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Restoring Elective Surgery Caseload Post COVID-19,Part 2 Webinar Transcript

IRIS: OR Manager is pleased to welcome you to today’s webinar “Restoring Your Elective. Surgery Post COVID-19,” presented by LeanTaaS, a company that works with health systems, hospitals, and ORs to provide software solutions that combine lean principles, predictive analytics, and machine learning to transform hospitals and infusion center operations. My name’s Iris, and I’ll be the moderator for today’s event. Thank you for everyone joining us today. Please note today’s call is being recorded. If you experience technical difficulties with the web portion of today’s program, please be sure to email. You can also refer to the links box located to the left of the screen where we have resources for you to view, save, or print. This does include a tech help overview and details on how to obtain the continuing education for this event. Just click on the link, and a separate web browser window will open. And be assured that this will not interfere with your viewing of the program. This presentation will last 45 to 60 minutes and will include question and answer opportunities at the end. You can submit a question at anytime by typing into the chat box in the lower left corner of the screen and clicking the Send button. Your questions are not viewable by other attendees but will be received. Both speakers have generously agreed to extend today’s presentation time, if needed, to be able to address as many attendee questions as possible. Finally, today’s presentation will also include live polling questions. When a poll appears on your screen, simply click in the box next to the answer of your choice. It’s now my pleasure to introduce today’s speakers. Ashley Walsh is Director of. Client Services for LeanTaaS. and Zetong Li its Director of. Product Management for iQueue for Operating Rooms. Both are experts on the topic of managing and restoring elective surgery caseload. And we are thrilled to have them with us today. Ashley and Zetong, welcome to the program. 

ASHLEY WALSH: Thank you, Iris. Thank you everyone for joining us today. Good morning, good afternoon, depending on where you’re at. We’re excited to connect with all of you, and of course, beyond this, excited to continue the discussion with many of you. So as a reminder for everyone, this is a CE session event. So there are learning objectives that you will obtain throughout this presentation. So just as a quick reminder, we’re going to understand how to estimate your backlog of elective surgery volume. We’re going to talk about methods to create more open time, identify approaches to distributing cases, and discuss how to formulate an elective surgery caseload action going forward. So our agenda today starts with talking about the impact of COVID-19 on elective surgery. And what is that rising backlog? What does it look like? Then we’re going to share with you a seven-step approach to restoring the elective surgery caseload. For those of you that joined us on April 15, we’re going to touch on seven steps again with some enhancements from some lessons learned since then. 

And of course, at the end, we’ll allow as much time as possible for a question and answer section. If we don’t get to all of your questions that you write in, we will be sure to respond to you personally after the webinar. We’d also love to continue this discussion. So feel free to reach out to us at at any time. And we can continue answering any questions or the discussion on the topic. So first, let’s take a look at the typical impact COVID-19 has had on elective surgery volumes. We’re showing you two examples, one from a partner of ours on the East Coast and one from a partner of ours on the West Coast. Let’s start with the hospital on the East Coast over on the left-hand side of the screen. So this represents a medium-sized hospital who by May 10 was running less than 5% of their typical volume. Now let’s move over to the right. On the right, we’re showing you an example from the West Coast. 

Now, this is coming to us from a large system we partner with. And you can see by May 17, it, too, across the entire system, was down to running approximately 10% of its daily volume, so a huge impact and both the East Coast and the West Coast. Now we want to know a little bit about you. So we’re going to jump into our first poll here. So some of you are still in an elective surgery ban, others are not. We want to know when you’re elective surgery ban was effect, what percent of your pre-COVID-19 volume were you doing? So we’ve given you five options here and would love to learn a little bit more about what’s happening in your region. So were you doing less than 20%, 20% to 40%, 40% to 60%, I doubt 60% to 80%, but maybe there’s a couple, or even 80% and beyond. So we’ll make this up just for a few minutes– or a few seconds, actually, I should say, and allow you to fill in your results. So again, we’re trying to understand your elective surgery volume when the elective surgery ban was in effect. And really, I shouldn’t have said elective surgery. I know how much surgery period you’re doing during this ban, which it looks like most of you are answering in that 0% to 20% range. Let’s leave this up for just a few more seconds, and then we’ll keep going. It looks like about half of our attendees have responded to the poll. But we can see that the majority of you are experiencing A, about– somewhere probably between 5% and 20% of your pre-COVID-19 surgical volume. So imagine all that volume you’re not doing. Some of you it looks like you’re able to accommodate maybe 20% to 40%. But get a little bit deeper, maybe we can offline to find out what part of the country you’re in, what type of hospital or surgical practices do you have, what your impact on the house was. I think we’re going to move on, but thank you for those who participated in the poll. So it looks like definitely the majority of you are experiencing 0% to 20%, a little 20% to 40%, and even smaller numbers beyond 40% of your pre-COVID-19 volume.

So let’s talk about some updates since April 15. We know that some of you on this webinar today attended a webinar we hosted on April 15. And we want to share with you some progressions we have made some observations that we have seen. So since that webinar, we’ve observed that many states and counties have started reopening. Some have executive orders to limit surgery ramp up still. For example, we’ve learned that. Colorado is requiring hospital systems to run no more than 50% today of its pre-COVID volume. Another observation is some hospitals have seen an inpatient occupancy rate surge immediately after the lift of shelter in place. Now, this, of course, is putting major additional constraints on the hospital and subsequently your surgical capabilities. For those that have reopened a fair portion of their pre-COVID-19 elective surgery practices, we’ve observed a variety of ways people are handling block scheduling, which we’re going to be happy to share with you later in the presentation. So we’ve been busy as a team here at LeanTaaS on the iQueue for. Operating Room products as well as things that we have put out for everyone, our calculator, which we launched April 15, to model your backlog. 

