Editor's note: This is the first in a two-part series outlining key steps to help your facility prepare for the return of elective surgeries. Part 1 covers case prioritization and scheduling. Part 2 will cover day-of-surgery through patient discharge.
The “Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic”[i] is an excellent guide for returning the elective patient to your operating room. Complementing this document, Surgical Directions has a number of recommendations for implementing a “COVID-safe” return of elective surgery to your operating room.
The operating rooms are the financial engine of most hospitals, and being nimble enough to recapture elective volume during this unique period is key. This means that hospitals should temporarily NOT return to the pre-pandemic block system. Using this system will significantly limit your ability to adjust to backlogged case demands. Working closely with surgeons, hospitals should consider temporarily reserving up to 80% of their OR capacity for day-to-day backlog management. The remaining capacity should be reserved for more urgent cases.
Here are some additional operational and management suggestions:
Leadership: Developing the specifics of this plan will require an empowered leadership group that represents surgeons (proceduralists), anesthesia, nursing and administration. A surgeon should chair this committee with additional surgeon membership representing an appropriate cross section of specialties. The chair should be carefully chosen and ideally be a leader who can facilitate collaborative agreement on the many operational issues required managing the elective backlog.
This committee should meet to develop and manage the specific components of the plan. This will include:
- Setting a date (or dates) for start-up
- Developing a fair and consistent prioritization strategy (this is key!)
- Assigning specific components of the plan to appropriate teams
- Developing a communication plan for keeping surgeons, their offices, and patients continually informed of updates and changes.
- Collecting appropriate data to assist the leadership group
- Defining clear roles and responsibilities
Prioritization and Scheduling Process: Building a prioritization and scheduling process that ramps up elective surgical care in a “COVID Safe” environment is a foundational requirement.
Properly scheduling these elective (and urgent) cases will require daily oversight. A dedicated and empowered multi-disciplinary group should meet daily, either face to face or virtually, at an assigned time to build the daily schedule based upon clearly delineated prioritization principles. To help ensure success, the group should work under the sponsorship and guidance of the leadership committee.
Building a schedule will require continual two-way communication with surgeons, their offices, and patients. Patient selection should be driven by readiness to commence.
It is recommended that surgeons submit their current and ongoing backlog to the hospital’s scheduling office. The schedule oversight team will work with surgeons, using a mutually agreed upon prioritization system, for scheduling of backlogged elective cases. The prioritization process should be based on a variety of patient, procedure, and urgency considerations. For example:
- Outpatient vs inpatient procedures
- Patient has been screened and deemed low risk for COVID-19
- Low risk vs more complex surgeries
- Co-existing disease
- The readiness of patient for surgery (i.e., chart completeness, financial clearance, etc.)
- Urgency of the case
- All else being equal – financial considerations such as case margin, payer coverage, etc.
Once the daily case load has been established, the schedule oversight team should align case order and room based on average case length and expected turn-over-time.
Surgical Directions can help you facilitate the return of elective surgeries to your operating room. We have developed state-of-the-art prioritization and scheduling process and tools that can be adapted to your unique needs. We can also help in building leadership teams needed for a safe and rapid return to “normal” operations.
This blog was co-authored by Brian Watha, Surgical Directions Associate Vice President of Consulting Services and Barbara McClenathan, Surgical Directions Director of Perioperative Nursing.