A scalable tool for adjudication of time sensitive cases during COVID-19 pandemic
- PDF / 1,104,028 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 61 Downloads / 153 Views
and Other Interventional Techniques
A scalable tool for adjudication of time sensitive cases during COVID‑19 pandemic S. Scott Davis Jr.1,5 · Michael L. Williford1 · Scott Isenburg2 · Matthew Klopman3 · John F. Sweeney1 · Scott D. Boden4 Received: 7 July 2020 / Accepted: 30 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background During the COVID-19 pandemic, prioritization of care and utilization of scarce resources are daily considerations in healthcare systems that have never experienced these issues before. Elective surgical cases have been largely postponed, and surgery departments are struggling to correctly and equitably determine which cases need to proceed. A resource to objectively prioritize and track time sensitive cases would be useful as an adjunct to clinical decision-making. Methods A multidisciplinary working group at Emory Healthcare developed and implemented an adjudication tool for the prioritization of time sensitive surgeries. The variables identified by the team to form the construct focused on the patient’s survivability according to actuarial data, potential impact on function with delay in care, and high-level biology of disease. Implementation of the prioritization was accomplished with a database design to streamline needed communication between surgeons and surgical adjudicators. All patients who underwent time sensitive surgery between 4/10/20 and 6/15/20 across 5 campuses were included. Results The primary outcomes of interest were calculated patient prioritization score and number of days until operation. 1767 cases were adjudicated during the specified time period. The distribution of prioritization scores was normal, such that real-time adjustment of the empiric algorithm was not required. On retrospective review, as the patient prioritization score increased, the number of days to the operating room decreased. This confirmed the functionality of the tool and provided a framework for organization across multiple campuses. Conclusions We developed an in-house adjudication tool to aid in the prioritization of a large cohort of canceled and time sensitive surgeries. The tool is relatively simple in its design, reproducible, and data driven which allows for an objective adjunct to clinical decision-making. The database design was instrumental in communication optimization during this chaotic period for patients and surgeons. Keywords COVID · Surgery · Case · Adjudication · Time sensitive
* S. Scott Davis Jr. [email protected] 1
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
2
MHA, Emory Healthcare, Atlanta, Georgia
3
Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
4
Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, Georgia
5
Department of Surgery, Emory School of Medicine, 1365 Clifton Road, Suite A4200, 30322 Atlanta, GA, Georgia
The COVID-19 pandemic brought novel challenges and forced difficult decision-making. As
Data Loading...