We have added some enhancements to it, so allowing you the ability to model a second wave as well email your results to yourself. So if you haven’t gone back and taken a look at that since April 19, we encourage you to do so. And, of course, after this webinar, if you don’t know what. I’m talking about, we’ll make sure that we get you links to those resources because the backlog calculator tool is free for everyone. On top of that, we’ve built some interesting things that they’re not products for those we partner with. So we’re going to talk a little bit about how we are addressing the backlog and helping hospitals prioritize. But for those of you we don’t partner with on a product level, we’re going to give you some suggestions and some other resources and tools for your consideration. So let’s now review the seven-step approach we first introduced on that. April 15 webinar. So the seven steps that we’ve really found are going to be very effective in talking about and restoring your elective surgery caseload is first and foremost, of course, continue to estimate the backlog, continue to try and identify how long it’s going to take you to recover. 

There are a lot of factors to consider in doing so. So we’ll get to some of the factors for you. Two, identify your real surgical capacity. What is real surgical capacity? Well, of course, there are constraints on your operating rooms you have to consider as well as constraints from your house and your inpatient unit you have to consider to really identify your capacity. 

Number three, let’s talk about our favorite topic, the block schedule. What is the goal? Of course, the goal is we want you to have people to maximize your utilization as you open up a new ramp back up. Step four, let’s make it really easy for clinics, for physicians and their offices just find the time that you are opening up, to also release time they’re not going to use, make it easy to request into the right open time, drive the volume, find your demand, and drive it where you need it Of course, executing as one team is critical. We’ve talked about this a lot in perioperative services. But specifically what we’re actually talking about here is as a hospital, one team throughout your hospital– your inpatient units, your perioperative services, et cetera, environmental services, all of those departments very, very, critical supply chain management, of course. Step six, we’ve got to measure. We’ve got to iterate and reiterate, so having deep visibility into the right metrics at the right time. And step seven, be prepared for that next wave. With that, I want to turn it over to my colleague, Zetong, who’s going to talk about identifying and estimating that backlog. 

ZETONG LI: Thanks, Ashley. Hello, everyone. This is Zetong. And in the next few minutes, we will talk about the very first step to restore your elective surgery caseloads. So like with many other problems, the first step is to really have clarity into the problem itself. And in this case, it’s really important to understand how big a backlog your institution has accumulated during this crisis and accordingly, how much time it may take you to recover from that. So our team has built this tool just for that. I will walk you through the web application with some screenshots. And you will see how it can help you. The URL link is right here on the slides. And after the webinar, we are going to share both the link and also the slides. One quick note, for best experience, we recommend using Chrome. And other browsers like Safari, Firefox might also work well, but not Internet Explorer. One final note before we get into this tool, so you don’t have to be an iQueue customer to use this. Anyone who has access to the internet can use it for free. If you need help, we can help you as well regardless if you are a customer or not. Let’s get into this. So it’s a pretty straightforward tool. On this screenshot, you can see what’s on the left is basically our inputs. And you can change things there. And on the right, it’s the outputs that will show you your results. 

A couple fundamental beliefs to this model is that first, the longer the pandemic looms, the larger the elective case backlog will grow. These cases, at least a large percentage of them, are not likely to dissipate. Instead, they are systematically postponed because we believe that most people who need surgeries will still need surgeries. So in some sense, this is the maximum backlog you should expect based on your numbers during normal times. Second belief, some special measures need to be taken after. COVID-19 and doing the recovery periods to meaningfully increase our OR throughputs. Essentially, you need to work harder and work a bit more because if the post crisis OR throughput is reduced or kept the same with your baseline volume pre-COVID-19, then the backlog will never be caught up. 

And in that case, actual loss of case volume could potentially occur because these unmet demands could go somewhere else that could take that extra volume. So now let’s get into inputs. The first three inputs on a lot is the basic context of OR Metrics pre-COVID-19. The first one is, what was your baseline monthly volume pre-COVID-19? So if you manage your fee OR locations, including some main ORs and also ASC locations, we recommend you to enter just the volume for your main OR only without the ASC or other procedure rooms because they typically have very different utilization levels. 

And they can be regarded as buffers to divert some traffic from the busy main OR. And the second question is, what percentage of baseline volume are you doing during COVID-19? So that essentially is the question that Ashley was asking you. And it looks like you guys are able to answer that. Then third question is, when did you start canceling or postponing elective surgeries? In case you had a gradual reduction of case volume over a period of time, you can take a rough midpoint. So if you click the March 16, 2020, you will see something like this as a date picker. Imagine that the ORs started reducing volume on March 16, but it took a good two weeks to drop to a stable bottom, then in that case, I can choose March 23, which is the midpoint as my inputs. Now let’s get to the second set of inputs, which describe when things will get back to normal. We assume that most ORs will take a phased approach to gradually return to normal. So that’s why we have three questions here, first being, when do you expect to get to roughly 50% of your pre-COVID-19, OR capacity, then second, third for 75% and 100%, respectively? Remember, this is and interactive tool. So if you are not sure, put in your best guess, and you can adjust it later. Now let’s scroll down further on the left. And you will see that this is the third set of the inputs, which describe the levers to accommodate the surge volume post COVID-19. These can be regarded as your strategies to cope with the backlog. So the first lever is, by what percentage can you increase our current primetime utilization? 

