Risk Stratification
In order to define the working relationship for these small group partnerships, common otolaryngologic procedures were identified and risk-stratified based on existing evidence. Faculty and resident patient care roles were assigned based upon patient status, clinical care requirements, and mitigation of provider risk. Patients were categorized into three groups based on risk: COVID-positive patients, patients under investigation (PUI), and non-COVID/non-PUI. For this third category which may include asymptomatic carriers, a shared model of faculty/resident care was devised based upon provider experience and procedure risk.
Drawing from available evidence for the SARS-CoV-2 virus and related viral infections including SARS-CoV and MERS-CoV,6–10clinical patient encounters and procedures were divided into low risk and high risk categories. Special consideration was given to procedures with high potential for viral transmission by aerosol generation: endoscopy (nasal and laryngoscopy) and tracheotomy (Table 1). Levels of faculty and resident involvement were defined as faculty only direct patient care, direct supervision, and consultation followed by indirect supervision (Figure 1).