Getting back to work: A framework and pivot plan to resume elective surgery and procedures after COVID-19

Abstract

Introduction The COVID-19 pandemic has compelled a majority of hospital systems to reduce surgical and procedural volumes in an attempt to preserve resources. Elective surgery and procedures (ESP) resumption has proven to be a calculated risk between COVID-19 exposure and resource depletion and patient morbidity and mortality from surgical deferral. Methods Within a few days of halting ESP, our 7-hospital (2427 in-patient beds, 26,647 inpatient surgeries) healthcare system developed a multidisciplinary Pivot Plan with the primary outcome of a phased resumption of ESP. The plan entailed the integration of our electronic medical record, order entry automatization, perioperative staff utilization, partnering with primary care providers, and a step-wise COVID-19 testing algorithm based on a pre-determined hierarchy of case acuity and timeliness of patient care. Results The Pivot Plan was instituted on May 10, 2020. Since then, 22,624 patients have been tested for COVID-19 in anticipation of an ESP; 140 (0.62%) tested positive for COVID-19 and had their procedure deferred. As our testing capability has increased, we have been able to increase our added ESP capacity from 13 cases per day to 531 cases per day. In turn, we have seen the case volume increase by 52%. Conclusion Our academic healthcare system located in one of the initial COVID − 19 hotspots in the United States has successfully resumed ESP in part due to a receptive and supportive culture, based upon nimbleness, agility, and rapid integration of multiple resources from a cohort of diverse disciplines applied to the perioperative services workflow.

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