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Returning to the 'New Normal': Handling the Backlog of Elective Surgeries

Medscape features a Q&A with Bryan T. Kelly, MD, MBA, surgeon-in-chief and medical director at HSS, discussing COVID-19 response efforts, his experience in resuming elective surgeries and the safety protocols in place at HSS.

Dr. Kelly noted, “To treat critical care and urgent medical surgery patients, we converted operating rooms into intensive care units (ICUs) and anesthesia machines into ventilators, and hundreds of frontline staff adapted to meet unimaginable challenges. When our number of newly hospitalized patients with COVID started trending downward, we were able to rapidly discharge patients or transfer them back to other hospitals that had more equipped ICUs, ICU nursing staff, and critical care doctors. We then conducted terminal cleaning and rebuilt, and we are now on an accelerated return to a ‘new normal.’”

“We never stopped providing emergent orthopedic surgeries and conducted a process to define "essential" and other classifications of care. We prioritized emergency surgeries that needed to be done within 24-48 hours, urgent surgeries within 4-6 weeks, and priority surgeries within 12 weeks of the diagnosis and the predetermined treatment plan,” explained Dr. Kelly. “The biggest challenge for us is that we had a backlog of approximately 6,000 surgeries that were suspended for a 7-week period. I think it's going to take 3-4 months to get through this backlog. We typically do somewhere around 130-140 orthopedic surgeries a day here. We're currently operating at around 75 percent capacity. More ambulatory surgery is occurring, and we're now seeing is a significantly shorter length of stay. Patients who have a total joint replacement, where you might have expected a 2- or 3-night hospital stay, are discharged on the same day. I think that's great for the patient. It's something that there has been momentum in healthcare to do that anyway, to reduce length of stay.” he added.

Dr. Kelly noted, “In the context of COVID, the HSS website is populated with a lot of safety and educational materials for patients. We also have an informed consent statement ─ an attestation that the surgeon has spoken with the patient regarding COVID and informed them of all safety measures that we put in place. One of the nice things about our hospital is we do have a reputation and a history of being an extremely safe place to have your surgery with a very low complication rate, and a very low infection rate. In our outpatient department, we're limiting the number of patients per hour. It's the first time you can go to the doctor without having to wait for the doctor. We have also made changes and optimized our overall surgical schedule. In the past 3 months and in the middle of the pandemic, we had time to think about ways we can improve operational efficiencies related to surgeries."

Read the full article at Medscape.com.