Supporting COVID-19 elective recovery through scalable wait list modelling: Specialty-level application to all hospitals in England.

The recovery of elective waiting lists represents a major challenge and priority for the health services of many countries. In England's National Health Service (NHS), the waiting list has increased by 45% in the two years since the COVID-19 pandemic was declared in March 2020. Long waits associate with worse patient outcomes and can deepen inequalities and lead to additional demands on healthcare resources. Modelling the waiting list can be valuable for both estimating future trajectories and considering alternative capacity allocation strategies. However, there is a deficit within the current literature of scalable solutions that can provide managers and clinicians with hospital and specialty level projections on a routine basis. In this paper, a model representing the key dynamics of the waiting list problem is presented alongside its differential equation based solution. Versatility of the model is demonstrated through its calibration to routine publicly available NHS data. The model has since been used to produce regular monthly projections of the waiting list for every hospital trust and specialty in England.

Discontinuity of psychiatric care for patients with schizophrenia, relation to previous psychiatric care and practice variation between providers: a retrospective longitudinal cohort study.

BACKGROUND: Patients with schizophrenia need continuous integrated healthcare, but many discontinue their treatment, often experiencing adverse outcomes. The first objective of this study is to assess whether patient characteristics or treatment history are associated with discontinuity of psychiatric elective care. The second objective is to assess whether practice variation between providers of psychiatric care contributes to discontinuity of elective care. METHODS: A large registry-based retrospective cohort of 9194 schizophrenia patients, who were included if they received elective psychiatric care in December 2014-January 2015. Logistic regression models were used to identify predictive factors of discontinuity of care. The dependent variable was the binary variable discontinuity of care in 2016. Potential independent predictive variables were: age, sex, urbanization, and treatment history in 2013-2014. Practice variation between providers was assessed, adjusting for the case mix of patients regarding their demographic and care utilization characteristics. RESULTS: 12.9% of the patients showed discontinuity of elective psychiatric care in the follow-up year 2016. The risk of discontinuity of care in 2016 was higher in younger patients (between age 18 and 26), patients with a history of receiving less elective psychiatric care, more acute psychiatric care, more quarters with elective psychiatric care without antipsychotic medication, or receiving no elective treatment at all. No evidence for practice variation between providers was found. CONCLUSIONS: Our findings show that the pattern of previous care consumption is an important prognostic factor of future discontinuity of elective care. We propose that previous care consumption can be used to design strategies to improve treatment retention and focus resources on those most at risk of dropping out.

Public Perceptions of Resuming Elective Surgery During the COVID-19 Pandemic.

BACKGROUND: Many U.S. health systems are grappling with how to safely resume elective surgery amid the COVID-19 pandemic. We used online crowdsourcing to explore public perceptions and concerns toward resuming elective surgery during the pandemic, and to determine factors associated with the preferred timing of surgery after health systems reopen. METHODS: A 21-question survey was completed by 722 members of the public using Amazon Mechanical Turk. Multivariable logistic regression analysis was performed to determine factors associated with the timing of preferred surgery after health systems reopen. RESULTS: Most (61%) participants were concerned with contracting COVID-19 during the surgical process, primarily during check-in and in waiting room areas, as well as through excessive interactions with staff. Overall, 57% would choose to have their surgery at a hospital over an outpatient surgery center. About 1 in 4 (27%) would feel comfortable undergoing elective surgery in the first month of health systems reopening. After multivariable adjustment, native English speaking (OR, 2.6; 95% CI, 1.04-6.4; P = .042), male sex (OR, 1.9; 95% CI, 1.3-2.7; P < .001), and Veterans Affairs insurance (OR, 4.5; 95% CI, 1.1-18.7; P = .036) were independent predictors of preferring earlier surgery. CONCLUSION: Women and non-native English speakers may be more hesitant to undergo elective surgery amid the COVID-19 pandemic. Despite concerns of contagion, more than half of the public favors a hospital setting over an outpatient surgery center for their elective surgery. Concerted efforts to minimize patient congestion and unnecessary face-to-face interactions may prove most effective in reducing public anxiety and concerns over the safety of resuming elective care.

Classification of hospital admissions into emergency and elective care: a machine learning approach.

