should be placed on attempting these conversations via telemedicine to decrease use of PPE (and decrease potential exposures for gynecologic oncologists who are also caring for immunocompromised gynecologic cancer patients)
- Provide basic assistance with initiating comfort measures, including management of pain and other symptoms
In the time of the COVID-19 pandemic, it is appropriate for gynecologic oncologists to assist in the care of patients and families regardless of the patient’s gender. It is preferable for gynecologic oncologists to work in concert with a palliative care specialist who can provide guidance in particularly difficult social or clinical scenarios.