Blocking and Tackling of Capacity Management in Surgical Services

Abstract Objective To develop a predictive analytics tool that would help evaluate different scenarios and multiple variables for clearance of surgical patient backlog during the COVID-19 pandemic. Materials and Methods Using data from 27 866 cases (May 1 2018–May 1 2020) stored in the Johns Hopkins All Children’s data warehouse and inputs from 30 operations-based variables, we built mathematical models for (1) time to clear the case backlog (2), utilization of personal protective equipment (PPE), and (3) assessment of overtime needs. Results The tool enabled us to predict desired variables, including number of days to clear the patient backlog, PPE needed, staff/overtime needed, and cost for different backlog reduction scenarios. Conclusions Predictive analytics, machine learning, and multiple variable inputs coupled with nimble scenario-creation and a user-friendly visualization helped us to determine the most effective deployment of operating room personnel. Operating rooms worldwide can use this tool to overcome patient backlog safely.

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Cataract Surgical Services in Palestine

Ophthalmic Epidemiology ◽

10.1080/09286586.2021.1923755 ◽

2021 ◽

pp. 1-9

Author(s):

Ranad Maswadi ◽

Covadonga Bascaran ◽

Gerry Clare ◽

Maged Abu Ramada ◽

Alaa AlTalbishi ◽

...

Keyword(s):

Surgical Services

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Riding the waves: the ongoing impact of COVID-19 on a national surgical training cohort

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02739-4 ◽

2021 ◽

Author(s):

Orla Hennessy ◽

Amy Lee Fowler ◽

Conor Hennessy ◽

David Brinkman ◽

Aisling Hogan ◽

...

Keyword(s):

Surgical Training ◽

World Health Organisation ◽

World Health ◽

Training Methods ◽

Viral Spread ◽

Surgical Services ◽

Global Pandemic ◽

Surgical Trainees ◽

Secondary Survey ◽

The Impact

Abstract Background The World Health Organisation declared a global pandemic on the 11 March 2020 resulting in implementation of methods to contain viral spread, including curtailment of all elective and non-emergent interventions. Many institutions have experienced changes in rostering practices and redeployment of trainees to non-surgical services. Examinations, study days, courses, and conferences have been cancelled. These changes have the potential to significantly impact the education and training of surgical trainees. Aim To investigate the impact of the COVID-19 pandemic on training, educational, and operative experiences of Irish surgical trainees. Methods Surgical trainees were surveyed anonymously regarding changes in working and educational practices since the declaration of the COVID-19 pandemic on 11 March 2020. The survey was circulated in May 2020 to both core and higher RCSI surgical trainees, when restrictions were at level five. Questions included previous and current access to operative sessions as well as operative cases, previous and current educational activities, access to senior-led training, and access to simulation-/practical-based training methods. A repeat survey was carried out in October 2020 when restrictions were at level two. Results Overall, primary and secondary survey response rates were 29% (n = 98/340) and 19.1% (n = 65/340), respectively. At the time of circulation of the second survey, the number of operative sessions attended and cases performed had significantly improved to numbers experienced pre-pandemic (p < 0.0001). Exposure to formal teaching and education sessions returned to pre-COVID levels (p < 0.0001). Initially, 23% of trainees had an examination cancelled; 53% of these trainees have subsequently sat these examinations. Of note 27.7% had courses cancelled, and 97% of these had not been rescheduled. Conclusion Surgical training and education have been significantly impacted in light of COVID-19. This is likely to continue to fluctuate in line with subsequent waves. Significant efforts have to be made to enable trainees to meet educational and operative targets.

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Principles of capacity management, applied in the mental health context

Australian Health Review ◽

10.1071/ah17007 ◽

2018 ◽

Vol 42 (4) ◽

pp. 438

Author(s):

Kathryn Zeitz ◽

Darryl Watson

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Average Length ◽

Patient Flow ◽

Waiting Times ◽

Capacity Management ◽

Mental Health Setting ◽

Mental Health Consumer ◽

Mental Health Consumers ◽

Flow Improvement

Objective The aim of the paper was to describe a suite of capacity management principles that have been applied in the mental health setting that resulted in a significant reduction in time spent in two emergency departments (ED) and improved throughput. Methods The project consisted of a multifocal change approach over three phases that included: (1) the implementation of a suite of fundamental capacity management activities led by the service and clinical director; (2) a targeted Winter Demand Plan supported by McKinsey and Co.; and (3) a sustainability of change phase. Descriptive statistics was used to analyse the performance data that was collected through-out the project. Results This capacity management project has resulted in sustained patient flow improvement. There was a reduction in the average length of stay (LOS) in the ED for consumers with mental health presentations to the ED. At the commencement of the project, in July 2014, the average LOS was 20.5 h compared with 8.5 h in December 2015 post the sustainability phase. In July 2014, the percentage of consumers staying longer than 24 h was 26% (n = 112); in November and December 2015, this had reduced to 6% and 7 5% respectively (less than one consumer per day). Conclusion Improving patient flow is multifactorial. Increased attendances in public EDs by people with mental health problems and the lengthening boarding in the ED affect the overall ED throughput. Key strategies to improve mental health consumer flow need to focus on engagement, leadership, embedding fundamentals, managing and target setting. What is known about the topic? Improving patient flow in the acute sector is an emerging topic in the health literature in response to increasing pressures of access block in EDs. What does this paper add? This paper describes the application of a suite of patient flow improvement principles that were applied in the mental health setting that significantly reduced the waiting time for consumers in two EDs. What are the implications for practitioners? No single improvement will reduce access block in the ED for mental health consumers. Reductions in waiting times require a concerted, multifocal approach across all components of the acute mental health journey.

