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Surgical Planning in a Crisis: Leaders Share Lessons Learned
By KAREN BLUM
Assessing patients’ priority for surgical care, taking more precise inventory of predicted bed use after surgery, and moving some cases to same-day operations or ambulatory surgery centers are some ways surgical teams can still manage their caseloads during times of disruption, a panel of clinicians said during a recent webinar hosted by Becker’s Healthcare.
One of the biggest recent and ongoing disruptors has been the COVID-19 pandemic. Spectrum Health, an integrated health system in western Michigan, has introduced seven critical interventions to continue to deliver surgical care during an overwhelming period, said Adam Post, MSN, MBA, the system’s senior director of business operations for radiology and surgery.
In March 2020, the health system opened a command center in response to COVID-19 to offer a systemwide approach to coordinate clinical activities and any incident-related communications. A few days later, the surgical services division launched a “surgery camp” to support all COVID-19 operations, consisting of surgeons, project specialists and business intelligence analysts.
Mr. Post and his colleagues first realized they needed a way to prioritize surgical cases. While they had never leveled patients by need before, the team introduced and built into the electronic health record a prompt for surgeons to assign patients a priority level of 1 to 4 based on surgeons’ professional assessments, patients’ acuity and projected length of stay; LACE+ index scores and American Society of Anesthesiologists physical status; and preoperative diagnoses. Level 1 cases were considered urgent/ emergent and level 4 were those that could be deferred. They began deferring surgeries for level 4 patients, then for level 3 patients, but as time progressed and more safety protocols were put in place, the system was able to bring in many of those patients for surgery.
“We took the performing providers’ assessment and level assignment very seriously in our process, and had surgeon leaders reviewing assigned leveling and assuring adherence to our criteria,” Mr. Post said.
As the pandemic wore on, by August 2020, the team wanted to better understand patients’ postoperative destination. Some surgeons who previously were uncomfortable with the idea of safe, same-day discharges for procedures soon became followers, to continue to deliver much-needed care to their patients.
“Everything we did was, of course, rooted in what was best and most safe for each patient,” he said. “As of today, we haven’t seen any uptick in clinical outcomes such as emergency department visits or readmissions.”
Along with the transition to outpatient care and same-day discharges, the team wanted to better predict their volume of available surgical beds. Some providers were scheduling patients as admissions when they planned to discharge the same day, while others were scheduling patients as outpatient if they required a bed. The team added a post-procedure destination field in the electronic health record to coordinate planned surgical admission volume. It was so helpful—a “game changer for predictive analytics,” Mr. Post said—that the team plans to keep the procedure in place even after the pandemic recedes.
Next, by the end of 2020, the team created a deferral dashboard to track all deferred cases. “We treated every deferral like the precious surgical patients that they were, and wanted to assure that when we were able, that their care would be delivered,” he said. The team worked hard to understand where each patient was in the surgical process, either waiting to be scheduled or rescheduled, and whether their procedure was completed or no longer needed.
Finally, in April 2021, the team introduced daily deferral calls with representatives from incident command, as well as the physician on call, inpatient nursing director, staffing office, bed planning and surgery operations to understand what deferrals, if any, need to be made each day based on the current situation. All together, these methods allowed the team to predict their census for a 1,000-bed-plus hospital system within 0.5%.
Some Fortune 500 companies like IBM use the “what if” philosophy to plan for crises, said Lee Ausmus, the administrator of St. Michael’s Ambulatory Surgery Center in Clearwater, Fla. “I think that’s really key to our ability for quick responses to disruptions or unexpected components,” he said.
Organizations like the Federal Emergency Management Agency, as well as first responders, are tuned in to vulnerability assessments, Mr. Ausmus said. “As healthcare leaders, if we can have ongoing readiness, that potentially allows us to conduct the ‘what if’ with tremendous frequency,” he said. “From flooding, to heating, ventilation and air conditioning failures, to fullblown hurricanes, I think we’re going to have better plans and better response strategies, and quicker response times. I think our patient outcomes and our operational effectiveness will be enhanced as a result.” ■
