How hospitals are handling these important procedures during the pandemic
At the height of the pandemic’s first wave, governors issued executive orders, and hospitals responded to the looming crisis by suspending elective services. The cancellation of such procedures has had a significant impact, with the potential to affect patient health and quality of life, and the hospitals themselves.
According to the National Institutes of Health (NIH), canceling all elective procedures could not only result in an increase in disease progression and death rates, but it could also cause estimated revenue losses of $16.3 to $17.7 billion per month to U.S. hospitals.
In the months that followed the first wave, hospitals began bringing back much-needed elective surgeries to patients. Member facilities had to carefully approach the reintroduction of these procedures, which is essential to informing how to handle future waves.
The importance of elective procedures
“There can be a tendency to conflate elective procedures with optional procedures, but we know that’s not the case,” says Kelsey Duggan, Ph.D., MBA, former Assistant Vice President, Medical Device Management at HealthTrust.
Delaying elective procedures can result in more disease, higher rates of increased pain, heightened depression and anxiety, and an overall decline in quality of life for patients. So it became a priority for hospitals to bring them back—carefully. “There is clinical rationale for these procedures, but everything can’t launch at once, so there’s typically a phased approach to bringing them back,” Duggan says.
In August 2020, Duggan joined Rick Phillips, BS, R.T.(R)(MR)(CT)(ARRT), CRA, Vice President, Advisory Services at HealthTrust, and Physician Advisor Jeffrey Hodrick, M.D., Orthopedic Surgeon at TriStar Centennial, on a webinar to discuss options for approaching elective procedures in the era of COVID-19. Phillips explained in the webinar that it takes flexibility. “As rigid as we can be with our policies and procedures within healthcare, I’ve seen policies and procedures change more quickly over the last few weeks and months than I’ve seen happen in my career,” he says.
Changing with the times
Many essential infection prevention practices—such as universal masking, visitation policies and patient cohorting—had already been implemented within hospitals, says Duggan, so it wasn’t a big pivot when it came time to resume these procedures. “Hospitals have used a lot of the best practices they already had in place to make this transition more seamless,” she explains.
However, some changes were required to meet this unique circumstance, including finding ways to reduce the amount of time patients spend at the hospital. At Centennial, Dr. Hodrick notes they now offer some of their pre-procedure patient education online. This new approach has the added benefit of allowing patients to access the learning whenever they need it. They are also using telemedicine for post-op appointments and to triage patients.
To Dr. Hodrick, the need to change the mindset within the operating room stands out as one of the biggest modifications that needed to take place. “It’s part of the OR culture that you’re used to being tired and run down, but the risk of coming to work if you’re not feeling well, and explaining that to our staff, has been one of the big things. It’s been a little bit of a cultural shift,” he says.
Planning for the new normal
The pandemic has reset baselines. When planning for the future, it’s necessary to focus on current market drivers and not prior year trends, says Phillips. To anticipate upcoming trends, the Advisory Board recommends tracking indicators around a future surge, such as the levels of social distancing in your community. Other suggestions include:
- Conducting scenario planning and creating short-term contingency plans for each scenario
- Communicating with your community to reassure them you have a safe environment for care
- Concentrating on outpatient capacity
Ongoing communication and collaboration between teams is critical in resuming elective procedures. The recommendation is to bring together key stakeholders from medical leadership, administration, infection control, environmental services, supply chain and bed management on a core governance committee to manage the process. Daily huddles can be used to address emergent or acute needs, with weekly all-hands meetings being better suited for strategic planning and looking at issues such as:
- Staffing levels
- Supply chain sustainability
- Patient safety and cohorting
- Screening of patients, visitors and staff
“Most importantly, communicate the risk of patients avoiding care. We talk about social distancing, but that doesn’t mean medical distancing,” says Phillips. It’s important that patients understand the difference.
He adds, “The more you can do to communicate what steps you have taken and what you’re doing to create a safe environment, the more likely your patients are to come back and want to receive care.”
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