Transition of general surgery procedures to outpatient settings during COVID-19

Editor's Note

This study from the Mayo Clinic finds that despite calls for the expansion of outpatient surgery to mitigate the growing backlog of surgical cases during COVID-19, the transition of general surgery procedures from inpatient to outpatient settings occurred in only a small subset of procedures.

This cohort study included 988,436 patients who underwent 16 general surgery procedures—823,746 had surgery before COVID-19 and 164,690 had surgery during COVID-19.

Multivariate analysis found that the odds of outpatient surgery during COVID-19 vs before were higher in patients having:

• mastectomy for cancer
• minimally invasive adrenalectomy
• thyroid lobectomy
• breast lumpectomy
• minimally invasive sleeve gastrectomy
• parathyroidectomy
• total thyroidectomy.

However, only four procedures had a clinically meaningful overall increase in outpatient surgery rates:

• mastectomy for cancer (+19.4%)
• thyroid lobectomy (+14.7%)
• minimally invasive ventral hernia repair (+10.6%)
• parathyroidectomy (+10.0).

Further studies should explore potential barriers to the transition to outpatient surgery, particularly for procedures that have been shown to be safely performed in an outpatient setting, the researchers note.

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Abstract:

As a hospital leader, it is indeed frustrating for you and/or your perioperative leadership to have  difficult conversations with surgeons about block allocation and utilization, particularly when the data isn’t defensible and when surgeons can take their cases elsewhere. It is also challenging to decide how much time and flexibility you can afford to give new surgeons to grow their practice without tying up potentially underutilized time.

How can your organization establish a more effective, less stressful program for managing and optimizing your operating room schedule- particularly given today’s challenging environment of constrained nursing and anesthesia resources?

Join The University of Kansas Health System’s (TUKHS) Senior Director of Business Operations, Perioperative and Procedural Services to learn about creating an Effective Block Management System and learn how TUKHS was able to, in less than a year’s time, achieve a 20% increase in block utilization, 5% increase in prime time utilization and facilitate 98% more manual releases/transfers of time before the auto-release deadlines.

Learning Objectives:

• Define the characteristics of an effective block management system.
• Identify ways to break through historical barriers and confidently make quicker block allocation decisions.
• Explain why, even after a significant EHR investment, hospitals still need to invest in data management systems, particularly for the operating room.

Speakers:

Megan Eubanks, MBA Senior Director of Business Operations, Perioperative and Procedural Services The University of Kansas Health System	Ashley Walsh, MHA Vice President Client Services, iQueue for Operating Rooms and Inpatient Beds LeanTaaS

 Critical Components of Optimized OR Performance: Credible Data and an Effective Surgery Block Management System
Wednesday, December 14 2022 | 2:00 PM ET
1 CE Credit

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Abstract

Operating Room risk factors require education about and protection from sharp injuries as well as physical, chemical and biological insults. Evidence, professional recommendations and statistics outline these risks and offer solutions. Content will outline protocols and implementation suggestions.

Learning Objectives:

• Discuss the impact of occupational exposure on healthcare workers today
• Describe the ECRI method of product review
• Identify the benefits of Double Gloving in the OR

Speakers:

Deborah L. Spratt, RN, BSN, MPA, CNOR, NEA-BC CRCST CHL	Lorrie Calabrese, RN, BSN, CNOR Senior Clinical Specialist Molnlycke

Culture of Safety: Sharps Safety
Tuesday, December 6, 2022 | 12:00 PM ET
1 CE Credit

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Abstract

As an OR leader, you’re facing overwhelming challenges due to staffing shortages, pent-up demand for OR time, and financial pressures. What new strategies can you use to rapidly optimize existing resources while simultaneously preventing burnout?

During this webinar, discover how Allina Health uses AI-powered automation software to simplify the OR scheduling process, re-energize staff and rapidly boost OR & block utilization. By automating manual OR processes, the health system rapidly increased OR access for surgeons, improved utilization, and grew strategic case volumes — delivering millions to the bottom line.

