The COVID-19 crisis is requiring OR leadership to make decisions on several key issues including:

  • How many OR rooms to convert to ICUs and other Bed Capacity
  • How to triage elective cases to only do the most important ones

Donna Pederson (Business & Informatics Supervisor), Silje Kennedy (Director of Perioperative Services) at MultiCare Health, Dr. Mike Meyer, Interim CMO Tacoma General/Allenmore, CT Surgeon, Pulse Heart Institute, and Dr. Atilla Kett, Chief of Anesthesia at Saint Peter’s University Hospital in New Brunswick, NJ, held an hour-long roundtable discussion to share the best practices they have developed for triaging OR capacity during the COVID-19 pandemic.

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Executive Summary

How should we determine criteria for urgent and emergent cases during the COVID-19 crisis?
Organizations are handling this several ways. For example, some like St. Peter’s University Hospital in New Jersey are utilizing the American College of Surgeons’ recommendations with a formal approval process for case booking. The formal process includes committee review plus CMO sign off. Other organizations, like Washington state-based MultiCare, are using less formal structures and are relying on surgeons “self-monitoring” for case selection. Each perceives success with their respective strategies, with minor interventions by leadership. If/when there is a difference of opinion, the CMO and Perioperative Medical Director will then sign off. Multicare is also using an electronic triaging tool for physician offices to input frequently asked questions of urgency, which helps to expedite the approval process.

How can we best communicate changes and plans to staff and patients?
One of the biggest pain points for hospitals currently is ensuring effective patient communication, particularly around sensitive topics like canceling elective surgeries. MultiCare has taken an extra step to improve the patient experience. The OR leadership team is in regular contact with all surgeons, and then surgeons are contacting their patients personally if the surgery needs to be canceled. They’ve also found success in curating relevant information from the broader health system to the perioperative specialty specifically. Much communication coming out from the executive level pertains more broadly to hospital processes overall. MultiCare sends tailored information directly every couple of days to promote transparency and reduce confusion with the daily operations of the OR.

What type of creative workforce solutions support our staff’s health and wellness?
MultiCare has proactively reduced its workforce to safeguard that not all staff are working in this time of high risk; this ensures a supply of staff who can replace anyone who becomes sick or needs a mental break. Located in New Brunswick, New Jersey, St. Peter’s University Hospital is already in a high state of emergency, with rapidly increasing positive patients. They are working aggressively to protect their employees during the surge period where providers becoming infected pose a serious added risk to the community. Redeploying staff is one tactic used, which requires matching your workforce skill sets with other hospital departments to determine how they can offer value in a safe manner. For example, both health systems are using post anesthesia staff in ICUs (primarily as a secondary unless they have prior work experience in an ICU), because their skill sets are similar. Other ideas include redeploying OR staff to review RN documentation for COVID related analyses, as well as assisting other departments in education on the proper techniques for PPE and isolation protocols.

How do we plan for the increased need for ICU and other beds?
Both organizations are planning tactics such as repurposing OR suites to ICUs, utilizing post-operative isolation rooms to intubate / extubate any known COVID-19 patients, and repurposing anesthesia equipment in a time of need to be used as additional ventilators. Considerations include an organization’s ability to convert the air flow in these rooms. Both MultiCare and St. Peter’s include this in their surge planning. MultiCare shared that it will create additional COVID-19 units by repurposing one of its surgical floors, and will also utilize OR suites if needed. However, the use of the OR suites is prioritized as step 6 on the hospital’s triaging list because other overflow units have been identified. Whereas at St. Peter’s, using OR suites to care for COVID-19 patients is more likely due to minimal overflow spaces in the hospital. What measures can preserve PPE and best protect the front lines of patient care? There is a lot of concern and discussion around which PPE should be used, when, and where. St. Peter’s University Hospital and MultiCare both utilize N95 masks or surgical “capper”’ as a primary line of defense for front line staff. In surgery, N95s & or surgical ‘cappers’ are used for intubations of positive or suspected positive patients (not all OR intubations). In addition, intubations /extubations for both organizations are occurring in an isolation room in PACU for any positive or suspected positive patients. Should we already be preparing for the backlog of elective surgery reschedules post-crisis? St. Peter’s University Hospital and MultiCare both define themselves as in “crisis” mode and future planning for how they will address the elective surgery backlog is ambiguous, and overwhelming at present. However, common ideas around future tactics include expanding OR hours of operation, reducing or eliminating block time to create more open spots, extending release times to 2-4 weeks, and seeking ways to predict how much OR time they will need in the upcoming months to address demand issues with elective surgery backlogs.

Text transcript here

Presented By:

Donna Pederson

Business & Informatics Supervisor
MultiCare Health System

 

 

Silje Kennedy

Director of Perioperative Services
MultiCare Health System

Dr. Mike Meyer

Interim CMO Tacoma General/Allenmore
CT Surgeon Pulse Heart Institute

 

 

Dr. Atilla Kett

Chief of Anesthesia
Saint Peter’s University Hospital