Rising admissions from emergency departments (EDs) to hospitals are a primary concern for many healthcare systems. The issue of how to differentiate urgent admissions from non-urgent or even elective admissions is crucial. We aim to develop a model for classifying inpatient admissions based on a patient's primary diagnosis as either emergency care or elective care and predicting urgency as a numerical value. We use supervised machine learning techniques and train the model with physician-expert judgments. Our model is accurate (96%) and has a high area under the ROC curve (>.99). We provide the first comprehensive classification and urgency categorization for inpatient emergency and elective care. This model assigns urgency values to every relevant diagnosis in the ICD catalog, and these values are easily applicable to existing hospital data. Our findings may provide a basis for policy makers to create incentives for hospitals to reduce the number of inappropriate ED admissions.

Delivery of elective care in the future.

The delivery of elective care needs to be reimagined to tackle the increasing demand for services that is currently outstripping the available capacity; a problem exacerbated by the impact of the COVID-19 pandemic. This article highlights key strategies to improve the delivery of elective care combined with local and national examples of best practice. It is based on key recommendations from the Getting It Right First Time (GIRFT) programme: the UK's largest healthcare quality improvement programme operating across 42 clinical specialties. GIRFT has visited every integrated care system in England over the last 12 months to discuss elective recovery and the learning from these visits is captured in this article. Rethinking the delivery of elective care, utilising advances in technology, and harnessing the power of data to identify unwarranted variation and targeted areas for improvement, will dramatically change the future delivery of elective care for the better.

Towards a standardised method of patient prioritisation that accounts for clinical harm.

COVID-19 has highlighted the need for a standardised approach for prioritising patients requiring elective care. The Royal College of Surgeons of England (RCS) developed guidance at the start of the pandemic for prioritising surgical patients based on the urgency of different procedures. Imperial College Healthcare NHS Trust (ICHT) has extended this to all aspects of elective care to enable standardised decision-making based on clinical priority, clinical harm and patient vulnerability. This was a clinically led project that involved close collaboration with lay partners, who were concerned that the RCS guidance lacked the sensitivity to reflect individual patients' needs. Our novel elective care recovery matrix is designed to be applicable across all elective care services and at Trust or system level. Implementation at ICHT progressed rapidly: as of 28 August 2020 >200 consultants have received training on the process and 58% of all surgical orders have been prioritised using the new framework (5,134/8,800). While COVID-19 was the driver, the applicability can be wider and could inform new ways of working. The framework enables rapid quantification of individual patient care requirements, thus enabling clinicians to target more accurately those patients with the greatest need and those who would see the greatest benefit.

The perception of patient safety in an alternate site of care for elective surgery during the first wave of the novel coronavirus pandemic in the United Kingdom: a survey of 158 patients.

BACKGROUND: We undertook a prospective qualitative survey to ascertain the perceptions and experience of National Health Service patients in the United Kingdom who underwent planned or elective procedures and surgery at alternate 'clean' hospital sites during the coronavirus disease 2019 (COVID-19) pandemic. These alternate 'clean' hospital sites were independent hospitals running active staff and patient testing programmes for COVID-19 and which did not admit or treat patients suffering with COVID-19. METHODS: A prospective survey was undertaken to include patients at least 30 days after a planned surgery or procedure conducted at a 'clean' alternate hospital site during the COVID-19 pandemic. The study was conducted using structured interviews undertaken by trained assessors. A 20% sample group of patients were randomly selected to participate in this study. Qualitative data related to confidence, safety and perceptions of safety were collected. RESULTS: Ninety-five patients (60%) reported that they had prior worries or concerns about undergoing an elective procedure during the COVID-19 pandemic. A total of 47 patients (30%) had delayed their surgery at least once because of these concerns. A total of 150 patients (95%) felt that the precautions in place to protect their safety in the setting of an alternate 'clean' hospital site were well thought out and proportionate. Patients reported high levels of confidence in the measures undertaken. Separation of patient pathways using the independent sector and patient testing were identified by patients as having the greatest impact on their perception of safety. CONCLUSIONS: Patient confidence will be key to ensuring uptake of planned and elective procedures and surgery during the COVID-19 pandemic. Perceptions of safety will be key to this confidence and efforts to demonstrably enhance safety are well received by patients. In particular, patients felt that a dedicated programme of patient testing and separation of patient pathways provided the greatest levels of confidence in the safety of their treatment.

The long road to recovery: at six months since the first COVID-19 wave, elective orthopedic care has still not fully recovered in Belgium.