Learning Objectives:

• Add 2+ cases per OR per month and grow robotic cases by 50%
• Increase case volume by up to 10%
• Reduce manual work and boost staff satisfaction
• Create more predictability for staff schedules and decrease late-running cases

Speakers:

Whitney A. Johnson, RN, MHA, Director of Surgical Services & The Center for Advanced Endoscopy, Abbott Northwestern Hospital, a part of Allina Health	Derek Fine, Customer Success, Qventus

How to Rapidly Boost Your OR Utilization and Re-energize Staff: Allina Health’s Strategic Partnership Using AI & Automation
Wednesday, November 30, 2022 | 1:00 pm CST
1 CE Credit

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Abstract

Disruption to the OR schedule is far too common.  Attempts to fix issues come at a high cost (overnighting supplies, staff overtime). These disruptions frustrate staff, impact patient care, and cut into profit margins.

When you are able to streamline operational planning for cases through automation, you can minimize day-of impacts, maximize efficiency and reduce scheduling conflicts. Provide OR leadership with ample time to proactively resolve problems related to staffing, equipment, supplies, case length and patient readiness (including some issues you may have not otherwise been aware of).

In this session, learn how perioperative readiness helps run your surgical day as planned, giving you enough time to proactively and economically address barriers and optimize OR operational efficiency.

Learning objectives 

• Learn how to automate surgical case planning to run cases more efficiently and run the surgical day as planned
• Anticipate and identify operational issues with staffing, equipment, supplies, case planning and patient readiness ahead of time
• Discover effective ways to streamline communication and overcome operational scheduling barriers

Presenter:

Shawn Sefton, MBA, BSN, RN CNO & VP, Clinical Solutions Hospital IQ

Perioperative Readiness to Optimize the Surgical Schedule
Thursday, November 10, 2022 | 1:00PM ET
1 CE Credit

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Abstract

Ever walk into your OR and everything is suddenly perfect? Please join this session to learn how new AI enabled technology combined with analytics and surgical video can help you uncover root causes that create dysfunction and inefficiencies in your Operating Rooms. Let’s open up that black box (without the Hawthorne effect) to improve surgeon and staff satisfaction, as well as improve clinical outcomes such as SSI rates.

Learning Objectives

• Learn how analytical and video-based data can be used to improve performance and enhance teamwork.
• Discover how benchmarking can facilitate engagement for performance improvement.
• Participants will gain an understanding of technical skill and non-technical skill evaluation tools and their use.

Presenters

Gail Pietrzyk, DNP, RN, CNOR Chief Nursing Officer Caresyntax	Joan White, APRN Director, Clinical Consulting Caresyntax	Jason Till Senior Product Manager Caresyntax

Lights, Camera, Action – for Performance Improvement
Thursday, October 27 | 1:00 PM ET
1 CE credit
FREE WEBINAR

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Abstract

When your ORs are not efficiently utilized, revenue is lost, patient and staff satisfaction declines, and resources are misallocated. However, optimizing capacity is a complex challenge:

• Block schedules intended to help with efficiency can unintentionally hinder OR scheduling, resulting in underutilization.
• You don’t have the information available to plan for cases and address barriers ahead of time.
• Cases that run longer than booked create delays. Those that run shorter result in missed opportunities for cases and revenue.
• Your perioperative staff schedule does not align with the upcoming case mix, leading to chaotic scrambles as you seek out the OR workforce you need to meet the planned day’s requirements.

In this session, learn how to take a holistic approach to managing the perioperative suite that will maximize efficiency, even with limited OR resources. Discover ways data and automated workflows can streamline operations and standardize case planning to create, find, and fill more OR time and maximize your surgical case volume based on available resources.

Learning objectives  

• Develop a holistic approach to managing perioperative operations that creates transparency and enhances your workflows for creating, finding and filling more OR time
• Identify staffing gaps and consider solutions that align the OR schedule with your workforce to optimally allocate your staff
• Learn how to proactively address barriers to running cases and build predictive operational case planning into workflows at your organization

Presenters

Shawn Sefton CNO & VP, Clinical Solutions Hospital IQ

Deb Tse Senior Solution Design Consultant Hospital IQ

Putting the Puzzle Together. A Holistic Approach to Perioperative Operations that Optimizes OR Capacity and Aligns Resources
September 28, 2022  |  1:00PM EDT |  1 CE credit
FREE WEBINAR