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822 Lessons Learnt During the COVID-19 Pandemic on Emergency Surgical Admissions in A District General Hospital

British Journal of Surgery ◽

10.1093/bjs/znab134.090 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

K Ahn ◽

N Khan ◽

N Desai ◽

M Abdu ◽

L Hiddema ◽

...

Keyword(s):

General Hospital ◽

Public Health Intervention ◽

District General Hospital ◽

Lifestyle Changes ◽

Severe Respiratory Distress ◽

Surgical Services ◽

Record Data ◽

Efficacious Vaccine ◽

Severe Respiratory Distress Syndrome ◽

The Impact

Abstract Introduction Coronavirus disease (COVID-19) is an acute severe respiratory distress syndrome which resulted in an unprecedented impact on NHS service provision. We aimed to assess the impact of COVID-19 on general surgical services in a district general hospital. Method Electronic health care record data was retrospectively collected from 6th of April to 6th of May for both 2019 and 2020. Results Despite fewer referrals and admissions in 2020 (133 vs 177 admissions in 2019), there were more failed discharges (29 vs 17 in 2019) and higher associated costs. Higher numbers of biliary related pathologies and pancreatitis (50 in 2020 vs 25 in 2019), and fewer complaints of non-specific abdominal pain (10 in 2020 vs 22 in 2019) were observed. The use of outpatient investigations decreased by approximately 40% in 2020; however, utilisation of inpatient investigations was comparable. Conclusions Better utilisation of outpatient investigations and virtual clinic services may surmount pressures from further peaks of COVID-19. The increase in biliary related cases and pancreatitis may be consequent upon lifestyle changes during lockdown. This merits further investigation and if appropriate, public health intervention. In the absence of an efficacious vaccine, further research would be essential to streamline general surgical services based on clinical risk stratification.

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The Impact of COVID-19 on Surgical Training: the Past, the Present and the Future

Indian Journal of Surgery ◽

10.1007/s12262-021-02964-2 ◽

2021 ◽

Author(s):

Marina Yiasemidou

Keyword(s):

Infection Control ◽

Surgical Training ◽

New Technologies ◽

Negative Impact ◽

Elective Surgery ◽

Control Measures ◽

Negative Consequences ◽

Surgical Services ◽

The World ◽

The Impact

AbstractThe COVID-19 pandemic and infection control measures had an unavoidable impact on surgical services. During the first wave of the pandemic, elective surgery, endoscopy, and ‘face-to-face’ clinics were discontinued after recommendations from professional bodies. In addition, training courses, examinations, conferences, and training rotations were postponed or cancelled. Inadvertently, infection control and prevention measures, both within and outside hospitals, have caused a significant negative impact on training. At the same time, they have given space to new technologies, like telemedicine and platforms for webinars, to blossom. While the recovery phase is well underway in some parts of the world, most surgical services are not operating at full capacity. Unfortunately, some countries are still battling a second or third wave of the pandemic with severely negative consequences on surgical services. Several studies have looked into the impact of COVID-19 on surgical training. Here, an objective overview of studies from different parts of the world is presented. Also, evidence-based solutions are suggested for future surgical training interventions.

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668 The Consequences to Emergency Surgery During COVID19 Pandemic in a UK District General Hospital in The North East of England

British Journal of Surgery ◽

10.1093/bjs/znab134.075 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

R Evans ◽

C Ng

Keyword(s):

Surgical Treatment ◽

General Hospital ◽

Emergency Surgery ◽

Early Identification ◽

District General Hospital ◽

Public Confidence ◽

Surgical Services ◽

North East ◽

The North ◽

Initial Reduction

Abstract Aim COVID19 pandemic has significantly affected surgical services. We aim to review its effects on our theatre output and risk of encountering COVID 19 cases. Method Serial record of operations performed locally were reviewed from start of UK COVID19 pandemic lockdown on 23rd March 2020 to 13th July 2020 after it was lifted. A weekly average by month of operations and the percentage of COVID19 cases diagnosed within 30 days of the procedure were noted. Results 733 operations performed through this period. In March, 33 operations/week performed, 88.4% emergency and 7% diagnosed with COVID19. April, 31 operations /week performed, 95.9% emergency and 10.6% diagnosed with COVID19. May 46 operations /week performed, 94.5% emergency and 3.3% diagnosed with COVID19. June 56 operations /week, 80.9% emergency and less than 0.01% diagnosed with COVID19. By July 80 operations/week, 59.4% emergency and none diagnosed with COVID 19. Since testing capacity increased, only 6 of the 27 operated were diagnosed with COVID19. Conclusions There was initial reduction to non-emergency workload. However, this has gradually shifted as protocols are in place improve public confidence to return for surgical treatment. Mandatory admission testing allows early identification and remains essential for planning of services and protecting the workforce.

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Physician reimbursement under Medicare

Neurosurgical FOCUS ◽

10.3171/foc.2002.12.4.9 ◽

2002 ◽

Vol 12 (4) ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Alan M. Scarrow

Keyword(s):

United States ◽

The United States ◽

Payment System ◽

Reimbursement System ◽

Physician Services ◽

Physician Payment ◽

Value System ◽

Physician Reimbursement ◽

Surgical Services ◽

Relative Value

Payment for physician services in the United States is directly tied to the payment system implemented in the Medicare system. The use of a code to categorize medical and surgical services, as well as a relative value system to assess physician services and reimburse them accordingly, is now well established. In light of this, it is important for physicians to possess knowledge of how this coding and reimbursement system was established, how it is updated, what means are available to modify it, and how it is used in practice. The author addresses these issues, offering a primer for the neurosurgeon on the Medicare system as it relates to physician payment.

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