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Pediatric Modification of the Medically Necessary, Time-Sensitive Scoring System for Operating Room Procedure
Mark B Slidell1, Jessica J Kandel1, Vivek Prachand2
1Sections of Pediatric Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL; Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL.
Insights
Surgeons developed a pediatric scoring system to prioritize medically necessary, time-sensitive (MeNTS) operations for children during the COVID-19 pandemic. This ethical framework ensures equitable surgical care for pediatric patients facing resource limitations.
Area of Science:
- Pediatric Surgery
- Healthcare Management
- Pandemic Response
Background:
- The COVID-19 pandemic necessitated a re-evaluation of surgical procedure prioritization.
- Factors like PPE conservation, infection risk, and resource allocation became critical.
- Existing adult frameworks for prioritizing operations did not fully address pediatric specific needs.
Purpose of the Study:
- To adapt an existing adult scoring system for prioritizing medically necessary, time-sensitive (MeNTS) operations for pediatric surgical patients.
- To create a scoring system that accounts for the unique medical conditions and challenges faced by children.
Main Methods:
- Modification of the adult MeNTS scoring system to create a pediatric version.
- Application of the pediatric MeNTS scoring system to 101 surgical cases (performed and deferred).
- Evaluation of the system's utility during the initial phase of the COVID-19 pandemic.
Main Results:
- The pediatric MeNTS scoring system was successfully applied to prioritize surgical cases.
- The system demonstrated a safe, equitable, transparent, and ethical approach to decision-making.
- 101 pediatric cases were analyzed, involving both performed and deferred surgeries.
Conclusions:
- The developed pediatric MeNTS scoring system offers a practical framework for prioritizing children's surgeries.
- The system is adaptable to different healthcare institutions.
- It is projected to be valuable during both the acute and recovery phases of the pandemic.
Background:
The COVID-19 pandemic forced surgeons to reconsider concepts of "elective" operations. Perceptions about the time sensitivity and medical necessity of a procedure have taken on greater significance during the pandemic. The evolving ethical and clinical environment requires reappraisal of perioperative factors, such as personal protective equipment conservation; limiting the risk of exposure to COVID-19 for patients, families, and healthcare workers; preservation of hospital beds and ICU resources; and minimizing COVID-19-related perioperative risk to patients.
Study Design:
A scaffold for the complex decision-making required for prioritization of medically necessary, time-sensitive (MeNTS) operations was developed for adult patients by colleagues at the University of Chicago. Although adult MeNTS scoring can be applied across adult surgical specialties, some variables were irrelevant in a pediatric population. Pediatric manifestations of chronic diseases and congenital anomalies were not accounted for. To account for the unique challenges children face, we modified the adult MeNTS system for use across pediatric subspecialties.
Results:
This pediatric MeNTS scoring system was applied to 101 cases both performed and deferred between March 23 and April 19, 2020 at the University of Chicago Comer Children's Hospital. The pediatric MeNTS scores provide a safe, equitable, transparent, and ethical strategy to prioritize children's surgical procedures.
Conclusions:
This process is adaptable to individual institutions and we project it will be useful during the acute phase of the pandemic (maximal limitations), as well as the anticipated recovery phase.
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