Medically Necessary, Time-Sensitive Procedures: Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic

J Am Coll Surg. 2020 Aug;231(2):281-288. doi: 10.1016/j.jamcollsurg.2020.04.011. Epub 2020 Apr 9.


Hospitals have severely curtailed the performance of nonurgent surgical procedures in anticipation of the need to redeploy healthcare resources to meet the projected massive medical needs of patients with coronavirus disease 2019 (COVID-19). Surgical treatment of non-COVID-19 related disease during this period, however, still remains necessary. The decision to proceed with medically necessary, time-sensitive (MeNTS) procedures in the setting of the COVID-19 pandemic requires incorporation of factors (resource limitations, COVID-19 transmission risk to providers and patients) heretofore not overtly considered by surgeons in the already complicated processes of clinical judgment and shared decision-making. We describe a scoring system that systematically integrates these factors to facilitate decision-making and triage for MeNTS procedures, and appropriately weighs individual patient risks with the ethical necessity of optimizing public health concerns. This approach is applicable across a broad range of hospital settings (academic and community, urban and rural) in the midst of the pandemic and may be able to inform case triage as operating room capacity resumes once the acute phase of the pandemic subsides.

MeSH terms

  • Betacoronavirus
  • COVID-19
  • Chicago / epidemiology
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / prevention & control*
  • Decision Making / ethics*
  • Disease Transmission, Infectious / prevention & control*
  • Efficiency, Organizational
  • Health Resources / supply & distribution*
  • Humans
  • Infection Control / organization & administration*
  • Pandemics / prevention & control*
  • Patient Selection / ethics*
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / prevention & control*
  • Risk
  • SARS-CoV-2
  • Surgery Department, Hospital / ethics*
  • Triage / ethics