With the increasing spread of COVID-19 infections, the governor of Arizona declared a moratorium on “elective surgeries” on March 19, 2020, in order to conserve hospital PPE supplies and build capacity for potential COVID-19 patients needing hospitalization.

The moratorium lasted for six weeks and was finally lifted on May 1, 2020. The end of the suspension resulted in a backlog of more than 3,000 surgical procedures at Phoenix Children’s Hospital.

THE PROBLEM

“While it is true that elective surgeries are typically nonurgent, many of these are medically necessary and important for a child’s health and well-being,” explained Dr. Vinay Vaidya, chief medical information officer at Phoenix Children’s Hospital.

“Besides the delay in surgery for the patient, deferring all elective surgeries put a major financial strain on hospitals across the country. The challenge we had to address was how to resume the thousands of deferred surgeries, in addition to the new surgeries that were being added each day.”

These operations needed to be conducted in a timely and efficient manner while ensuring utmost safety for patients and healthcare providers. The scheduling of surgeries is a complex process that involves many players and requires a series of sequential and interdependent actions. The COVID-19 pandemic added magnitudes of complexity to each step in this process.

“This was an unprecedented situation that needed coordination across our entire system of care, from executive leadership to surgeons, anesthesiologists, nursing staff, operating room staff, schedulers, and ultimately patients and their families,” Vaidya said.

“We needed to build a common communication highway, based on information technology, that would provide real-time visibility through the entire scheduling process, and to all stakeholders.”

PROPOSAL

Once the moratorium on elective surgeries was lifted, the process of rescheduling the backlog of more than 3,000 cases could begin.

Clearly, what was needed was much more than simply throwing additional scheduling staff to work through the backlog one patient at a time, Vaidya said. Amidst a pandemic, staff had to rewrite the rules of how a surgical scheduling process would unfold.

“Based on our previous experience of successfully using information technology in general, and data analytic dashboards in particular, it was evident at the very outset that we would need a similar approach to address the complex logistics,” he said. “The solution to resuming these surgeries was the development of a proprietary dashboard, which could facilitate the entire triage of operations.”

MEETING THE CHALLENGE

Given the challenges posed by COVID-19, it was important to take into consideration a number of factors such as: the type of surgery, medical necessity and need for hospital/ICU stay, Vaidya explained. These elements needed to be balanced with the availability of PPE, adequate staffing, general and ICU bed availability, and ventilator availability, while ensuring the highest standards of safety for patients and hospital staff.

“Using a careful and well-planned approach, a surgical prioritization was developed and uniformly communicated to all surgical teams,” Vaidya said. “To support the assignment of surgical priority for 3,000-plus cases, a new dashboard was created. This technology allowed each surgeon to review all their respective cases, and rapidly assign a priority of high, medium or low to all the backlogged cases, as well as new cases.”

As this data was captured electronically, it was used to feed a separate dashboard created specifically for the schedulers, who found it easy to work through the list, based on surgical priority. This significantly improved the efficiency of the process, allowing staff to schedule a much higher number of patients each day than previously possible.

"The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations."

Dr. Vinay Vaidya, Phoenix Children’s Hospital

“For those patients who were successfully scheduled for surgery, it was mandatory to test them for COVID-19 in the 72 hours preceding the date of surgery,” Vaidya noted.

“This process was also facilitated using the dashboard, which displayed the patients who were scheduled for COVID-19 testing, those who completed the test, and those who tested negative and were finally cleared for surgery. It also identified patients who tested positive for COVID-19 and needed to have their surgeries postponed.”

The entire end-to-end electronic process provided a single enterprise-wide view that allowed streamlined tracking of the patient throughout the multiple steps, not unlike that of an Amazon package, right from ordering to final delivery, Vaidya described.

“This also obviated the need for inefficient and time-consuming internal communication via emails, phone calls and spreadsheets between the surgeons, operating room staff and the schedulers,” Vaidya said. “The dashboard thus became the de facto central hub and the single source of truth, updated in real time, and extensively used across the entire organization, from the frontline staff right up to senior leadership.”

Vaidya added that it is important to point out that the hospital was able to accomplish all of this very quickly.

“We already had in place an existing robust data warehouse structure that was receiving feeds from almost every information system used in the hospital, including live feeds from our EHR,” he said. “In addition, much of the data needed for the dashboards had already been prepackaged into ready-to-use analysis cubes that had been previously built for other surgical projects preceding COVID-19.”

Finally, a couple of data analysts who were already proficient in rapidly building visually informative, interactive, actionable dashboards using Microsoft’s Power BI software, were able to deliver the dashboards in record time.

RESULTS

The one success metric of this project that stands out is that the hospital was not only able to catch up quickly on the backlog of surgeries, but actually ended up performing 166 more surgeries in June and July of this year, compared with the same period last year – 4,199 versus 4,033 – Vaidya reported. This volume speaks to the approach: an extensive use of data, analytics and dashboards to support every stage of the process, from surgeon prioritization to scheduling, testing and finally surgery, he added.

“Among the numerous types of surgeries performed during this challenging period, it is worth highlighting the results of our surgical volumes for two very complex surgeries,” he said.

“Phoenix Children’s Hospital is nationally recognized as a center of excellence, and draws patients from all across the country for Pectus surgery, done to correct chest wall deformities, and Scoliosis surgery, to correct abnormal spine curvature. Both are complex, long-duration surgeries that require a hospital stay, and are often planned months in advance to coincide with school summer break.”

In the case of Scoliosis surgery, the hospital succeeded in performing more surgeries this year during May through August compared with the same period last year, 95 versus 91. The results for Pectus repair surgery were even more noteworthy. The surgical teams outperformed by 41% the number of surgeries performed this year from May to August compared with the same period last year, 72 versus 51.

“The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations,” Vaidya said. “Throughout this project, given that patient and provider safety was our highest priority, it is important to point out that no surgeon or anesthesiologist has tested positive for COVID-19 since surgery restarted – a testament to extensive safety protocols that were supported by dashboard usage at every stage.”

ADVICE FOR OTHERS

The success of this project no doubt depended on the collaboration and cooperation of many different teams, Vaidya said. However, its foundation was built upon the optimum use of data analytics, and dashboard technology, to provide precise, real-time, actionable information to all the key players, he added.

“Fortunately, most hospitals and health systems have developed their electronic capabilities over the last 10 years and are sitting on a trove of data,” he said.

“Ensuring that the multiple, often disparate, information systems in a hospital setting all feed their data to a common data warehouse platform allows for optimum use of this data,” he explained. “Mining the data, and providing it to frontline users via intuitive interfaces, turns it into actionable intelligence that produces results.

“As IT professionals, we have been promising our health providers that data can be used to produce higher quality outcomes,” he added. “Using technology in the resumption of surgeries is a perfect example of delivering on this promise.”

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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