We are in this together.

The ORDx+Rx team realizes that everyone has been impacted in different and stressful ways by COVID-19, and we stand ready to collaborate with hospitals and health care organizations to assist in delivering safe care during critical patient and procedural encounters.

As doctors and nurses, the patient is always our highest priority. Providing safe and effective patient care continues to be our primary objective, and we recognize that this care must be rendered with the least risk possible to our colleagues.  While, like most, we at ORDx+Rx have been impacted by the current pandemic (for example, a temporary past interruption in our ability to travel and/or to have access to staff and facilities) we are once again committed to working on-site with our clients and all healthcare providers to devise solutions that reflect the substantial advances in COVID-19 diagnostics, treatment and infection prevention as part of our approach to maximizing the safety and quality of surgical and invasive procedures in a COVID environment.

We must all take the opportunity to reflect on the way we comport ourselves in the midst of such stressful circumstances. This has become even more essential when those who would behave in ways that disregard the notion of teamwork and collaboration might endanger their own lives or that of others. Such hardships can be countered by the good in people as we watch: heroes emerge, communities take constructive action, more consideration and cooperation is shared in everyday encounters among colleagues and, especially, with patients and families. The importance of this latter point has most recently been highlighted by the keynote speech at this July’s American College of Surgeons Conference on Quality and Safety. 

We continue to play our part in working closely with our clients to overcome the challenges that have been placed upon us all. While much of what has been experienced by healthcare organizations is unprecedented, most challenges are ones that our team has faced in various contexts in the past as well as in our more recent consultations. We encourage you to get in touch with us to take advantage of our experience and guidance.

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We Can Help During This Continuing Pandemic:

  • We are ready to work with your team to facilitate effective short-and long-term plans to deal with issues around restoration of capacity (if you are or are close to currently limiting elective procedures) and to prepare for optimal future responses should that be necessary.
  • We can help mediate discussions around collaboration, communication and teamwork, which may have been problematic for the organization prior to COVID-19 and potentially exacerbated during earlier as well as current phases of the pandemic.
  • We can facilitate surgical scheduling priorities and procedures, and recommend other key departmental and institutional imperatives to manage variable elective and COVID-19 demand curves.
  • Our experienced team can support current key hospital leaders in administration, quality, patient safety, risk management, infectious disease and prevention, surgery, anesthesia, and nursing. We are also able to fill temporary gaps in or augment hospital leadership teams during planning sessions centered on pandemic response(s).
  • With our medical, nursing and hospital leadership experience, we can assist in optimizing financial opportunities for hospitals via strategic allocation of surgical schedules and resources.
Resurgence

How Well Have You Managed Post COVID-19 Surges? Are You Prepared for Endemic COVID-19?

As the United States’ healthcare systems confront a flattening of the COVID-19 outbreak curve, healthcare organizations and caregivers must reflect on their capacity to deal with new surges – the surge of delayed treatments. Operating rooms and the entire perioperative process have been and will be stressed to meet the demand for immediate interventions whenever a community has had to deal with crisis levels of care or merely substantial triaging of levels of immediacy of care. The same organizations must be mindful that a reemergence of significant numbers of COVID-19 patients could again stress their system’s ability to deal with the myriad of other illnesses that seek their attention each day.

To help prepare your organization for post COVID-19 surge patient care or, perhaps, evaluate the quality of prior restarts, consider:

  1. What dismantling did your organization undergo to manage surge capacity?
  2. Did you deploy anesthesia machines as ventilators?
  3. Were there other critical supply shortages that required extraordinary measures?
  4. Was your perioperative staff redeployed elsewhere and were they ready to function effectively?
  5. Was your staff impacted emotionally? How fatigued is leadership and frontline staff? Did this impact initial reopening? 
  6. Did repurposing of your PACU into an ICU delay restarting your surgical schedule? (Many PACUs had to have walls built for air handling purposes that ICUs require.)
  7. How prepared were and are you for the risks to surgical staff from a nosocomial transmission of coronavirus ? How clear is it now what precautions you should take (have taken) to prevent this upon the restart of your elective surgical schedule?
  8. What should you do (have you done) if an elective surgical patient or a member of your surgical/perioperative staff develops COVID-19? How have you prevented this from shutting down your re-start or your current operations?
  9. How do you organize (or have you organized) your oversight and management of the institutional response to the pandemic? How have you communicated effectively with your (surgical and perioperative) staff about changes large and small related to the above and to myriad other ad hoc approaches to COVID care?

