Examination of Trends in Compliance with Institutional Guidelines for Add-On Surgical Cases In Relation To The COVID-19 Pandemic
*Alex Richard, *Rachel Schneider, *Cedrick B. Chiu, *Sneha Karthikeyan, *Arianna Markel, *Obinnaya Okereke, *Avery Pullman, *Adam Skura, *Suhas Suddala, James Carroll
Department of Surgery, UMass Chan Medical School, Worcester, MA, United States.
Background:
Add-on surgical cases present challenges for hospitals due to unplanned and often urgent need to assemble staff, equipment, and other resources to provide patient care. These challenges were exacerbated by consequences stemming from the COVID-19 pandemic including staffing shortages and rationing of resources. At our institution, add-on surgical cases are booked with target time from case request to operating room. We seek to examine compliance with these institutional targets related to add-on cases over time, particularly examining compliance before the pandemic, during the pandemic, and after the acute phase of the pandemic.
Study Design:
Add-on operating room case requests for adult patients from 10/2017-3/2024 were identified through Epic reporting. Canceled and duplicate cases were excluded. Time from case request to arrival in the OR was identified for each case, which was compared against institutional target to determine compliance. The period of the COVID-19 pandemic was defined as the state of emergency in Massachusetts from 3/10/2020-6/15/2021. We examined add-on surgical cases at our institution, stratified over time based on the declaration of emergency in response to the pandemic, specifically using compliance with targets for case request to arrival in OR as a metric for OR staffing, availability, and preparedness for unplanned cases. Statistical analysis was performed using STATA
Results:
29251 cases met inclusion criteria. Table 1 demonstrates breakdown of cases across three time periods and compliance rates for each group. Cases during the pandemic period were more likely to be compliant with institutional targets (p<0.01). Compliance was greatest in April 2020 (78.4%) and rates of compliance were significantly greater in the acute pandemic phase and post-pandemic compared to pre-pandemic, as demonstrated in Figure 1.
Conclusions:
The COVID-19 pandemic placed significant strain on healthcare resources. This exacerbated the existing challenges of performing unscheduled and often urgent surgical surgical cases. Compliance significantly increased during the acute phase of the pandemic, perhaps due to increased OR resources given cancellation of elective cases or increased scrutiny in booking urgent cases during the pandemic. Future directions may delineate factors related to increased compliance during the pandemic at the institution level and implement solutions in the post-pandemic to improve case compliance.
Table 1: Case Compliance Rates Stratified in Relation to Pandemic
| Time Period | Number of Compliant Cases | Number of Noncompliant Cases | Total |
| Pre-Pandemic (10/1/2017-3/10/2020) | 7053 (64.69%) | 3850 (35.31%) | 10903 |
| Pandemic (3/11-2020-6/15/2021) | 3871 (69.89%) | 1668 (30.11%) | 5539 |
| Post-Pandemic (6/16/2021-3/24/24) | 8382 (65.44%) | 4427 (34.56%) | 12809 |
| TOTAL | 19306 | 9945 | 29251 |
| Pearson chi2(2) = 47.4367 Pr = 0.000 | |||
Figure 1: Monthly Rates of Compliant Cases (10/2017-3/2024)
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