How to ‘Restart’ Your Perioperative Department in the COVID-19 Era
The pandemic has ushered in a new era of expectation, creativity and spirit of collaboration among healthcare providers. This is especially true of the perioperative department — typically the greatest regenerating department of any hospital. While hospital leaders are still defining the new normal and what it will look like, perioperative teams must strike while the iron is hot.
The Evolving Situation
For a time, COVID-19 halted elective surgeries, bringing many hospitals to the brink of financial ruin. As the population gets inoculated, the nation is turning the corner, and perioperative teams have learned a thing or two. Hospital administrators understand how to schedule elective surgeries better, and perioperative teams have developed new methods or leading practices to adapt operations. While overall goals remain the same, positive patient outcomes, objectives have shifted. One such objective is increasing case volume during surgical restrictions.
A Two-Part Problem
There are two primary issues hospitals and ambulatory surgery centers (ASCs) are currently facing.
1. Surgery case volume is stalled at the 70% level and the department cannot achieve pre-COVID volumes.
2. The perioperative department has rebounded to pre-COVID numbers but is still struggling to scale surgery volume because of patient resistance out of fear of infection and hospitalization.
This is where Sullivan Healthcare Consulting (SHC) can lead the way, helping to build the new normal based on lived experiences during the height of the COVID-19 pandemic.
How Can a Large Hospital of 70% Case Volume Achieve 100%?
Cooperation, standardization of patient protocols and expert guidance is the answer. Surgeons and anesthesiologists have recently become less resistant to adapting surgery protocols and working collaboratively to reach pre-COVID numbers. However, they are not the only group within the perioperative ecosystem to adopt more creative and flexible solutions. Human resources and primary care physicians (PCPs) also join the fray to define the new normal.
SHC’s Roadmap for Restarting Elective Surgeries
With over 46 years of perioperative consulting expertise, SHC can identify and swiftly implement leading practices to manage the new normal.
Flexible Scheduling Models: Block scheduling that provides the flexibility to increase or decrease surgery case volume is key for successfully operating in the new normal. A successful block scheduling program will include a commitment to transparency and an ability to increase, decrease, or modify blocks as utilization changes. As the nation emerges from the pandemic, the perioperative department must take these lessons learned and not revert to old rigid schedules with less flexibility in meeting demand week to week. SHC perioperative consultants have always suggested lower utilized blocks be released a week to two weeks in advance. As blocks are released, surgeons are assured they can still schedule cases that come in. Hospital administrators can find other surgeons that could utilize that block if released — booking patients in open blocks to reduce resources that won’t be needed on that surgical day.
Balance Flexibility with Layoffs: Hospitals have had a very rigid staff schedule, commonly requiring four weeks’ notice. An often overlooked option is to downsize the staff a few days a week and schedule other staff members for longer shifts on another day. This tactic is something SHC consultants have employed during the pandemic to avoid significant layoffs. Without staffing flexibility, steady case volume will not come to fruition and hospital leadership will be forced to lay off staff.
Higher Concierge Level of Service: Shifting to an increased concierge level or more personalized level of service to address patient fears and concerns during COVID is paramount. There needs to be a partnership between surgeons and PCPs to contact and assure patients of safeguards and heightened protocols. Perioperative staff must get on the phone to talk to patients about comfort level and minimization of risk to instill confidence.
Increase Same-Day Discharge (SDD): SHC perioperative consultants can work with providers to reduce risk to hospital admissions and increase SDD protocols to alleviate patient fears. From Pre-admission patient preparation and education to Post-op preparation and discharge, SHC knows the correct “monitors and metrics” to employ and redirect leading practices.
Offer Virtual Patient Preparation classes: Prior to surgery, offer virtual patient classes to address comfort level and risks surrounding elective surgery. SHC has successfully implemented this practice with total joint surgery patients to help alleviate fears. While seemingly minor, these classes have been instrumental in optimizing preoperative prep of patients (pre-anesthesia screening and protocols) to ensure patients are clinically ready before surgery and reducing the number of cancellations.
Incorporate Technology Into the Patient Experience: At this time, significant others cannot enter preop, but hospitals can promote technology use to ease patient fears. Encourage the use of patient tablets and smartphones to connect with significant others in the preop space and be present on the day of surgery. Perioperative departments should plan for this connectivity and make this a part of routine care.
The Bottom Line
If states begin lifting restrictions, perioperative teams must be ready at a moment’s notice to pivot operations. Even as the vaccine rollout is underway, there is still a concern of a resurgence in parts of the U.S. and much is still not known about the duration of vaccine protection. The most successful hospitals will create programs that require the perioperative department to be both nimble and resourceful.
Randy Heiser is the President of Sullivan Healthcare Consulting. Randy has been a hospital consultant since 1983 and has specialized in perioperative consulting since 1992. He has directed more than 500 surgery department operational improvement studies (and participated in an additional 350) in programs ranging from small community hospitals and freestanding surgery centers to some of the largest university hospitals in the U.S. He was instrumental in the design, development and implementation of the Surgery Benchmark Program that has been used by more than 280 hospitals. He has also participated in the design of several proprietary surgery scheduling information systems currently available in North America.