Patient-Centered, Gynecology-Specific Prioritization of Nonurgent Surgeries during the COVID-19 Pandemic: Proposal of a Novel Scoring System

Borahay, Mostafa A.; Wethington, Stephanie L.; Wang, Karen C.; Christianson, Mindy S.; Martin, Stephen; Lawson, Shari; Esguerra, Cybill R.; Lippitt, Melissa; Wu, Harold; Handa, Victoria L.; Satin, Andrew J.; Fader, Amanda N.

doi:10.1016/j.jmig.2020.05.026

Cited by 8 publications

(7 citation statements)

References 8 publications

(32 reference statements)

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“…Due to the large variety of surgical procedure types performed at both institutions, we did not consider changes in individual gynecologic procedures or surgical indications. Gynecologic surgical practices during this public health crisis were likely influenced by published professional society guidelines for modifying surgical practice during the COVID-19 pandemic [ 22 – 24 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on gynecologic and obstetrical services at two large health systems

et al. 2022

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Background The COVID-19 pandemic disrupted medical care in the US, leading to a significant drop in utilization of some types of health services. We sought to quantify how the pandemic influenced obstetrics and gynecology care at two large health care organizations. Materials and methods Comparing 2020 to 2019, we quantified changes to obstetrics and gynecology care at two large health care organizations in the United States, Allegheny Health Network (in western Pennsylvania) and Johns Hopkins University (in Maryland). The analysis considered the numbers of surgical encounters, in-person visits, and telemedicine visits. For each system, we quantified temporal changes in surgical volume, in-person and telemedicine visits, and financial impact related to professional fee revenues. We used segmented regression to evaluate longitudinal effects. Results At both institutions, the volume of care was similar in the first few months of 2020 compared to 2019 but dropped precipitously in March 2020. From April to June 2020, surgical volumes were 67% of the same period in 2019 at Allegheny Health and 48% of the same period in 2019 at Johns Hopkins. During that same interval, televisits accounted for approximately 21% of all ambulatory care at both institutions. Although surgical and ambulatory volumes recovered in the second half of 2020, annual surgical volumes in 2020 were significantly lower than 2019 at both institutions (p<0.05) and 2020 ambulatory volumes remained significantly lower at Johns Hopkins (p = .0006). Overall, revenues in 2020 were 91% of 2019 revenues for both institutions. Conclusions Obstetrical and gynecologic ambulatory visits and gynecologic surgeries were sharply reduced during the COVID-19 pandemic. Although care volumes returned to 2019 levels in late 2020, we observed an overall reduction in the volume of care provided and a 9% reduction in professional revenue for both institutions.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on gynecologic and obstetrical services at two large health systems

et al. 2022

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“…A number of other scoring systems and algorithms have been proposed to guide decision making for prioritisation of surgeries during the COVID-19 period. These include broadly applicable tools such MeNTS [7], designed for use on a wide range of surgical specialties, as well as specialtyspecific tools such as the Johns Hopkins Gynaecologic Prioritisation System [12] (JH-GPS). The Spine Urgency Score is another such tool [13], jointly developed by neurosurgeons and Orthopaedic spine surgeons for prioritising spine surgery cases in resource-limited settings.…”

Section: Discussionmentioning

confidence: 99%

The MeNT-OS Score for Orthopaedic Surgery: An Objective Scoring System for Prioritisation of Orthopaedic Elective Surgeries During a Pandemic

Prabhakar

Decruz

Kunnasegaran

2021

IJOO

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Introduction The reintroduction of elective Orthopaedic surgery during the COVID-19 pandemic is likely to occur in phases, dictated by resource limitations and loco-regional pandemic status. Guidelines providing a general framework for the prioritisation of surgery have largely been based on surgical urgency, while scoring systems such as the MeNTS score may have limited applicability in the setting of Orthopaedic Surgery. We, therefore, propose an Orthopaedic-specific algorithm (‘MeNT-OS’), based on a modification of the MeNTS scoring system, that may be used to objectively triage and prioritise Orthopaedic cases during the COVID-19 pandemic. Methods We developed a scoring algorithm modified from the Medically Necessary Time-Sensitive Procedure (MeNTS) score with 13 unique variables, reflecting human and physical resource utilisation, surgical complexity, functional status of patients, as well as COVID-19 transmission risk. This score was then trialled in a sample of 118 cases, comprising 69 completed and 49 postponed cases. A higher overall score was intended to correlate with lower surgical prioritisation. Results The use of our scoring system resulted in higher average scores for postponed cases compared to completed cases, as well as higher median, 25th and 75th percentile scores. These results were statistically significant and showed concordance with the ad hoc decisions made before the scoring system was used, with the lower scores for completed cases suggesting a more favourable risk–benefit ratio for being performed as compared to the postponed cases. Conclusion The utility of the proposed ‘MeNT-OS’ scoring system has been assessed using data from our institution and offers an objective and systematic approach that is geared towards Orthopaedic procedures. We believe this scoring tool can provide Orthopaedic surgeons a safe and equitable approach to making difficult decisions on prioritisation of surgery during the COVID-19 period, and possibly other resource-limited settings in the future.

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“…There is no reason why the same cannot occur at the larger scale, where the managed and prioritization are significant in evaluating assets and facilities to combat the disease and contain it in an adequate timeframe. Some examples suggest contingency planning [35], while the others suggest scoring systems for the evaluation of priorities [36]. In all cases, we can reflect on the importance of management and prioritization plan [2].…”

Section: Early Asset Management and Prioritization Planmentioning

confidence: 99%

Reflection on Early Lessons for Urban Resilience and Public Health Enhancement during the COVID-19

Cheshmehzangi¹

2020

Health

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With growing impacts on public health systems and economies across the world, as a result of the COVID-19 pandemic outbreak, we need to reflect on some of the early lessons for urban resilience enhancement. In this paper, a brief discussion is made through several recommendations that could make our cities more prepared specially in the probable future waves of this current outbreak or potential spikes in infections or clustered cases. The experiences from global examples highlighted in this study address what has worked in the past few months at the spatial levels of communities and cities. The COVID-19 outbreak highlighted the deficiencies and shortfall across multiple sectors of the urban systems and enabled us to identify risks, challenges, and pathways to better city management. With regard to urban resilience enhancement, the negative impacts of the COVID-19 outbreak are assessed to suggest a checklist of what could be done through early preparedness. The findings are novel in ongoing research related to urban resilience and public health during the COVID-19 pandemic. The early lessons here reflect on the ongoing situation of this pandemic outbreak, but could effectually help to enhance the resilience of our cities and communities, and especially addressing the protection of public health and societal well-being. The findings contribute to major sectors of urban resilience, city management, and public health. The recommendations from this study could be utilised and adapted in any context, allowing for the consideration of all-inclusive decision-making and much-enhanced planning processes.

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Patient-Centered, Gynecology-Specific Prioritization of Nonurgent Surgeries during the COVID-19 Pandemic: Proposal of a Novel Scoring System

Cited by 8 publications

References 8 publications

Impact of COVID-19 on gynecologic and obstetrical services at two large health systems

Impact of COVID-19 on gynecologic and obstetrical services at two large health systems

The MeNT-OS Score for Orthopaedic Surgery: An Objective Scoring System for Prioritisation of Orthopaedic Elective Surgeries During a Pandemic

Reflection on Early Lessons for Urban Resilience and Public Health Enhancement during the COVID-19

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