In early 2020, many states shut down hospitals’ elective surgeries to conserve beds and PPE for COVID-19 patients. Since then, elective care has resumed at most locations, and the fear of an elective surgery backlog seems not to have come to fruition. Yet with stronger waves of COVID cases hitting facilities across the country, many hospitals have announced they are again postponing elective procedures.
Not only does this affect patient care, it impacts hospital revenue. According to a report by healthcare consulting firm McKinsey & Company, healthcare systems lost an estimated $200 billion between March and June 2020 alone due to cancelled surgeries, and another shutdown will further increase losses.
How big is the backlog?
It’s unclear just how much of a backlog there may be, and it likely depends on a facility’s location and size.
Healthcare executives responding to the McKinsey & Company survey stated they were worried about a potential backlog and may have trouble addressing it due to “workforce availability, enhanced sanitation protocols, and reserved inpatient capacity.” The report cites two additional studies that echo this sentiment — the Journal of Bone and Joint Surgery estimates a cumulative backlog of more than 1 million joint and spine surgeries by 2022 and the Journal of Cataract & Refractive Surgery estimates a backlog of between 1.1 and 1.6 million cataract surgeries in the same time frame.
The report estimates that even if hospitals were to operate at 10% above their baseline volumes, “around 20 months would be required to work through the pent-up demand from 2020.”
Yet, this dire prediction may not actually play out on the ground for many facilities. Gary L. Roth, DO, MBA, FACOS, and Chief Medical Officer for the Michigan Hospital & Health Association, says he’s not hearing about a backlog of non-time sensitive procedures and believes many Michigan healthcare organizations caught up on postponed cases from the first wave over the summer and fall.
Steve Jacobs, senior physician recruiter at Einstein Healthcare Network, agrees. He says his organization is now better prepared than they were at the start of the pandemic, and they’ve used what they’ve learned over the past nine months to implement new policies and procedures. “It doesn’t have the craziness of a first-time event,” he says.
Strategies for addressing an elective surgery backlog
While it remains to be seen how many more non-time sensitive procedures and surgeries will be postponed or cancelled, healthcare facilities can effectively address pandemic-related backlogs with careful planning. Here are four strategies for addressing the elective surgery backlog at your facility.
1. Use data analytics to prioritize procedures
Many hospitals have turned to data in order to prioritize which patients should be seen following a delay in surgical procedures.
With cases rising across the country, hospitals need to figure out a smarter way of doing surgeries with limited bed space, says Randy Rodriguez, a business intelligence analyst for CHG Healthcare. “A lot of hospitals are starting to create algorithms and analytical tools,” he says.
For example, Phoenix Children’s Hospital was able to successfully reschedule 3,000 backlogged surgeries thanks to a newly-created dashboard. It served as a central hub for all information and assisted surgeons, schedulers, and other frontline staff in coordinating care.
Likewise, HCA Healthcare created a dashboard with color-coded warning levels that alert staff to potential surges, and Tenet Healthcare is monitoring public health data to better anticipate their patient census as COVID-19 cases rise and fall.
2. Watch for signs of burnout and monitor provider health
“Burnout is a big issue and it’s ongoing,” says Dr. Roth. “We’re seeing staff that are just starting to recover from the traumas they dealt with during the peak of COVID in the spring and early summer, and now here they are again without even having a chance to completely recover from it.”
Yet he says many surgeons thrive on being busy, and they’re happy to return to normal surgical volumes. Jacobs echoes this sentiment and adds that many of those working under an RVU model are eager to do more procedures to recoup lost income.
Either way, healthcare organizations should be mindful of their employees’ mental health and adjust staffing as necessary.
3. Use temporary staff to increase capacity when needed
In cases of staffing shortages or provider burnout, temporary staffing options — like locum tenens physicians or travel nurses, therapists, and lab techs — may be a way to help your facility meet surgical demands.
Workforce shortages are the number one barrier facilities face in increasing surgical volume, according to the McKinsey report, and Dr. Roth says he’s heard from many organizations who are short on staff — particularly nurses, respiratory therapists, lab techs, and pharmacists.
One way to keep procedures on schedule is to bring in temporary staff who can support your surgical team, says Rodriguez. “We can get a locum or traveler in place to help with the backlog, and then you can return back to normal capacity when it’s over.”
Without knowing how cases will impact hospital capacity, having the ability to bring in additional staff quickly can help organizations remain nimble and recover lost revenue while continuing to provide care.
4. Coordinate with other facilities in the community
When working through your elective surgery backlog, patient care needs to take top consideration, even if that means patients will be better served by going elsewhere.
Regional cooperation between facilities is the top solution listed in the “Roadmap for maintaining essential surgery during COVID-19 pandemic,” a joint statement released by several medical associations, including the American College of Surgeons. “Facilities should engage in regional cooperation to address capacity and new patient needs,” it states, adding that organizations should work together to ensure the appropriate numbers of beds, PPE, and trained staff are available.
In Wisconsin, Advocate Aurora Health has been transferring patients from crowded hospitals to those with available beds. They’ve also been bringing in nurses from hospitals in Illinois to address patient surges. Additionally, recent regulatory changes removed CMS requirements for inpatient procedures, which may allow some patients to receive faster care in ambulatory surgery centers.
Focusing on patient care
This year has stretched healthcare organizations and providers to their limits, but they’re still finding ways to provide care to those who need it most. Implementing a variety of creative strategies to address surgical backlogs — from dashboards to community cooperation — will help ensure patients are treated without unnecessary delay and contribute to a better patient experience.
CHG can provide your healthcare facility with the doctors, nurses, and allied professionals you need to provide the best care for your community. Contact us by phone at 866.588.5996 or email at firstname.lastname@example.org.