As hospitals continue to reschedule the backlog of elective surgeries cancelled due to COVID-19, guidelines and best practices continue to evolve. Increasing urgency due to the cumulative effect of delays on patient health and hospital revenues has pushed hospitals to quickly implement new workflows using the best information available.
Whether your organization is in the early stages of reopening or midway through rescheduling your backlog of cases, assessing challenging areas with an eye toward optimizing your system can help ease the process.
In this article, we highlight three key challenge areas hospitals are tackling and identify methods to address them within Epic.
Risk Assessment and Pre-Surgical Screening
Patient and staff safety is a chief concern while reopening operating rooms (ORs). In addition to isolation and safety precautions on the day of surgery, quickly updating pre-surgery workflows to include COVID-19 and antibody testing can be challenging. Updating pre-operative planning tools can help ensure patients are properly tested and provide data to ensure proper adherence.
Here are a few recommendations for risk assessment and pre-surgery screening.
- Consider updating pre-surgical screening workflows to include lower-risk options such as e-visits and off-site testing.
- Create Procedure Pass tasks for COVID-related protocols such as COVID-19 and antibody tests.
- Create a dashboard to track testing tasks for upcoming cases to get a high-level view of the completion rate for upcoming cases. Include metrics on order placed, completed, positive patients, results pending
- Update Order Sets and consider creating a to alert the provider to place the correct COVID-19 orders.
Triaging and Scheduling Backlog
Case prioritization and scheduling is perhaps the biggest challenge during the reopening process. Identifying key stakeholders and developing a prioritization process requires a multidisciplinary team and the correct tools for success. To improve efficacy, this should also be an iterative process.
First, ensure all backlogged cases have a COVID-specific cancellation code. You’ll want to assess the reliability of this data to determine whether cases were properly identified at time of cancellation.
Next, identify and assess your strategy for prioritization. Key factors here include case acuity, case , risk, and revenue/margin. Organizations using generalized criteria should consider a rule-based prioritization score such as MeNTS, from the University of Chicago Medicine and Biological Sciences. Use discrete questions in the Case Request and Scheduling forms, such as the effect of a delay on the patient, the availability of alternative treatments, the potential need for ICU bed, the potential for the procedure to be done at an ambulatory surgery center (ASC), and the procedure’s overall priority.
Finally, update case backlog reports to include the prioritization factors you identified. Establish who owns the prioritization process and what communication methods should be used.
Monitoring and Reporting
Once workflows are incorporated into your EMR, put this data to good use by designing reporting content. These reports can be used for advanced-planning as well as retrospective data in a few different ways.
- Evaluate case backlog against OR utilization and capacity. Group cases based on the prioritization methods defined above. Use case length averages and turnover times, then compare cases to currently allotted block time. This helps determine whether to adjust OR hours or block allocations.
- Remember that block utilization will need to be continually re-addressed to account for the constantly changing circumstances.
- Incorporate your prioritization levels into block utilization assessments to determine whether certain blocks should be temporarily adjusted to accommodate a backlog.
- In addition, adjust automatic block release and manual block release requirements to allow for more flexibility in scheduling; this is preferred to breaking up block schedules to maximize existing block usage and maintain consistency.
- Consider reallocating blocks between your ASC and your hospital OR to account for patient acuity and risk.
- Use reporting tools to proactively reach out to patients through reports via patient-portal messages.
- Consider whether to collect additional patient metrics for future reporting on COVID-related outcomes and infection numbers.
As healthcare organizations reopen and reschedule necessary surgeries, it’s imperative that they keep their staff and the patients safe. Epic provides many tools to help organizations develop strategies for surgery preparation and prioritization. Contact Healthcare IT Leaders to learn more about how we can help your organization leverage Epic for an effective OR reopening.
Dan Stracco is a Senior Epic Consultant and former Project Manager for Epic Systems. He is certified in Epic OpTime and Epic Anesthesia.