Deferment of medical care during the pandemic has had negative consequences for patients and providers. And even now, with most states lifting restrictions on so-called elective surgeries, the issue of how to quickly and effectively restart these services could bring unintended consequences.
Ambiguous policies and procedures for scheduling and distributing resources across elective surgical cases can create bottlenecks that impede overall hospital operations, a group of clinical and operations management leaders at Johns Hopkins recently noted in the Harvard Business Review. Likewise, restart strategies that fail to provide equitable access to care inadvertently may favor economically advantaged patients while reinforcing existing disparities in access and quality.
The authors explain that most elective surgical cases fall somewhere between vital preventive measures (e.g., colonoscopy screenings) and essential surgery (e.g., cataract surgery) and that clinical research across surgical specialties demonstrates worse patient outcomes and higher costs when these treatments are delayed.
They offered several strategies that health care leaders can employ to meet their clinical goals while striving for better operational efficiency and equity in access to care, including:
Simplify Patients’ Surgical Care Experiences
Deploying dedicated surgical navigators can help patients by providing logistical planning information and critical visibility to financial and clinical information. These navigators can assist with preoperative appointments and requisite work-up including COVID-19 testing, telemedicine logistics, day-of-surgery arrival and drop-off details, and postoperative care coordination.
Form Dedicated Teams to Improve Operating Room Efficiency
Hospital and surgical leaders often expect that staff should cross-train to work interchangeably with a diverse range of surgical teams. The idea is to optimize use of limited resources and ease staffing restraints, but these models often can generate significant inefficiency in the OR, the authors state. Substantial research shows that dedicated OR teams help increase throughput, lower error rates, reduce waste and improve satisfaction among team members.
Develop Bias-Aware Algorithms to Prioritize Surgeries
Algorithms already are being developed to automatically prioritize patients in real time. Johns Hopkins Medicine‘s Hopkins Business of Health Initiative is working on one such algorithm. It considers: surgical risk factors (e.g., patient age, surgical urgency), capacity requirement factors (e.g., OR time, personal protective equipment consumption, intensive care unit bed requirements), and COVID-19 risk factors (e.g., COVID-19 status, case transmission risk and COVID-19-specific comorbidities) to provide consistent, systematic prioritization decisions among those patients in need of elective surgery. The trick will be to ensure that algorithms are aware of potential biases and are transparent and consistent.