Dan Towarnicke is Vice President, Perioperative Services at University Hospitals in Cleveland, OH. He recently joined Hospital IQ for a leadership roundtable on re-opening surgical services during COVID-19 recovery.
In just the past two and a half months, we’ve had over 4,000 surgical procedures and 2,000 cath lab procedures, elective procedures, and endoscopies postponed due to COVID-19. Across University Hospitals in Cleveland which comprises 15 operating locations, we’re down to about 30% of what we would normally do.
Like all hospitals, both our revenue and patient care have been impacted. The good news is that the Governor of Ohio has permitted medically necessary cases that don’t require an overnight stay or an inpatient admission to be rescheduled and performed, so we’re getting back to normal on the outpatient spectrum.
Our process for this started back in March when we were initially ordered to only perform essential surgeries. We created a COVID-19 cancelation code in our EHR and we’ve aggregated all of those cancelations. What we’re really focused on is trying to understand, from those 6,000 procedural and surgical cases that were canceled, what does that really equate to in OR time? It’s nice to know the number of cases, but for us to be able to effectively manage our schedules, staff, added blocks, weekends, and extended shifts, we’ve had to dig into our performance measurement tools to quantify by service line and location how much block time is going to be needed to make up for all of this demand.
Strictly from a business perspective, we’re also analyzing which patients are ready to come back from a financial clearance standpoint. Which ones still have a valid authorization or don’t need insurance authorization for Medicare, Medicaid, and things of that nature? We’ve given our surgeons that information so that it’s easier on the patients, it’s easier on our scheduling process, and it’s easier on our revenue cycle to be able to get those cases loaded on the schedule sooner rather than later.
From an OR standpoint, there are several considerations that we have been talking about across our system. First, we want to make sure we’re making best use of our existing OR time. One of our tactics and strategies is to open blocks as much as possible and have the service lines dedicate a larger portion of their block time to open time so that we can make the best use of the existing capacity. That will certainly help us dig out of this backlog of cases.
Additionally, in our ambulatory surgery centers and the Cleveland Medical Center, we’re going to be expanding block hours from 8 to 10 hours to 10 to 12-hour blocks. That is a quick way to immediately improve access. We think that’s going to be the most advantageous for both us and the service lines that tend to have shorter cases. However, that’s not going to be uniform across the board because it may not be necessary. We don’t want staff locations that are not going to be utilized because you can’t add on a longer case. We’re also extending the block release policy from 72 hours to 1 to 2 weeks depending on the need and the demand.
We’ve had a fantastic response from our surgeons, and I think having the surgeons be part of this governance is key. We have a surgical operations executive committee with our surgeons, anesthesia and nursing all communicating what our proposed recommendations are for improving access and capacity across the system. These decisions are made as a multidisciplinary team. Surgeons are anxious to take care of their patients. Based on the specialty and the surgeon’s practice, we’ve seen a wide variety of impact. We’re still not booked to the capacity that we would be on a normal operating day. That’s probably going to come with time, but the surgeons are on board. They are open to all strategies that we have to make to ensure that they have easy access to the ORs. Working together is the only way to get through this.