Getting back to work: A framework and pivot plan to resume elective surgery and procedures after COVID-19

Area of Science:

• Healthcare Management
• Surgical Operations
• Infectious Disease Control

Background:

• COVID-19 pandemic necessitated reduced surgical volumes to conserve resources.
• Resuming elective procedures balances COVID-19 exposure risks with surgical deferral complications.

Purpose of the Study:

• To describe a multidisciplinary plan for the phased resumption of elective surgery and procedures.
• To evaluate the effectiveness of the plan in a large healthcare system.

Main Methods:

• Developed a multidisciplinary Pivot Plan integrating EMR, order entry, staff utilization, and primary care partnerships.
• Implemented a stepwise COVID-19 testing algorithm based on case acuity and timeliness.
• Phased resumption of elective surgeries and procedures across a 7-hospital system.

Main Results:

• Instituted the Pivot Plan on May 10, 2020.
• Tested 22,624 patients; 140 (0.62%) deferred due to positive COVID-19 tests.
• Increased daily surgical capacity from 13 to 531 cases, with a 52% increase in case volume.

Conclusions:

• Successfully resumed elective surgery and procedures in an academic healthcare system within a COVID-19 hotspot.
• The plan's success attributed to a culture of nimbleness, agility, and rapid interdisciplinary resource integration.
• Demonstrated a safe and effective model for restarting surgical services during the pandemic.