How ‘Surge Staffing’ Can Help Fight COVID-19 More Effectively

Kate Tulenko, MD, MPH, MPhil; Natasha D'Lima, MHM


April 14, 2020

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The world has been reeling under the spread of the new coronavirus. Much has been said about protecting health care workers, but almost nothing has been said about surge staffing for when patient loads double and triple in most hospitals.

Kate Tulenko, MD, MPH, MPhil

Even before the pandemic, every region in the world already suffered from a shortage of physicians, nurses, and other healthcare workers to care for their regular load of patients. COVID-19 pushing droves of people into hospitals compounds this existing predicament, putting inordinate pressure on healthcare workers. This pressure and the high patient-to–healthcare worker ratios lower the quality of care given and increase the risk of loss of healthcare workers to COVID-19, exhaustion, stress, and burnout.

It's now time for countries and systems to focus on surge staffing and tap into hitherto unused reserves of healthcare workers to bolster the healthcare workforce and meet the exponential increase in demand for their services in hospitals and health systems worldwide.

Health systems need to do what in the field of medicine is called "task shifting," and decide what type of tasks will be done by existing healthcare workers and what less complex but equally vital tasks will be done by newly onboarded healthcare workers, many of whom may not have worked at the hospital level for years. The design of new surge teams needs to be decided.

How to Do Task-Shifting

For example, one ICU attending may lead a team of five community doctors for the medical management of a large ICU. A senior ER nurse could lead a team of five community nurses to screen or care for patients in the ER. Emergency contracts must be created to bring these new workers onboard. Licensing and medical malpractice issues must be arranged with regulators, insurers, and governments.

The federal government has already taken a large step in allowing US licensed physicians to work across state borders, and states are waiving restrictions on other healthcare workers. Many governments will waive COVID-19 malpractice lawsuits during this crisis, but this needs to be documented. We must develop short, competency-based trainings and job aids to get surge staff up to speed on the management of COVID-19 patients.

Most important, every facility needs to create a list of healthcare workers who have agreed to work in the hospital during the COVID-19 surge. Local hospital associations can help as well to ensure that healthcare workers who are available to work are distributed to local hospitals according to need.


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