Typically, ORs are running at, let’s say, 50% to 70% utilization during primetime, which means there is some room for improvement. If we can encourage the block owners to, for example, better utilize their blocks by putting more cases earlier or release them earlier, more cases could be scheduled. And you will see an improvement in primetime utilization. I typically start the model with the assumption to keep it 5% here because with our customers, even in normal times, we have seen improvements of 5% to 10%. The second lever is, what percentage increase in volume can you expect by extending weekday work hours? This, of course, will be dependent on staffing. So you can enter a number by first estimating how many additional hours you can run in ORs during your previous schedule and then estimates how well you can use those new hours to get to the percentage of the additional volume. So we also have a workbook as a resource to help you model this number, which we are going to talk about later in the webinar. The third lever here is, how may weekend days a month will you be operating assuming that you have eight weekend days in a month? So this one is pretty straightforward. The maximum you can run is going to be eight. So meaning, in a week– in a month, there are four weeks, and you work every weekend. So that’s eight weekend days in a month. And if you work every. Saturday, you can enter four. And if you work every other Saturday, you can enter something like two. And in a case study, only half of the ORs you can slash the number by half. So if you work every Saturday but only open half your ORs, you can draw two here. 

The fourth lever is, how many cases per month will you be diverting to. ASCs or other procedure areas not included above? So this is only for those who have a set of locations and have the luxury to divert some traffic out from the main ORs. You can talk to the surgeons and find out who can fill the void, take what type of cases, and how many to the nearby ASCs and aggregate that number. We are almost done with all the inputs. The last two inputs are the lost volume considerations. So during the COVID-19 crisis, how much volume do estimates will dissipate due to COVID-19? For example, as people are staying home, there is less crime reported and fewer car accidents. So fortunately, fewer people should get hurt, and fewer trauma cases need to be performed. The second loss volume factor is, after the crisis, what percentage of cases do you expect to lose due to recession? So intuitively, when people lose jobs and insurance, they may reduce the desire to do surgeries. We have also seen a few academic studies show that there is a correlation there. Now after we have entered all the inputs, we can see how the results are looking. 

So with the seven inputs, I made, it’s estimated that the backlog will be more than 2,600 cases for my ORs. And it was the levers, we’re able to do 366 additional cases per month on top of baseline volume. With these two pieces put together, it’s going to take about seven months to catch up. And now the interactive part of the model kicks in. So maybe the seven months is a bit too much. Let’s say I’d like to aim to recover before the holiday season begins. Therefore, I can go back to the inputs and make some changes. In this case, let’s say that I’m trying to do better on the weekend. So if I change it from two days to four days per month of weekend days that. I’m going to work, you can see that this output is changing. And it’s only going to take me five months to recover. So I can finish the backlog before the holiday starts. 

And yesterday, our team has built a new function into this tool. As we have learned from a lot of medical experts, it is very likely that there may be a second wave of COVID-19 when states reopen. Therefore, we are right now allowing you to model the impact of a second wave. You can see the default dates are in the fall season, October and November. And we have made some assumptions to make the input a bit simplified to say that the impact of the COVID-19 will be similar to the first wave of what is see in the second wave. And also, it’s going to be the same gap between when you are at 50%, then getting to 75%, and 100%. Basically the rate at which you can recover will be similar as well. So with those assumptions put in, once you select that, these are the new results you can see. So it’s going to look like a W-shaped recovery. In this W-shaped recovery, the hospital will see the second wave the impact before it gets a chance to clean up fully the first wave’s backlog. So maybe you want to adjust the model to see what do you need to do in order to catch up with the first wave fully before seeing the second wave. And in this case, I added a few more weekend days to the lever. And you can see that now it looks like two independent waves. Another helpful new feature we just released is the email results function. If you scroll down on the right panel a little bit, you will see an input box like this. All you need to do is put in the organization name and also your email address, then you will get an email with a link to the results. So if you go to that link, it will be direct to a web page that looks like this. So you can see that on the left panel, the input becomes uneditable. 

And they’re grayed out. In And then in the right, the results are locked down. In this way, you can essentially save your results. And you can also further share it with others, meaning that if you forward the email to someone else or if you just copy/paste that link to someone else, they can see the same thing. And you can see that your hospital name– in this case, I’m just putting my name Zetong Test2. That is the hospital name here. Anyway, if you want to update any inputs, you can simply click the reconfigure calculator on the top right, and then you will be able to adjust things as you like. So a couple more things on the right panel. If you scroll down a little bit more, you can see the full details of how our calculation and a model works step by step with a lot of details. And if you scroll down to the bottom, there is one more section some of you may find helpful– may find useful, which is the part– prioritization considerations. This is saying that if we have any kinds of prioritization mechanism when you are catching up, and among the hundreds of backlog cases, there is a portion of them that you really want to get done before others, then depending on the percent of the prioritized cases in the backlog, you can see how long those will take to get done. So that’s pretty much it for the calculator tool. And I hope you find it helpful. 

