Development of a decision analytical framework to prioritise operating room capacity: lessons learnt from an empirical example on delayed elective surgeries during the COVID-19 pandemic in a hospital in the Netherlands.

OBJECTIVE: To develop a prioritisation framework to support priority setting for elective surgeries after COVID-19 based on the impact on patient well-being and cost. DESIGN: We developed decision analytical models to estimate the consequences of delayed elective surgical procedures (eg, total hip replacement, bariatric surgery or septoplasty). SETTING: The framework was applied to a large hospital in the Netherlands. OUTCOME MEASURES: Quality measures impacts on quality of life and costs were taken into account and combined to calculate net monetary losses per week delay, which quantifies the total loss for society expressed in monetary terms. Net monetary losses were weighted by operating times. RESULTS: We studied 13 common elective procedures from four specialties. Highest loss in quality of life due to delayed surgery was found for total hip replacement (utility loss of 0.27, ie, 99 days lost in perfect health); the lowest for arthroscopic partial meniscectomy (utility loss of 0.05, ie, 18 days lost in perfect health). Costs of surgical delay per patient were highest for bariatric surgery (€31/pp per week) and lowest for arthroscopic partial meniscectomy (-€2/pp per week). Weighted by operating room (OR) time bariatric surgery provides most value (€1.19/pp per OR minute) and arthroscopic partial meniscectomy provides the least value (€0.34/pp per OR minute). In a large hospital the net monetary loss due to prolonged waiting times was €700 840 after the first COVID-19 wave, an increase of 506% compared with the year before. CONCLUSIONS: This surgical prioritisation framework can be tailored to specific centres and countries to support priority setting for delayed elective operations during and after the COVID-19 pandemic, both in and between surgical disciplines. In the long-term, the framework can contribute to the efficient distribution of OR time and will therefore add to the discussion on appropriate use of healthcare budgets. The online framework can be accessed via: https://stanwijn.shinyapps.io/priORitize/.

[When the health care inspectorate closes the operating theatres: a case study]. / Als de Inspectie de operatiekamers sluit.

BACKGROUND: The topic of 'quality of care' is subject to intense interest from the media, the public and the government. One of the key roles of the Dutch Health Care Inspectorate (IGZ) is the supervision and monitoring of quality of care. When the IGZ pays a visit, this generally has many consequences for the hospital concerned. CASE STUDY: Following an unannounced inspection of a hospital, the IGZ closed the operating department due to shortcomings in the quality of care. The IGZ and the hospital proved to have different ideas concerning the norms of quality. Using a theoretical framework we have tried to provide some insight into the consequences of this situation. CONCLUSION: A hospital comprises a number of different domains each with its own value system (market, governmental and political, societal, medical profession). To prevent these differences standing in the way of good care, we advise all parties to look outside their own domain in order to overcome the boundaries and connect to other domains and value systems.