Reinstating Elective Surgeries in MedStar Health: A Roadmap for Healthcare Organizations

David E Stein; Stanley H Chia; Thomas H Breakey; David H Song; Edward Y Woo; Rollin J Fairbanks; David Jordan; Leigh Ann Curl; Henry R Boucher; Lisa Boyle; Karol Edwards; Hanna Friedrich; Robert J Gilbert; Jeffrey Matton; Kathy Mucci; Bradley Chambers; Michael Sachtleben; Thomas J Watson

doi:10.1097/AS9.0000000000000002

Reinstating Elective Surgeries in MedStar Health: A Roadmap for Healthcare Organizations

Ann Surg Open. 2020 Aug 11;1(1):e002. doi: 10.1097/AS9.0000000000000002. eCollection 2020 Sep.

Authors

David E Stein¹, Stanley H Chia², Thomas H Breakey³, David H Song⁴, Edward Y Woo⁵, Rollin J Fairbanks⁶, David Jordan³, Leigh Ann Curl⁷, Henry R Boucher⁸, Lisa Boyle⁹, Karol Edwards¹⁰, Hanna Friedrich³, Robert J Gilbert¹⁰, Jeffrey Matton¹¹, Kathy Mucci¹², Bradley Chambers¹¹, Michael Sachtleben¹³, Thomas J Watson⁹

Affiliations

¹ From the Department of Surgery, MedStar Franklin Square Medical Center.
² Department of Otolaryngology, MedStar Washington Hospital Center.
³ MedStar Medical Group Anesthesia, MedStar Health.
⁴ Department of Plastic Surgery, MedStar Georgetown University Hospital.
⁵ Department of Vascular Surgery, MedStar Washington Hospital Center and MedStar Medical Group.
⁶ Department of Quality and Safety, MedStar Health.
⁷ Department of Orthopedics, MedStar Harbor Hospital.
⁸ Department of Orthopedics, MedStar Union Memorial Hospital.
⁹ Department of Surgery, MedStar Georgetown University Hospital.
¹⁰ Administration, MedStar Ambulatory Services, MedStar Health.
¹¹ Administration, MedStar Union Memorial Hospital.
¹² XXX.
¹³ Administration, MedStar Georgetown University Hospital.

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) infections have strained hospital resources worldwide. As a result, many facilities have suspended elective operations and ambulatory procedures. As the incidence of new cases of COVID-19 decreases, hospitals will need policies and algorithms to facilitate safe and orderly return of normal activities. We describe the recommendations of a task force established in a multi-institutional healthcare system for resumption of elective operative and ambulatory procedures applicable to all hospitals and service lines.

Methods: MedStar Health created a multidisciplinary task force to develop guidelines for resumption of elective surgeries/procedures. The primary focus areas included the establishment of a governance structure at each healthcare facility, prioritization of elective cases, preoperative severe acute respiratory syndrome coronavirus 2 testing, and an assessment of the needs and availability of staff, personal protective equipment, and other essential resources.

Results: Each hospital president was tasked with establishing a local perioperative leadership team answering directly to them and granted the authority to prioritize elective surgery and ambulatory procedures. An elective surgery algorithm was established using a simplified Medically Necessary Time Sensitive score, with multiple steps requiring a "go/no-go" assessment based on local resources. In addition, mandatory preoperative COVID testing policies were developed and operationalized.

Conclusions: Even when the COVID pandemic has passed, hospitals and surgical centers will require COVID screening and testing, case prioritization, and supply chain management to provide care essential to the surgical patient while protecting their safety and that of staff. Our guidelines consider these factors and are applicable to both tertiary academic medical centers and smaller community facilities.

Keywords: Algorithm; Coronavirus disease; Governance; Medically Necessary Time Sensitive; Operations; Safety; Surgery.