IRIS: We’re going to get our next poll set up. Stand by just a moment while we restore the speaker line. ZETONG LI: Sounds like we lost Ashley.

IRIS: Yeah, thank you, Zetong. Let’s get– 

ZETONG LI: So I can maybe continue for the poll while we wait for Ashley. So this our second poll. So in the next seven days, what percent of your pre-COVID-19 volume will you be running? So in this case, we are just trying to understand how much you can catch up with. So we’ll stay on this question for a few seconds and see people’s response. And sorry about [INAUDIBLE] difficulty we’re dealing with. We are seeing a lot of inputs coming in. So it looks like– 

ASHLEY WALSH: Hi everyone. Are you able to hear me? ZETONG LI: Yes, we can hear you right now. ASHLEY WALSH: Oh, wonderful. I’m so sorry. I’ve been talking and apparently couldn’t hear. Apologies. OK, that’s great. Thank you everyone for your responses. I also was [INAUDIBLE]. So thank you for sharing your information. This is great to see. So so far, it looks like still the majority are still going to be in that lower range, maybe 20% of their pre-COVID-19 volume, but others increasing. So it looks like there’s a healthy mix between 20% to 40% and even some of you creeping up to 41% to 60% of your pre-COVID-19 volume. While we’re letting some others fill in their answers here on the poll, I just wanted to address a few things. I noticed some of you are sending in questions through the chat. Thank you for doing that. A fair number of questions are on ASCs. 

So definitely– think about this not only for inpatient hospitals, large facilities, but also for ASCs. While parts of the steps that we’re going to get to coming up, some might not be as applicable to. ASCs, many others are. And first and foremost, getting a great understanding on your backlog, we’re going to talk about prioritizing that backlog here in a few minutes, definitely all relatable to ASCs. Some other things we’re not going to touch on as much today but certainly want to put out there as considerations that we have found, and I think probably will be more so even on the ASC side just because of the criticality are things like supply chain. How is that affecting your ability to bring back to your cases, et cetera? So I’m going to stop the poll for right now. Thank you everyone that has responded. Definitely looks like still the majority of you that are on this webinar right now are only going to be doing about 20% or less of your volume within the next seven days. If you go back to April, we were all talking and thinking that perhaps in mid. May we were going to be ready to be ramping back up at about 50%. And every day, every week we’re learning more and more. And we can see as a result of this poll, not everyone is likely going to be doing more than 20% in the next seven days. So it’ll be great to see what happens after that. Some of you are. And so I’d be really interested to chat with a couple of you after this session on, how are you able to do more? What area of the country are you living in? So now let’s talk about identifying your real surgical capacity. 

Now, what do we mean by “real surgical capacity?” And this is where I really am referring to part of this, of course, will not related much to ASCs, but part of it will. For those that are on the call that are part of larger hospitals or medium-sized hospital, small hospitals, whatever it may be, to identify your real surgical capacity, you’ve got to have a great understanding of your OR constraints. Now, what are OR constraints? Lots of things. You have supply chain, physician availability. But in addition to that, what are your house constraints? What are your bed constraints most specifically for surgical cases that are likely to be admitted patients, your outpatient transitioning to an inpatient case even. So very, very important to really sit down and plan thoroughly. I touched on this in an earlier slide, but we’ve already found that facilities who are opening back up in areas where your shelter in places are listing are seeing massive surges to their inpatient units. So be prepared. That could happen to you. And how will you respond? So let’s talk a little bit more in depth about the OR constraints and what we mean very, very specifically. So some things to consider are, when are you going to start running at your 50%, 75%, or 100% of your pre-COVID-19 capacity? As we just saw in that earlier poll a minute ago, we’re not there yet in a lot of places. And do we have any indications of when we can be? Talking about this every day is going to be critical. So if creating more open time is a goal, which I think it will be for almost all of us, you’ve got to determine what is possible and what is not. 

This, too, is changing daily. So having these conversations on a regular cadence is critical. So I’m going to save the block schedule topic for step three because that really needs its own dedicated attention. But aside from that, what else can you do? Can you open up more rooms? Can you use procedural rooms for some of your surgical cases? How can you utilize the ASCs? So for those of you representing. ASCs on this webinar, I would love to chat with you more after because we have some great ideas and thoughts around partnerships between the community hospitals and the ASCs. Sometimes there is a financial relationship between those two entities, sometimes there’s not. So if you are an independent. ASC without an affiliation with a hospital, how can you partner with your community hospitals to open up your doors to absorb some of their volume, which will actually better help that hospital plan for its back load? And subsequently, honestly, it will drive up volume at your ASC, which is great. Another consideration, can you extend your business hours? How much of your business hours can you extend? Can you offer nights and weekends? Another thing to consider we talked about in the Colorado example, are there county or state regulations you need to consider? So extending your business hours and your weekend hours are going to be excellent options. But you’ve got to carefully assess that plan with OR staffing, environmental services, supply chain, sterile processing, equipment constraints, you name it. So we’ve got a couple resources to help you with that. And I’d like to Zetong to maybe walk us through some of these tools that we have available for you to use.

