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).