Getting back to work: A framework and pivot plan to resume elective surgery and procedures after COVID-19

Oscar K. Serrano, MD, MBA, FACS; Rocco Orlando, MD, FACS; Pavlos Papasavas, MD, FACS; Mitchell H. McClure, MD; Ajay Kumar, MD; Adam C. Steinberg, DO, FACS; Jeffrey L. Cohen, MD, FACS; Steven J. Shichman, MD; Rekhinder K. Singh, MD, FACS; William V. Sardella, MD, FACS; Bret M. Schipper, MD, FACS

Surgery Open Science (Apr 2021)

Getting back to work: A framework and pivot plan to resume elective surgery and procedures after COVID-19

Oscar K. Serrano, MD, MBA, FACS,
Rocco Orlando, MD, FACS,
Pavlos Papasavas, MD, FACS,
Mitchell H. McClure, MD,
Ajay Kumar, MD,
Adam C. Steinberg, DO, FACS,
Jeffrey L. Cohen, MD, FACS,
Steven J. Shichman, MD,
Rekhinder K. Singh, MD, FACS,
William V. Sardella, MD, FACS,
Bret M. Schipper, MD, FACS

Affiliations

Oscar K. Serrano, MD, MBA, FACS: Hartford HealthCare, Hartford, CT; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT; Corresponding author at: Hartford Hospital Transplant & Comprehensive Liver Center, 85 Seymour Street, Suite 320, Hartford, CT 06106. Tel.: + 1 860 972 4219; fax: + 1 860 549 1476.
Rocco Orlando, MD, FACS: Hartford HealthCare, Hartford, CT; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT
Pavlos Papasavas, MD, FACS: Hartford HealthCare, Hartford, CT; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT
Mitchell H. McClure, MD: Hartford HealthCare, Hartford, CT; Department of Medicine, University of Connecticut School of Medicine, Farmington, CT
Ajay Kumar, MD: Hartford HealthCare, Hartford, CT; Department of Medicine, University of Connecticut School of Medicine, Farmington, CT
Adam C. Steinberg, DO, FACS: Hartford HealthCare, Hartford, CT; Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT
Jeffrey L. Cohen, MD, FACS: Hartford HealthCare, Hartford, CT; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT
Steven J. Shichman, MD: Hartford HealthCare, Hartford, CT; Department of Urology, University of Connecticut School of Medicine, Farmington, CT
Rekhinder K. Singh, MD, FACS: Hartford HealthCare, Hartford, CT; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT
William V. Sardella, MD, FACS: Hartford HealthCare, Hartford, CT; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT
Bret M. Schipper, MD, FACS: Hartford HealthCare, Hartford, CT; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT; Department of Surgery, Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, CT

Journal volume & issue: Vol. 4
pp. 12 – 18

Abstract

Read online

Introduction: The COVID-19 pandemic has compelled a majority of hospital systems to reduce surgical and procedural volumes in an attempt to preserve resources. Elective surgery and procedures resumption has proven to be a calculated risk between COVID-19 exposure and resource depletion and patient morbidity and mortality from surgical deferral. Methods: Within a few days of halting elective surgery and procedures, our 7-hospital (2427 in-patient beds, 26,647 inpatient surgeries) healthcare system developed a multidisciplinary Pivot Plan with the primary outcome of a phased resumption of elective surgery and procedures. The plan entailed the integration of our electronic medical record, order entry automatization, perioperative staff utilization, partnering with primary care providers, and a stepwise COVID-19 testing algorithm based on a predetermined hierarchy of case acuity and timeliness of patient care. Results: The Pivot Plan was instituted on May 10, 2020. Since then, 22,624 patients have been tested for COVID-19 in anticipation of an elective surgery and procedures; 140 (0.62%) tested positive for COVID-19 and had their procedure deferred. As our testing capability has increased, we have been able to increase our added elective surgery and procedures capacity from 13 cases per day to 531 cases per day. In turn, we have seen the case volume increase by 52%. Conclusion: Our academic healthcare system located in one of the initial COVID-19 hotspots in the United States has successfully resumed elective surgery and procedures in part due to a receptive and supportive culture based upon nimbleness, agility, and rapid integration of multiple resources from a cohort of diverse disciplines applied to the perioperative services workflow.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

About the journal