 ZETONG LI: So the first resource here, it’s actually just a simple survey. We worked with some customers and noticed that it was quite manual for them right now to collect information and preference on each staff member, things like whether and how much they can take in additional shifts during the surge periods. So you can create a similar survey with tools like Google Survey– Google Forms and Survey Monkey. Here’s a link on the slide to the sample survey. And you can check it out for your inspiration. And it comes to our second resource, we made here is an Excel workbook to model how much impact there is to extend the work hours on the weekdays. So we noticed that it’s not as simple as adding an hour or two or adding 10%, 20% uniformly to every block every weekday. Typically many ORs who have long the weekdays run shorter hours due to some kind of early morning meeting or education. Also when you are going to extend hours, it’s hard to extend every day, every room. So this spreadsheet has basically pre and post. COVID-19 by weekday, by day of week work hours. 

And so you can put in what your numbers are for the pre-COVID-19 and then model out how many hours you want to run for each room each day of the week. And then you can see the impacts. So the number of additional hours has implications on your FTE planning, and then the expected percents of volume increase due to those extended hours. Same thing, the workbook template link is right on this slide. Again, we will share all these links and ours with the slide after the webinar. ASHLEY WALSH: Thanks, Zetong. Yes, I see a lot of questions coming in on links for these tools. We absolutely will share them with you. They are free to anyone who wants to take a look at them, including the calculator. Another question that came in from David on running smaller numbers of rooms because of staff, et cetera, certainly these tools are a great way for you to input what were you running. 

And in your considerations for running less or more, what does that mean for additional volume you can potentially accommodate? Then to take those numbers and input them back into that calculator to get an idea of, when are you going to be able to catch up, potentially, if you stick to the staffing plan? So these are relatively simple tools, but very, very powerful in helping you understand and get a really good clarity and picture into your potential for bringing back that case volume sooner. So in addition to our OR constraints, of course, there are some other ones to consider. Now, I’m moving on to our surgical admit cases and our inpatient because that problem is so complex. And I really want to give that some time here. But it doesn’t mean that there aren’t other constraints not included in these seven steps that you should consider. We feel that some of those other constraints are challenges, or problems, or discussions you can address almost one to one through a planning session, such as supply chain management. How many days of supplies on hand do you have, and can you have? Those are going to be numbers that are going to be fairly stable and consistent for you based on what is coming into your organization. 

The inpatient challenge is definitely much more complex. And we feel that it is very, very critical for the perioperative teams and the inpatient teams to really come together. So on this topic specifically, on inpatient considerations, things that we feel are very, very critical for you to prioritize are, how many beds are even available for your surgical patients? How many are totally off limits? They could be off limits for a number of reasons. Maybe we’re creating. COVID units, and we don’t want to commingle COVID patients with surgical patients. Or maybe we do for identifying our COVID surgeries. What other areas are there in the hospital for potential inpatient units? How does it vary by day of week? Are there even abilities for sister units to co-locate? Can we create areas where we have patients– we try to do that in hospitals as is. Because of demand and capacity, we tend to get a little bit more spread out from time to time. So keeping a close watch on the ability to co-locate patients, keep same services in the same areas. Consider things like transferring. Can we consider transferring low acuity patients? Is it even an option? And, of course, can we increase or enhance the discharge process based on partnerships with our EVS, administrative case management support, et cetera. Now, I keep talking about the criticality in bringing periop and inpatient departments together. In my own experiences in working in a hospital, we know that there are things like daily huddles, and command centers, and areas where we are being brought together. 

But how do we make this more systematic? And how do we continue that process going forward is I think something we’re all learning during this pandemic how important it is. So we feel it’s critical periop and inpatient integrate at a much deeper level than typical, even a much deeper level than you typically would on a heightened response time period when you are creating command centers, et cetera. So from our research, we’ve observed five suggested integration opportunities for periop and hospital house management teams to come together, to be on the same page, and to have deep visibility in these areas. So first and probably the most obvious is a capacity huddle tool, so identifying the numbers needed to drive inpatient capacity decisions. I’d ask you today, do you have this in your hospital? And/or as a perioperative leader, are you involved in monitoring this? Do you have access to this? Do you partner with your inpatient leaders to review this information together? If not, we definitely think that’s an opportunity for enhancements. 

Second, and this is a little bit deeper, consider analytics for surgical demand simulations. For example, if we do x number of surgical to-be-admitted patients, what impact will that have on our ICUs in other floors? This could be a project that you work on internally with your analytics teams. We certainly would love to chat with you about that as well and share some of our tools and our findings in that area. 

Number three, is there an opportunity for surgical smoothing? So can you strategically plan for certain service lines on certain days or certain numbers of outpatient cases versus to be admitted? This is a huge opportunity. It’s also a very large problem. There are so many inputs, and constraints, and considerations that go into surgical smoothing all the way from the provider in their clinics to the inpatient units and the number of beds. But now more than ever, we should be looking at this, and considering this, and planning for this going forward. 

Fourth, given opportunities to gain efficiencies in bed turnover, do we have an opportunity to optimize our EVS staffing patterns, our workflow during high demand times, the turnover of the actual bed? 

