Operationalizing the Operating Room: Ensuring Appropriate Surgical Care in the Era of COVID-19 28 Apr, 2020

Abstract

Over the past decade, most academic medical centers have experienced increasing demands for surgical services. In many instances, lack of capacity in the operating rooms has resulted in a back log of patients needing surgery. On March 12th, the World Health Organization declared COVID-19 as a worldwide pandemic. In the United States, in preparation for a surge in patients requiring hospitalization for COVID-19, national societies, including the American College of Surgeons (ACS) as well as the Centers for Medicare and Medicaid Services (CMS), and hospitals put forward recommendations for triaging surgical patients and prioritizing only emergent, urgent and semi-urgent procedures. Surgeons and hospitals undertook this work to address multiple strains on the healthcare delivery system as a result of the pandemic. These included the need to: (1) significantly expand inpatient capacity (both acute care and intensive care units) for surge patients; (2) reduce strain on the blood supply which was diminishing as a result of a diminished number of blood drives; and (3) decrease the chance of healthcare worker (physician, nursing, staff and learner) exposure to COVID-19. At the same time that these considerations were being addressed in the hospital, ambulatory clinic practices were maintained and rapidly transitioned to telehealth. We hypothesized that the rapid changes in surgical practice associated with the COVID-19 response would result in a growing backlog of patients in need of surgery. Therefore, we developed a surgical oversight group to evaluate allocation of the increasingly limited operating room resource as well as a technical solution with our electronic health record to ensure that high priority surgical care was triaged appropriately based on the most urgent indications; it was critical to be able to identify this subgroup quickly such that they could still proceed to the operating room.