PURPOSE: The primary aim of our study was to investigate elective orthopaedic care during the first wave government-imposed COVID-19 lockdown and at four weeks and 21 weeks after resuming elective care. The secondary aim of our study was to evaluate the implementation of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) COVID-19 Guidelines and Recommendations for Resuming Elective Surgery in the clinical practice of Belgian knee surgeons. METHODS: We sent three anonymous online surveys to 102 Belgian Knee Society members (BKS) at times mentioned above. Addressed topics were: (1) participant demographics, (2) elective surgeries, (3) outpatient visits, (4) ESSKA Guidelines, (5) patient and surgeon safety. RESULTS: During the COVID-19 lockdown, there was a decrease of 97% in elective knee surgeries and 91% in outpatient visits. At four and 21 weeks after resuming elective care, volumes were respectively 67% and 89% for elective surgeries and 81% and 91% for outpatient visits. Regarding ESSKA guidelines, 91% of surgeons had no COVID-19 testing prior to resuming elective care. Ninety-two per cent reported preoperative (< 72 h) patient PCR testing, and 45% gave preference to young patients without comorbidities. Seventy-two per cent did not use additional personal protective equipment (PPE) if a patient PCR test was negative. Forty-nine per cent continued to give preference to general anaesthesia. CONCLUSION: Our study shows that elective surgeries and outpatient visits were almost completely interrupted during the COVID-19 lockdown and were still below normal at four and 21 weeks after resuming elective care. Regarding ESSKA COVID-19 guidelines, our study observes good compliance in preoperative patient COVID-19 testing, but lower compliance for preoperative health care personnel testing, patient selection, use of PPE, and locoregional anaesthesia. LEVEL OF EVIDENCE: V.

Interdisciplinaridade em estágio de vivência acadêmica: reconhecimento da atuação profissional no Sistema de Saúde / Interdisciplinarity in an academic experience internship: recognition of professional performance in the Health System / Interdisciplinaridad en prácticas de experiencia académica: reconocimiento de la actuación profesional en el Sistema de Salud

Objetivo: Descrever a experiência de um estágio acadêmico vivenciado por universitários da área da saúde em um município do Baixo Solimões. Síntese dos dados:Trata-se do relato descritivo de um estágio acadêmico extramuro realizado em Manacapuru, Amazonas, ocorrido no período de outubro de 2019 a fevereiro de 2020. A realização da atividade teve a participação de acadêmicos de Medicina, Enfermagem e Odontologia e contou com a aplicação de práticas em saúde direcionadas à atuação individual e coletiva. Tendo como público-alvo os pacientes atendidos por uma Unidade Básica de Saúde (UBS), os universitários auxiliaram na realização de atendimentos eletivos em suas respectivas áreas de atuação e conduziram atividades de educação em saúde como rodas de conversa, gincanas educativas, palestras interativas e educação continuada à equipe da UBS. Conclusão: As práticas e ações em saúde realizadas no período do estágio extramuro proporcionaram uma integração interdisciplinar satisfatória entre os acadêmicos, possibilitando aos mesmos uma vivência apropriada na atenção básica do Sistema Único de Saúde (SUS).

Objective: To describe the experience of an academic internship completed by university students in the health field in a municipality in Baixo Solimões. Data synthesis: This is a descriptive report of an extramural academic internship carried out in Manacapuru, Amazonas, from October 2019 to February 2020. The activity was carried out with the participation of medical, nursing and dentistry students and included the application of health practices aimed at individual and collective action. Having as a target audience the patients assisted by a Primary Health Care (PHC) center, the university students helped in carrying out elective care in their respective fields and conducted health education activities such as conversation circles, educational scavenger hunts, interactive lectures and continuing education for the PHC center team. Conclusion: The health practices and actions carried out during the extramural internship enabled a satisfactory interdisciplinary integration among the students and allowed them to have an appropriate experience in primary care in the Unified Health System (Sistema Único de Saúde ­ SUS).

Objetivo: Describir la experiencia de una pasantía académica vivida por universitarios del área de la salud en un municipio del Baixo Solimões. Síntesis de los datos: Se refiere al informe descriptivo de una pasantía académica extramuros realizado en Manacapuru, Amazonas, ocurrido entre octubre de 2019 y febrero de 2020. La realización de la actividad tuvo la participación de académicos de medicina, enfermería y odontología y contó con la aplicación de prácticas en salud direccionadas a la actuación individual y colectiva. Teniendo como público meta los pacientes atendidos por una Unidad Básica de Salud (UBS), los universitarios ayudaron en la realización de atendimientos electivos en sus respectivas áreas de actuación y condujeron actividades de educación y en salud como charlas, juegos educativos, conferencias interactivas y educación continuada para el equipo de la UBS. Conclusión: Las prácticas y acciones en salud realizadas en el período de la pasantía extramuros proporcionaron una integración interdisciplinar satisfactoria entre los académicos, posibilitando a los mismos una experiencia apropiada en la atención básica del Sistema Único de Salud (SUS).