And, of course, last, do you have visibility into transfer optimizations? So these, again, are five areas of opportunities we have found in spending time with many organizations. I am sure there are countless other opportunities. These are just some of the ones we have found to be very consistent. In addition to the links to the tools we’re going to send out after this webinar, we’re going to send out a survey. At max, it might take you 30 seconds to fill it out. If you have a second, we would love for you to fill out that survey. It’s really focused around inpatient constraints and capacity considerations so we can continue to gain more knowledge on this topic and share lessons learned. Moving on, step three, our favorite topic in perioperative services I think is block scheduling. Hopefully, some of your laughing, or nodding, or agreeing, or disagreeing with that. So since many hospitals are gradually opening up their elective surgery practice, we want to share some of the consistent findings and what others are doing really just for your consideration. On the OR side of things, we are fortunate to work very closely with about 150 hospitals across many, many health systems. And so we’ve been able to speak to a lot of those people on a regular cadence. And they’re in all parts of the country to learn what are we actually doing, and what are we seeing? 

So the practices we’ve observed definitely are differing hospital to hospital, region to region. But consistent things are, most are running at different blocks schedules during the recovery period, for sure, some sort of a eased recovery plan and a scaled down block schedule of some sort. And others are setting those at different time periods– 30 days, 60 days, 90 days, et cetera. Some are leaving it open ended until the backlog is really caught up on. Some are organizing blocks of the service line level and letting each service handle their own prioritization. We have found that to be very consistent, especially in the academic setting. I would say that should come with some caution. I think it’s great to allow that accountability at the service line level. But, of course, when you’re going to do something like that, are you ensuring that you have visibility across service lines, and that we’re making sure to truly optimize the lesser use time in one service line with matching it with the demand of another? 

Another thing that’s definitely happening I would say a lot, I’ve noticed it more probably in the community setting especially, is the conversion of non-acute OR time to open time on a first come, first serve basis. So not to state the obvious, but I think definitely a deep consideration when you do that is, what effect would that have on your inpatient unit if it is an inpatient hospital, not an ASC? In an ASC, fabulous. This is a great way to drive all that demand and volume in the community in as soon as possible. But in an inpatient facility, there are definitely some considerations on that first come, first serve. So no matter what, we definitely feel considering an adjusted block schedule temporarily is absolutely a best practice, for sure. Inputs to consider, those top three really are listed there. Consider a reduced number of rooms running, consider whether or not you’re going to have COVID versus non-COVID ORs. 

We’ve even heard in some systems we’re creating COVID versus non-COVID hospitals for surgical patients. In doing that, you’re adding constraints. So anytime you’re adding constraints, for sure it will be a consideration for you on how long it’s going to take you then to catch up on the backlog. And definitely one thing if breaking up the block schedule is not an option, we talked about this before, but can we at least increase that auto-release lead time? So we’ve observed lots of you are collecting backlog information from your providers, which is great. This can allow you to adjust your ramp up. This is going to help you if considering an adjusted block schedule is something you are open to doing. So a suggestion we have is to ensure your role in this out to everyone. Make sure that if you are creating backlog prioritization, you are getting input from every single one of your providers. So having an easy, seamless way for providers to share this information back to the perioperative leadership team is critical. You want to create consistency, too, in the items you’re asking for, such as urgency, priority. Set a standard for priority within your system. Make that standard easy and visible to all the providers as they’re filling out this information. 

So create that consistency, roll it out, and do it in the easy way. If you’re not all on the same EHR from your community providers within your hospital or your hospital providers even, make it easy through Excel. We’re actually sharing a very simple template. This will be another link in your takeaway tool that you can customize on your own. You can create inputs for the metadata important to your hospitals or your ASC so you can prioritize your patients and consider an adjusted block schedule. I’m going to show you an example of what we’ve actually done in our tool, just an example. Consider the Excel spreadsheet optimized through automation through a browser. So for those of you that are partners of ours, this is something, as most of you know, are being rolled out soon to allow you to have really good visibility into your backlog. So not only are we showing the amount of cases by provider in their backlog, you can even get down to the case level in that backlog tool. You can customize the metadata as I said before as you could do in an Excel spreadsheet. We’re showing an example of how it could be scaled across an entire organization so that you can see that and be very nimble in making changes to your day-to-day surgical schedule. 

Now step four, let’s talk about once we find our adjusted block schedule, once we determine our open time, once you determine your waitlist considerations, that creates a brand new schedule for you. But like any schedule, schedules change. And even in the new normal, we never operate exactly as planned to a schedule. We see that with regular block schedules. No matter how hard we work at matching supply and demand, there’s still days that go unused. There are still future dates that we don’t need for various providers, and others need more. So one thing that no matter what you do with your schedule, how you readjust your block, how you create more open time, making it really, really easy to release time, to find time, to request time is critical, to make it easier for you as an organization to do business with. I think this is especially critical in the ASC setting for those in the community. So here’s a couple examples of what this could look like. So I’m showing you an example of a provider in their office looking to potentially release or transfer time. We talk a lot about rules around releases in hospitals. How far in advance can we release? Who do we release to? We keep it in a service line? Do we release it to open time? During these critical times, putting as much time in your open pool should be– I would recommend it to be a high priority for you as an organization. Building your marketplace, expanding your marketplace allows you to bring in more demand and will allow you then to create more supply for that demand. So just making it easy to release, making it easy to request. So I would ask you on this webinar, do you have the ability to show your providers when time is open for them? With that comes a lot of rules and constraints in hospitals. 