These are some of the questions that must be addressed as you evaluate your plans for or past approaches torestarting your system and/or managing through the many and undulating phases of pandemic COVID.. Every phase of COVID response should be seen as a clinical trial, subject to performance improvement assessments, for the next phase of pandemic or endemic infection. Perhaps even more importantly, these questions must be answered as plans are put in place to be certain that such national and local emergencies never again so negatively impact healthcare delivery.

Perhaps we must also address how you dealt with the usual surgical emergencies and semi-emergencies during the pandemic. Did your morbidity and mortality increase? If so, how do you plan to deal with that going forward? What lessons have you/can be learned from your past experience that can be applied to the quality and safety of care in the future?

As you planned and implemented the resumption of more “normal” operations what elements of longer-term planning should be addressed? SARS-CoV-2 has reappeared regionally in the fall and winter months coincident with seasonal influenza (in Europe it’s being referred to as the “twindemic”) and in geographic regions in which large numbers of residents have remained unvaccinated. What approaches should you take to deal with this likelihood – in terms of policies and procedures, testing approaches and engineering/structural controls?

These are all questions that ORDx+Rx can help answer. We can provide the expertise to help you develop plans for your future responses. Call us today to help you prepare to face the next healthcare crisis, and to deal with those crises your organization faces every day. Together, we can be ready!

Helpful COVID-19 and Post-COVID-19 Links

The articles and information shared here focus on the issues we see our clients and other healthcare organizations and hospitals facing as they work to meet the challenges presented by the current COVID-19 pandemic and its potential for future endemicity.  From recommendations regarding anesthesia, to helping your team stay mentally healthy during the pandemic, to resuming your organization’s normal surgical routines and schedules, to providing up-to-date advice on infection prevention these articles provide insight and guidance.

During the peak of the COVID-19 pandemic, surgical programs were disrupted in an unprecedented way. One dimension of the adaptation to the extraordinary demands of the pandemic was redeployment of healthcare staff from their usual roles to new ones. This essay reflects lessons learned from those who have supported this transition to help those planning for similar demands in the future.

This pointed assessment of how we managed common disease during the COVID-19 crisis points to the need for a rational, carefully designed plan as we move forward.

Hospitals will need a plan to resume a comprehensive surgical schedule to meet the needs of routine surgical care. There is a suggested plan available designed to help your institution. The American Society of Anesthesiologists (ASA), The American College of Surgeons (ACS), The Association of periOperative Registered Nurses (AORN) and the American Hospital Association (AHA) have issued a Joint Statement Roadmap for Elective Surgery.

A road map for navigating through the current COVID-19 pandemic in the United States will be useful to healthcare organizations. Specific directions for adapting public-health strategy to limit the epidemic spread of COVID-19 is outlined.

The management of surgical cancer patients will be a critical process to meet their needs as we resume a more rational system of care.

Psychological stress has emerged as a critical factor for many hospitals. Dealing with this and planning for the future are critical for your successful recovery.

There are stark lessons to be learned from how hospitals responded to the present pandemic.

Two recent Wall Street Journal Opinion pieces share viewpoints on the importance of “elective” surgery, and the difficulties hospitals are facing.

Anesthesia machines are equipped with sophisticated mechanical ventilators that can maintain patients with COVID-19 respiratory failure. They are not typically used for the extended periods of time required for critical care ventilation and this report addresses special considerations for this adaptation of use to supplement a facility’s supply of standard critical care ventilators.

The potential shortage of critical care ventilators for a surge of COVID-19 patients with respiratory failure has prompted interest in using a single ventilator for more than one patient. This statement from multiple critical care organizations discourage such practice.

