Surgical Case Selection: How the Laboratory for Transformative Administration Works with Surgeons to Schedule Cases During COVID-19

By Michelle Antoinette Macalino, Duke Surgery

Hospitals and the many healthcare professionals working in them strive to bring the best care to their patients no matter the circumstance. Once the threat of COVID-19 came to light, healthcare workers were advised to prioritize hospital admissions for those who were afflicted with the coronavirus, but where does that leave patients who already scheduled a surgical procedure during this time period?

Even in the face of a pandemic, faculty within the Section of Surgical Disciplines did not lose sight of their mission to continue with the provision of care for those patients whose surgical cases could not be safely delayed 30 days and partnered in the clinical review and ranking of every surgical case.

The Laboratory for Transformative Administration (LTA) developed a tactical plan, ensuring that all surgeons were engaged in the clinical review and priority assignment of their patients. Wendy Webster, Director of Clinical Operations partnered with department chairs, division chiefs and their designees in dissemination of cases for review and return of surgeon prioritization for the upcoming week. 

As the process was fluid, updates to the schedule were received daily and shared with Dr. Allan Kirk, the Surgeon-in-Chief and hospital leadership for their review with available resources such as ICU beds, inpatient beds and staffing.

Their review was also in context of staff and faculty well-being. In other words, gauging the stress levels of the staff and managing patient flow accordingly as to not exacerbate the stress levels any further. 

How was the Section of Surgical Disciplines prepared to respond to the request for a review process within 24 hours of the request?  Simply put, “The LTA,” which was formed in 2017 to use a scientific approach to answer healthcare challenges.

The team partners with clinical and academic leadership across Duke University Health System (DUHS) to understand the issue at hand and quickly provide the data to make the best care decision possible. This in turn provided a tremendous return on investment: immediate-access to real-time surgical case data for surgeon adjudication of clinical acuity, resource utilization and priority. 

“The nice part about our electronic medical record is the real-time access to patient data.  This allowed us to quickly create a new report and process for each department to review surgical cases and provide input,” says Ms. Webster.

The data driven approach and the transparency of the process assisted the surgeons was one of the factors that helped ease the minds of surgeons. The second one, was the leadership of Dr. Allan Kirk, Department of Surgery Chair, as well as the department chiefs, ensuring that the surgeons can still provide the necessary care for all patients.

“Dr. Kirk approached the situation with an attitude that didn’t cause panic as if the house was on fire,” says Dr. Michael Lipkin, LTA faculty leadership. “Instead, he saw it as there’s some smoke off in the distance. Let us do this in an intelligent and responsible way and let’s not forget about the patients who need us. That leadership was what kept us all steady.”

With that attitude and a data-driven process, the faculty and leadership are able to approach the resource challenges associated with COVID-19 and the surgical needs of their patients with much greater ease than before.

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