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News & Press: COVID-19

Tracking the Journey of Elective Surgery during COVID-19

Tuesday, June 30, 2020   (0 Comments)
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Written for AAOE by Sari Nossbaum, Director of Marketing, Surgimate


The Covid-19 crisis is definitely not behind us, but with case numbers stabilizing in many parts of the country, there has been a push to get back to the “new normal”. This includes a return to elective surgery - which was suspended in mid-March 2020 as most hospitals braced themselves for an onslaught of Covid-19 patients.


The haunting images of a popup hospital in Central Park will certainly be ingrained in memories for decades to come.


Surgical cancellations in numbers

According to data from surgical practices nationwide[1], the surgical cancellation & reschedule rate surged to 88% nationwide in April, as well as a reduction of over 70% in the number of new surgeries scheduled. To give perspective, the cancellation & reschedule rate typically hovers between 25-30% throughout the year[2].  


But those numbers only tell part of the story. 


The road to recovery

Now that many states have opened up, elective surgery has cautiously restarted in areas with low Covid-19 case numbers. This is all taking place in accordance with the guidelines laid down by a “roadmap” from the American College of Surgeons, the American Society of Anesthesiologists, the Association of periOperative Registered Nurses and the American Hospital Association that details when and how elective surgeries should restart.


Among the criteria for opening up ORs is that the rate of new Covid-19 cases in the “relevant geographical area” must have dropped substantially 14 days prior to elective surgery restarting. 


As of May 31, approximately 30 states had met those criteria and had resumed some elective surgeries - among them were Georgia, Indiana, Oklahoma, & Tennessee. This was reflected in the surgical coordination scheduling platform as well. 


In these newly opened areas, platform logins by both surgeons and their support staff had returned to 100% by the first week of June. “Even though the surgical volume has not returned to previous numbers, practices were busy rescheduling the huge backlog of cases that built up during the pause on elective surgery,” explains Rebecca Brygel, CEO of Surgimate. 


Elsewhere, there is a more difficult story to be told. “Practices in NY, NJ, CT, PA and MD as well as other deeply affected areas were still at 50-60% of their usual login rates by mid June.” Nonetheless, on June 8, elective surgery was given the green light in NYC and platform logins were back on track with pre-COVID days as surgeries were gradually scheduled to be performed in these hard-hit areas. 




In June, practices have (overall) seen a major improvement in surgical volume, albeit with a much higher percentage of cancellations and reschedules (41%) - mainly due to uncertainty, COVID-19 testing, and patient anxiety. 



Who gets surgery first?

Whether a surgical practice is in a region that has opened up again or if it’s located in an area that is still locked down, the questions for surgeons remains the same - how to triage and prioritize surgeries. Which surgeries can safely wait to be scheduled and which ones must take place as soon as possible to avoid placing further burdens on both patients and the healthcare system. This is also compounded by the fact that many practices are not yet at full capacity and scheduling staff may still be furloughed.


Although elective surgery was only suspended for two months, a huge backlog of patients has built up as a result. Not to mention that some of the procedures that were considered “elective” in the past may have become more urgent with the passage of time. Furthermore, as people feel safe enough to venture out to their healthcare providers once again, and life “goes on”, the number of new patients requiring surgery also increases.


Prioritizing the backlog of surgeries 

The parameters for which types of procedures or patients will take priority varies by practice. Variables include whether the procedure could be performed in an outpatient facility rather than in a hospital, the perceived risks (such as age, BMI, or pre-existing conditions), length of wait time or Covid-19 status of the patient, family member(s), surgeon and staff. That means, there will be a lot more planning that goes into surgical priority and line-up than ever before.


Each practice has had to quickly put in place a methodology to ensure that the parameters for prioritizing each case are clear and executable to all support staff. This will help reduce the backlog and maximize OR time as much as possible.  


The effects will linger 

While surgeons are eager to start practicing again, not all patients are willing to enter a medical facility so quickly and are reluctant to schedule surgery. It will certainly take time for fear to dissipate and to instill confidence in patients again. And let’s not forget that both surgeons and staff also remain at risk.  


Surgeons were out of the OR for over two months. The return to safe surgery in the Covid-19 environment has required an increase in turnover times for ORs as well as the time it takes surgical teams to scrub in. Given these new realities, even if ORs extend their hours, the backlog will linger for months, if not years.


Getting back on track

Pausing elective surgery has had a drastic trickle-down effect from surgical practices to patients, equipment vendors, and the health care system at large, including hospitals. It is estimated that US hospitals lost $50 billion a month during Covid-19. Practice managers face the challenging task of rebooting with this “new normal” while ensuring that their businesses are achieving profitability again. Having the right infrastructure, technology, protocols, and personnel in place is critical to the long-term success of a surgical practice. Let’s hope and pray the worst is behind us!   


[1] The Surgimate Practice™ cloud platform services thousands of surgeons and their support staff, automating the surgical coordination and scheduling process end-to-end.

[2] Data was generated from Surgimate Practice & represents cumulative data from practices across the country. This data is reflective of surgeries scheduled & canceled in Surgimate Practice and not in hospital systems.

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