For example maybe you only run four concurrent orthopedic rooms, maybe you only do laparoscopic cases in certain rooms. All of those constraints are critical to have visibility into to make it very, very easy and crystal clear for providers to see where they can book into time. Consider adding in our triaging tools. So are you trying to drive certain volume to certain locations like ASCs? Or are you trying to postpone other cases that are lower priority outpatient cases? Whatever that may be, are you having visibility into triaging for your providers? So step, closing out our seven steps, is execute as one team. Now, one team is the whole hospital, not just perioperative services. So of course, within periop, we’re always striving towards working as one team with anesthesia, with supply chain management, nursing, technologists, administration, et cetera. But right now, it’s critical we execute as one team throughout our hospital with a cohesive plan. 

So execution quality is as important as your strategy, for sure. True teamwork is bringing everyone to the table to talk about these considerations, to visibly share decisions made, to come back to the table and re-discuss it as need be. Across your hospital, examples are really working with your house supervisor, working with your inpatient management team, working with your supply chain management, ancillary services, MRI, labs, et cetera. One other step I would push all of us to consider, too, is, how do we work outside the hospital with our third parties? Are we asking them to be available with our additional business hours for insurance approvals, for transfer, or for consideration? Step six, do you have visibility into all of these things because continuing measuring and iterating is critical. So consider that view of the backlog. Not only do you know how many cases, do you know what cases? Do you know what their priorities are? What’s important for your specific location as far as priorities are concerned? Are you truly accommodating more cases? So going back to that poll we took earlier, a number of you within seven days we’re actually indicating you’re going to be working at upwards of 40% of your pre-COVID-19 volume. Are you continually monitoring that every single day to see are you executing as planned? Did we actually increase our primetime utilization? Did we actually increase our business hours? And then, how did we execute versus the plan? For sure, staff morale needs to be at the top of the list. If we’re going to be asking others to work more, to work longer hours, to work harder to accommodate these patients, how are we taking care of our staff? 

I’ve loved watching the chat rooms and what’s been happening in the communities with the hospitals and thanking our primary care workers, our hospital teams, et cetera. Well, let’s keep that up though, too. It will be critical to do so as we continue to bring in more patients into our facilities, do more surgeries, and work towards getting back towards a somewhat of a norm. 

Be prepared for the next wave. Zetong shared with you some adjustments we made to our calculator so you can model additional waves. It’s critical you plan for this. We don’t know what the future holds, but it’s better to plan than to not. As we have learned from the past, second and third waves can create more critical situations than even the first wave. This is the example of the illness during the pandemic starting in March 1918. And really we can see there were three waves, the second wave being the most critical, actually where the most deaths were found. So being prepared for that, being ready to execute and re-execute these seven steps and additional ones is definitely critical. So just to recap our seven steps, number one, find out what that backlog is. Utilize our tools or other tools, whatever you want, for sure. Ours are free for anyone out there interested in utilizing that calculator. 

Two, identify that surgical capacity. What is your real surgical capacity? Consider your constraints on your inpatient beds, your supply chain management, you name it. Think about opening up that block schedule with the number one goal of maximizing utilization is serving those patients that we could not serve in the previous weeks or months. 

Four, make it easy for clinics to release blocks, find, and requests the right open time. Of course, execute as one team, continually measure, iterate, and reiterate, and then be prepared. So it looks like I am near the top of the hour. But we definitely have some time for questions and answers. So thanks everyone for attending. And let’s try to get to your questions. 

IRIS: Thank you,. Ashley and Zetong. That’s right. So we do have some questions in. And just a reminder for attendees that we are coming on to the top of the hour here. And for those that can stay on, Ashley and Zetong will stay on as well to answer as many questions as we can. So let’s get started right away. Zetong, some questions were coming in during your presentation, from Colleen in particular. She asked, what are you basing the estimate of percentage of loss volume due to recession, unemployment in the area? 

ZETONG LI: So we have done some studies. And we found a few papers that talks about this issue. I think the most papers are talking about the relationship or correlation between the unemployment and the loss volume. Every percent of unemployment may lead to 2 points of case volume loss. That’s from the papers that we studied. But to be frank, a lot of papers have slightly different opinions. But the two percentage points– I mean, the one-to-two correlation is, I think, the most aggressive estimate we have seen. So if you want to be conservative, I guess you can use that estimate. And I answered the question with the link to the paper as well. 

IRIS: OK, very good. Thank you, Zetong. And one more follow-up here, for the weekend cases that you showed us, were you assuming the same average volume as the weekday? 

ZETONG LI: Yep. This is a great question. So it really depends on how much volume you plan to do on a weekend day. So if you plan to run your weekend day just like your weekday, then you can input the box in terms of the number of weekend days as if it’s a full day. Meaning if you want every Saturday, then do four out of eight weekend days. However, if you plan to only run, let’s say, 50% of your capacity every– every Saturday, then it’s going to be two or even less. If you plan to run 25% of every Saturday, then you can do only one. So one out of eight weekend days is equivalent to that. IRIS: Yes. Thank you, Zetong. Another question in here from Mike, and this was touching more on staff morale, Ashley, that you were just presenting on. He said, cutting our staffing plan is easy. The difficulty is I’m seeing if the hesitancy from staff feeling uncomfortable returning to work at this time. Do you have any recommendations for messaging? ASHLEY WALSH: Yes, we’ve definitely heard that in speaking with some of our partners that that has been consistent. So number one, I would encourage you to survey your staff continually. We showed one example of a survey tool for staff, but you could make it even more geared around morale. Maybe some aren’t comfortable discussing it face to face for fear of being the only one feeling that way, so creating a very non-confrontational way for them to share their thoughts and feelings for you to consider and evaluate. I definitely have heard of some great things being done in perioperative services to support and promote social distancing. So coming back to work definitely is a concern for those that have been at home for some time being. So being able to create areas where they can go privately and have lunch, spaces that are wide and open for them to have their breaks, et cetera, assessing if we’re ready to bring back surgery. Are we prepared with personal protective equipment? Do we have standards and protocols around– what are we doing for every case versus laparoscopic cases? Are we differentiating between the two? 