 

Multiple authors from settings with experience in managing anesthesia care of large numbers of COVID-19 patients report lessons learned in this compendium of published papers:

In a time of surge crisis our hospitals will need to set parameters for “elective” surgery:

This document from the Centers for Disease Control offers interim guidance for the prevention of nosocomial transmission of novel coronavirus to patients and staff. Although it requires adaptation to the elective surgical environment it offers some useful information related to the hospital environment. The second reference reviews other clinical care recommendations from the CDC also requiring adaptation to the surgical patient.

A recent editorial from Anesthesiology offers some ideas for prevention of cross-transmission in the operative setting from the dual perspectives of anesthesiology and infectious diseases.

Another set of suggestions for prevention of peri-operative transmission by authors from the fields of both anesthesiology, nursing and healthcare quality and safety.

  • https://www.apsf.org/news-updates/perioperative-considerations-for-the-2019-novel-coronavirus-covid-19/
  • Alvino RT. COVID-19 in the perioperative setting: applying a hierarchy of controls to prevent transmission. AORN Journal. 2021;113(2):148-161.
  • Messenger M. McNeill MM. Community hospital perioperative services department responds to the COVID-19 pandemic. AORN Journal. 2021;113(3) :165178.
  • Peneza D. White-Edwards KY. Bricker C. et al. Perioperative nurse educators: rapid response to the COVID-19 pandemic. AORN Journal. 2021: 113(3):180-189. 

Surgeons working in the head & neck region can be at higher risk. The suggestions and precautions linked here can be useful to all the perioperative team.

Supplies are frequently an issue for some institutions. There are some useful resources available. Massachusetts has set up such a resource.

Immunity testing can be problematic and thus hospitals must be vigilant as to validity before imposing mandatory testing in the “reentry” process.

The Council on Surgical and Perioperative Safety (CSPS) offers some useful resources to the Perioperative team on restart.

Dr. Atul Gawande outlines his views on COVID-19 in the New Yorker.

A brief and recent overview of the development and prevention of surgical site infections in the 2021 edition of an authoritative resource on the field of hospital epidemiology and infection prevention.

  • Seidelman JL SS Lewis AW Baker et al Surgical Site Infections in Weber DW, TR Talbot eds. Mayhall’s Hospital Epidemiology and Infection Prevention, Wolters Kluwer, 2021, 183-197

A very recent monograph with an extensive review of a broad set of infectious complications of surgery, their management and prevention.

  • Sartelli MR Coimbra L Pagani et al eds. Infections in Surgery: Prevention and Management,  Springer 2021 (Hot Topics in Acute Care Surgery and Trauma)

The use of unsolicited patient and staff observations that identify surgeons with behaviors that precipitate dissatisfaction have been correlated with an increased risk for postoperative complications. The authors of the articles below describe these associations and, as well, outline the implementation of a system (PARS – Patient Advocacy Reporting System, developed at Vanderbilt University Medical Center) as applied to a healthcare system concentrated outside of large metropolitan centers. The last article below associates injury in anesthesia malpractice claims to communication failures among care team members.

  • Cooper WO O Guillamondegui OJ Hines et al. Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications. JAMA Surgery. 2017; 152 (6): 522-529
  • Cooper WO DA Spain O Guillamondegui et al. Association of coworker reports about unprofessional behavior by surgeons with surgical complications in their patients. JAMA Surgery. 2019; 154 (9): 828-834
  • https://www.ahrq.gov/patient-safety/resources/liability/pichert.html Planning and implementing the patient advocacy reporting system in the Sanford Health system
  • Douglas RN LS Stephens KL Posner et al. Communication failures contributing to patient injury in anesthesia malpractice claims. Br J Anaesth. 2021; 127 (3): 470-478

The monograph below is a detailed overview of the complex set of elements that can help maximize patient safety in the care of the surgical patient including data collection and analysis, check list utilization, teamwork, the roles of trainees, safety considerations in telehealth and others.

  • Martin RF, Consulting Editor. Patient Safety. Surgical Clinics of North America. February 2021. Volume 101 (1)