Innovation and agility — The keys to managing surgical services amid uncertainty

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The COVID-19 pandemic has had an enormous influence on surgical services, which is one of the most critical financial engines for hospitals and ASC’s.

Many organizations have met this challenge with innovation, resilience and agility.

During a September webinar hosted by Becker's Hospital Review and sponsored by IBM Watson Health, three healthcare leaders discussed managing surgical services during times of disruption. Panelists were:

  • Lee Ausmus, administrator, St. Michael's Ambulatory Surgery Center in Clearwater, Fla.
  • Adam Post, senior director of business operations of surgery, Spectrum Health in Grand Rapids, Mich.
  • Leonard Henry, MD, medical director, The Goshen (Ind.) Center for Cancer Care
  • Moderated by Walt Sokac, associate partner of provider consulting, IBM Watson Health

Four takeaways:

1. Analytics are critical for managing deferred surgeries. Spectrum Health developed a framework with four procedural levels to prioritize surgical cases. "Level one is a case that is urgent and emergent and can't wait. Level four is a case that potentially can be deferred as long as the disruption lasts. We started deferring at level four and then moved to lower levels," Mr. Post explained. Adding surgical leveling data to the EHR and creating a deferral dashboard to track all patients increased surgeon engagement in the process. In addition to the surgical leveling data, the team considered factors like length of stay and patient acuity. Spectrum Health also added a post op destination field to the EHR. "This was a gamechanger for predictive analytics related to bed planning," Mr. Post said. "We are now able to predict census for our 1,000-plus bed hospital system with an accuracy of plus or minus 0.5 percent. This intelligence was foreign to us [before] the pandemic, but now it's really come to fruition."

2. New organizational structures in combination with real-time information enhance visibility. In response to COVID-19, the Goshen Center for Cancer Care implemented an incident command center and new communication channels that provided a high-level view of the entire health system. "We stood up a new structure so we could collect real-time information that we never had about the status of emergency rooms, hospital bed capacity and PPE inventories," Dr. Henry said.

3. Asking "what if?" enables health systems to respond quickly to disruptions. "IBM uses the 'what if?' philosophy and I think that's the key to our ability to respond nimbly to unexpected events," Mr. Ausmus said. If healthcare organizations are in a state of ongoing readiness, they can frequently conduct "what if" analyses. This leads to better response plans and faster response times. Patient outcomes and operational effectiveness are enhanced as a result.

4. Artificial intelligence and machine learning have the potential to improve surgical services. Spectrum Health, for example, has applied AI to robotic surgery to identify wasted instrument movements and to support the reading of radiology studies. For ophthalmic surgery patients, St. Michael's Ambulatory Surgery Center prepopulates testing equipment with patient demographic information from billing office systems. Before patients move into the operating room, test results are sent to the EHR so surgeons can confirm the correct cataract intraocular lens implant. "It's a very small example of the tremendous opportunity across all of perioperative services and healthcare," Mr. Ausmus said.

Although the pandemic has been traumatic for health systems, it has also represented a renaissance at many. "Over the last 18 months, we've reacted to unexpected change, we've evolved and matured," Mr. Post said. "We've taken everything we've done as a response to surgical care during the pandemic and made it better over time."

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