So if in your facility perhaps there is a deeper concern for being back at work, maybe consider enhanced. PPE capability. Work with supply chain management to see if that’s even a possibility that you could execute in every surgery as though you are performing surgery on a. COVID-positive patient, even if you don’t know. Essentially presume everyone is positive. Of course, that would take additional PPE, additional supply chain management considerations, for sure. But it might be a way to ease concerns at an expense. But in the big picture, is the expense that great? Surgery is driving the revenue in your hospitals. So if we’re decreasing our margin slightly by protecting our staff and our patients more, are we still on top? Probably yes. But of course, we have to make sure that we can bring in those extra supplies, et cetera. So just some of my thoughts, really not personal, just ones that we’ve gained in chatting with other hospitals that have started to bring back their surgeries. I hope that’s helpful. IRIS: Yes, thank you, Ashley. Let’s get to a couple more questions, this time around the topic of COVID testing. One attendee notes that they’re doing pre-op COVID testing on all surgical and endo patients. And are you seeing this across the country? And related, another attendee asks if facilities are performing pre-procedure COVID testing, and what types of self-quarantined once tested, or testing colonoscopies also? So any insights around the testing processes. 

ASHLEY WALSH: I would just say– and I’ll let Zetong add. We both divide and conquer and speak to a lot of different hospitals. I have been on some phone calls with some very large systems that as a system are putting forth the initiative of yes, testing everyone and including that in their pre-anesthesia testing and/or days in advance. So I would say I’ve heard that is occurring more than not. But I’ll also let Zetong reply based on his conversations. 

ZETONG LI: That’s similar to what I have heard as well. But this is clinical, so I’d rather people refer to the ALRN guidelines. And so if you search for ALRN guidelines, I think they have things in terms of pre-procedure COVID testing as well. 

ASHLEY WALSH: And same with the. ASA association and a couple of other associations to Zetong’s point that are clinically backed that have put forth some best practices and recommendations. 

IRIS: Very good. Getting back to surgical elective cases, assuming surgeons in these surgical specialties for elective cases have not been holding standard office hours during COVID and thereby feeding the pipeline, should we expect a surge at all other and the rescheduling of those canceled? 

ASHLEY WALSH: I think that goes back to making sure you have that deep partnership and assessing what the potential backlog is. So as we talked about in that backlog estimator in that template, identifying columns that are important for your organization, one could be maybe you want to know what percentage of patients your providers have seen in their clinics. And maybe you want to know, just like as you estimate your surgical backlog, maybe you want to estimate what were you seeing? How many patients per week were you seeing pre-COVID-19? And what were you seeing during COVID-19, from telehealth visits, to in-person visits? That can actually be a great input for you into are we potentially ready for the pent-up demand that might have occurred? So again, going back to those templates, customize them for what you need for your visibility. Some hospitals have great visibility into this because, for example in an academic setting, all the providers are in the system and on the same EHR. So you’ve got access to their ambulatory data. But for many, many, many others, you don’t have that access. So how can you create a simple input for your providers to share some of this with you so you can increase the communication rather than make guesses? I would absolutely encourage you to input those columns into those templates to assess and identify within the backlog. And in the community setting in the ASCs, doing that sooner than later so you can ensure the book of business coming back to your location and potentially not losing it to another one in the community will be critical for you. 

IRIS: Thank you. Ashley and Zetong, we’re getting some more questions in about how these templates and materials will be available. Can we get a sense of when attendees can expect to receive these materials, later this week, in the next day or two? 

ASHLEY WALSH: It would actually be our hope to get them to you today. I’ll be very honest, it just depends on when we receive the contact information. So at latest our hope is to do that within 24 hours. But feel free to reach out to us directly at, and you can get them today. So they will come to everyone who attended this webinar. We had hundreds of attendees. So we are very excited and grateful that you took the time to chat with us today. We want to stay in good communication with you. So we will work diligently to get you these tools ASAP. But know that you can email us there, and we’ll actually get in touch with you today. 

IRIS: Excellent. Well, I think that’s a lovely note to conclude on today. Again, as Ashley and Zetong note, they’re available for additional questions. You can reach out to them via email. One-on-one sessions are available too if you feel that that would be helpful. We want to thank all the attendees for the fantastic questions and the engagement. As we close out today, we just want to remind you that the session has been recorded. And you can access the recorded archive, a PDF of the presentation and the CE via your OR Manager account by using the same login information you used today for the webinar. On behalf of OR Manager, we want to thank LeanTaaS again for being our sponsor, our wonderful speakers, and all of today’s participants. Have a good afternoon. And you may now disconnect.

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