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Postponement of Non-Essential Surgeries

Sun, Mar 15, 2020 2:29 PM

Department of Orthopedics and Rehabilitation

 PLAN for postponement of all non-urgent surgeries and procedures beginning Wednesday March 18, 2020.

 Please read the entire document before sending inquiries – there is a lot of information and your question may be answered somewhere in here.

Per UW Health Incident Command, UW Health providers are directed to minimize non-urgent surgeries and procedures in order be a leader and role model in the community in social distancing and to support our ability to meet our patients’ urgent needs in the safest way possible.  Therefore, non-urgent surgeries and procedures should be adjusted such that only essential surgeries/procedures are performed after Tuesday March 17, 2020. At present, Monday and Tuesday elective schedules may proceed as scheduled, however, this could change as the situation develops. It is uncertain when normal operations are expected to resume – but we are currently looking 4 weeks ahead.

Stratification of Patients for Surgery into Essential (surgery should proceed) and Non-Essential (surgery should be postponed): Non-Essential surgeries will be cancelled or considered for cancellation as we work through the coming weeks.

Essential/Urgent patients:

  • Essential surgeries/procedures are listed below:
    • Fractures and other acute injuries, including some tendon and ligament tears and locked meniscus tears, for which a delay in surgery would lead to a compromised outcome
    • Nerve injuries
    • Some malignancies, i.e., sarcomas
    • Infections – discretion
    • Progressive neurological deficit or neuropathic pain due to nerve compression
    • Imminent failure of arthroplasty components, or adjacent bone (impending peri-prosthetic fracture)
    • Irreducible arthroplasty dislocation
    • Impending ulceration/soft tissue breakdown.
    • Surgery not listed here that is time dependent, i.e., any delay in surgery would lead to a compromised outcome.

Operational Plan:

Monday, March 16

  • Surgeons will review all scheduled cases/procedures in order to stratify – essential vs non-essential – through April 15th.
  • Surgeons will complete stratification by end of business Monday, March 16.
    1. Use the Green/Red dot system to stratify your patients on your Provider Planner (similar workflow as for clinic visit prioritization)
    2. Send email to Geoff Baer, Seth Williams, and Kim Beld the number of essential and non-essential surgeries you have for each week through April 15 – this information is needed in order for the OR to plan staffing. (Example: week of Mar 23-27, 2 essential and 12 non-essential surgeries). Surgeons who operate at MSC or at Meriter should not include those cases in the TAC list, but should send this information to Kim Beld to forward to the appropriate Meriter and MSC personnel.
  • APPs will compile a list of scheduled preop visits for March 17-20 and list them in order of their visit: Tues, Weds, Thurs, Fri.
    1. Provide this list to surgeons by Monday noon.
    2. Tomorrow (Sunday), an APP group will be contacting all Monday pre-op patients to cancel appointment and update them on possible surgery postponement
  • Surgeons will call patients scheduled for surgery with the following prioritization:
  1. Call patients with pre-ops scheduled Tuesday or Wednesday, to (A) cancel surgery and pre-op visit if surgery is this week or (B) cancel pre-op visit this week if surgery is scheduled later than this week and update them on possible surgery postponement once we have more information on the cancellation duration.
  2. Call patients with surgery scheduled Wednesday, Thursday or Friday to cancel pre-op visit (if it has not occurred) and surgery.
  3. Call patients with pre-ops scheduled Thursday and Friday to let them know their pre-op will be re-scheduled once we are provided further direction on the cancellation duration.
  • Document that you have spoken with the patient in a telephone encounter, and forward this communication to your surgery scheduler, as the surgery scheduler will handle logistics of cancelling pre-op visits and surgery.
  • We are awaiting direction from UW Health Incident Command on postponement window – we are supposed to hear by Thursday regarding cancellations the week of Mar 23-27.
  • Surgeons who need assistance calling patients for cancellation can work with their APP, or can call Kim Beld for guidance on assistance – as much as possible, communication should come from surgeons.
  • Talking points will be developed for providers and staff to guide calls for postponed procedures.

Tuesday, March 17

  • Surgeons and APP’s will continue to contact patients whose case/procedure is postponed – utilize talking points to structure conversation – surgeons should have these conversations as much as possible.
  • All Wednesday surgical patients requiring postponement should be contacted by noon on Tuesday, and all Thursday and Friday surgical patients should be contacted by noon on Wednesday and Thursday, respectively.
  • All preops requiring cancellation must be contacted by the prior day end of business.

Another way to look at all this: Below is a week-to-week breakdown of planned pre-op visit and surgery cancellations.  This will likely change!

  • Surgical Cases Monday (3/16) & Tuesday (3/17)
    • Currently, the OR schedule is going to proceed as planned.  This could change.
  • Surgical Cases Wednesday (3/18) through Friday (3/20)
    • PREOP: If the pre-op has not already occurred, it should be cancelled and should not occur.
    • SURGERY: Surgical case will be cancelled – defer to OR process for actual cancellation, surgical scheduler to track for need to reschedule once this settles.
  • Surgical Cases Week of 3/23
    • PREOP: If the pre-op has not already occurred, it should be cancelled and should not occur.
    • SURGERY: PENDING INCIDENT COMMAND DECISION/DIRECTION, ANTICIPATED BY 3/19: Surgical cases have not formally been cancelled.  If surgical cases are cancelled – defer to OR process for actual cancellation, surgical scheduler to track for need to reschedule once this settles.
  • Surgical Cases Week of 3/30
    • PREOP:If the pre-op has not already occurred, it should be cancelled and should not occur – impress upon patients that we will rapidly get them in if their case continues as schedules.
    • SURGERY: Surgical case will not be cancelled until future decision from incident command about timeframe – surgical scheduler to track potential need for short lead-time pre-op.
  • Surgical Cases Week of 4/6
    • PREOP: If the pre-op has not already occurred, it should be cancelled and should not occur – impress upon patients that we will rapidly get them in if their case continues as schedules.
    • SURGERY: Surgical case will not be cancelled until future decision from incident command about timeframe – surgical scheduler to track potential need for short lead-time pre-op.