Surviving the COVID-19 Pandemic

Surge Capacity Planning for Nonemergent Surgery

Lee Squitieri, M.D., Ph.D., M.S.; Kevin C. Chung, M.D., M.S.

Disclosures

Plast Reconstr Surg. 2020;146(2):437-446. 

In This Article

Abstract and Introduction

Abstract

Summary: The coronavirus disease 2019 (COVID-19) pandemic has confronted the U.S. health care system with unprecedented challenges amidst a tenuous economic environment. As inpatient hospitals across the country prepare for an overwhelming influx of highly contagious COVID-19 cases, many nonemergent procedures have been cancelled or indefinitely postponed without guidance regarding eventual safe accommodation of these procedures in the future. Given the potentially prolonged impact of the COVID-19 pandemic on health care use, it is imperative for plastic surgeons to collaborate with other medical and surgical specialties to develop surge capacity protocols that allow continuation of safe, high-quality, nonemergent procedures. The purpose of this article is to provide necessary and timely public health information relevant to plastic surgery and also share a conceptual framework to guide surge capacity protocols for nonemergent surgery.

Introduction

The rapid progression of the coronavirus disease 2019 (COVID-19) pandemic has confronted nations around the world with unprecedented clinical and economic challenges. With each passing day, news in the United States and many other countries becomes more dire, vividly exposing the strengths and weaknesses of governments and health systems as they scramble to manage this novel public health crisis. In the United States, the rising number of confirmed COVID-19 patients, limited testing capabilities, and a shortage of personal protective equipment have left many patients and health care workers vulnerable and unprepared to accommodate sudden increases in demand and also maintain necessary nonemergent care.[1–3] Furthermore, the fragmented health care system in the United States impedes a centralized, coordinated approach to confront this pandemic.

Epidemiologic models of the COVID-19 pandemic estimate that it may last as long as 18 months, with multiple waves of illness.[2,3] Given the potentially prolonged impact on health care use and personnel, it is imperative to develop surge capacity protocols that not only address acute care needs, but also guide organizational expansion for routine nonemergent care. To protect high-risk patients from unnecessary exposure, government, payers, industry, and health system stakeholders have worked in concert to rapidly expand access to telehealth.[3–6] Although virtual interfaces have the ability to offload many aspects of patient evaluation and management, they are not able to replace critical health care processes that require direct patient-provider encounters and interventions.

Currently, hospitals across the country have been urged to cancel thousands of nonemergent diagnostic tests, procedures, and operations, with limited guidance regarding when or how to accommodate these interventions moving forward.[4,7,8] To advocate for patients and participate in emerging discussions regarding surge capacity for nonemergent procedures, plastic surgeons must have in-depth knowledge regarding infectious disease epidemiology and public health strategies. The purpose of this article is to provide necessary and timely public health information relevant to plastic surgery and also share a conceptual framework to guide surge capacity protocols for nonemergent surgery. This information will enable plastic surgeons to critically evaluate their own patient practice capacity in the context of the current COVID-19 pandemic and stimulate productive discussion between plastic surgeons and health systems within their communities to meet their responsibility for other conditions and diseases that require similar attention.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....