• Sanjay R Parikh, Jeffrey R Avansino, Andre As Dick, Brianna K Enriquez, Jeremy M Geiduschek, Lynn D Martin, Ruth A McDonald, Suzanne M Yandow, Danielle M Zerr, and Jeffrey G Ojemann.
• Departments of Surgery, Seattle Children's Hospital, Seattle, WA; Departments of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA. Electronic address: sanjay.parikh@seattlechildrens.org.
• J. Am. Coll. Surg. 2020 Aug 1; 231 (2): 269-274.e1.

AbstractWashington was the first US state to have a patient test positive for COVID-19. Before this, our children's hospital proactively implemented an incident command structure that allowed for collaborative creation of safety measures, policies, and procedures for patients, families, staff, and providers. Although the treatment and protective standards are continuously evolving, this commentary shares our thoughts on how an institution, and specifically, surgical services, may develop collaborative process improvement to accommodate for rapid and ongoing change. Specific changes outlined include early establishment of incident command; personal protective equipment conservation; workforce safety; surgical and ambulatory patient triage; and optimization of trainee education. Please note that the contents of this manuscript are shared in the interest of providing collaborative information and are under continuous development as our regional situation changes. We recognize the limitations of this commentary and do not suggest that our approaches represent validated best practices.Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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