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Brief Reports, Book & Media Reviews, Correspondence, Errata: Letter to the Editor

Optimizing Clinical Staffing in Times of a Pandemic Crisis Such as COVID-19

Habib, Ahmed MD; Zinn, Pascal O. MD, PhD

Author Information
doi: 10.1213/ANE.0000000000004903
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To the Editor

With great interest, we read the article recently published by Mascha et al.1 Mascha et al1 discuss the logistics challenge that health care workers and institutions around the world are currently facing in the fight against coronavirus disease 2019 (COVID-19).2 At present, the COVID-19 pandemic is spreading across the world. The high infection rates and the mental stress of trying to stay healthy while providing health care to infected and possibly infected patients pose a challenge to the health workers across the world. Ensuring staff safety and operability is essential to ultimately providing optimal health care to any patients, if afflicted with COVID-19 or not. A bottle neck to overcome in times of such crises is shortages in staffing and possible staff burnout in the face of ever-increasing stresses to the health care system by a pandemic situation such as COVID-19. The need for a coordinated multidisciplinary approach across all medical specialties implicated and essential stake holders is of highest importance to address staffing issues in a pandemic setting as the here discussed article very elegantly demonstrates.3,4

Mascha et al1 proposed a staffing concept “pandemic-adjusted staffing” (Figure) that is based on comprehensive statistical modeling and simulations taking into consideration staff numbers and working hours, available intensive care unit (ICU) beds, and percentage of staff who could potentially get infected. Their seminal efforts go along with previous logistic scaling troubleshooting described by different groups from Singapore and United Kingdom.5,6

Adopting an adjusted staffing strategy is a vital part of logistic preparation during epidemics. A graphical representation of the routine staffing (A) and the adjusted staffing in pandemic setting implemented by our institution (B).

While Mascha et al1 described a model based on 84 staff members and 40 ICU beds, modifications of the proposed model should be considered for understaffed institutions as well as institutions with lesser logistics stockpile.

We had adopted a similar system to the one described in this study at our institution. The neurosurgery residents have been divided into 2 teams, alternating weekly with minimal contact between teams. By implementing this system, we minimized the risk of exposure and allowed the needed rest for the clinical staff in an effort to avoid burnout or subpar clinical care. We noticed that with this modified staffing schedule, clinical services including operating rooms and ICU care have not been negatively affected. This observation is in tune with the results presented here.

Finally, the need for grand-scale logistics preparation for pandemics has indeed proven vital. The core of any proposed measures to face pandemics should be to ensure adequate staff protection as well as taking into consideration any measures that may prevent possible staff burnout. This proposed pandemic-adjusted staffing system in this study represents a robust basis on which a reliable universal model could be developed for future health care–related crises management.

Ahmed Habib, MD
Pascal O. Zinn, MD, PhD
Department of Neurosurgery
University of Pittsburgh Medical Center and Hillman Cancer Center
Pittsburgh, Pennsylvania
[email protected]


1. Mascha EJ, Schober P, Schefold JC, Stueber F, Luedi MM. Staffing with disease-based epidemiologic indices may reduce shortage of intensive care unit staff during the COVID-19 pandemic. Anesth Analg. 2020;131:24–30.
2. James JJ. COVID-19: from epidemic to pandemic. Disaster Med Public Health Prep. 2020 [Epub ahead of print].
3. Bauer ME, Bernstein K, Dinges E, et al. Obstetric anesthesia during the COVID-19 pandemic. Anesth Analg. 2020;131:7–6.
4. Rajan N, Joshi GP. COVID-19: role of ambulatory surgery facilities in this global pandemic. Anesth Analg. 2020;131:31–36.
5. Wong J, Goh QY, Tan Z, et al. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth. 2020 [Epub ahead of print].
6. Willan J, King AJ, Jeffery K, Bienz N. Challenges for NHS hospitals during COVID-19 epidemic. BMJ. 2020;368:m1117.
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