In March 2020, the World Health Organisation (WHO) declared COVID-19 a global pandemic. Since that time, health systems and patients have been challenged to rapidly adapt in the face of capacity surges, unprecedented resource consumption and an array of new safety procedures. As vaccines continue to roll out, a surge of patients needing non-emergent care is likely to put new strains on our healthcare resources. Solutions and new workflows will be needed to cope with the increased volume of patients seeking care.
While patient and provider experiences vary by country, COVID-19 has illuminated the global nature of healthcare and tested the resilience of organisations. At the beginning of the pandemic, hospitals braced for an incoming wave of COVID-19 patients and took proactive steps to preserve hospital capacity and resources. Many countries directed public hospitals to cancel non-urgent surgeries and to ramp up their intensive care unit (ICU) bed capacity to accommodate any potential surge in pandemic patients.
At the individual level, many patients chose to delay their care and stay home to reduce their risk of contracting COVID-19. On this side of the world, research showed that fewer Canadians sought medical care for significant concerns like cardiac events and trauma, as well as for common concerns like abdominal pain colds and the flu1. In the Asian region, Malaysia saw an overall surgery cancellation rate of about 71 per cent, which was projected to take 11 months to clear the backlog of surgeries2.
This may be one of the largest indirect consequences of COVID-19: more than 28 million cancelled or postponed operations, which means a significant number of patients are waiting for care3. For conditions such as cancer, surgery is central to diagnosis and treatment, and a delay in either can significantly worsen outcomes4.
The true impact of the pandemic on our healthcare system — and the global population’s healthcare in general — is so far-reaching we likely do not yet know its full scale. It may likely take years before we can determine the full impact of these care delays, and potentially the same amount of time for the system to recover financially and operationally.
According to a global study3 using data from 359 hospitals across 71 countries, the total number of cancelled elective surgeries in 190 countries across duration of 12 weeks of peak disruption were estimated to be at 2.3 million operations per week. These numbers represent a massive backlog of delayed surgeries and procedures, which are likely to worsen with additional week of continuing restrictions and lockdowns. It will also place unprecedented stress on healthcare systems across the globe in the coming months and years, which for some countries, were already routinely filled beyond capacity even before the pandemic with patients experiencing long wait times for specialist referrals, surgeries or diagnostic procedures.
The same study also predicted that it would take at least 45 weeks to clear the surgical backlog and get back on track. However, these projections assume hospitals will be able to operate at 20 per cent above pre-pandemic volumes over the coming years, which remains an existential challenge for already overcrowded healthcare systems.
While increasing funding is critical to help our hospitals prepare for patient surges, healthcare leaders and decision-makers will also have to find innovative ways to increase volume and capacity above pre-pandemic levels to clear the backlog. Organisations are all at different stages of workflow modernisation, and, from a culture perspective, acceptance of technology is as important, if not more so, than the adoption of new solutions.
We need to explore solutions that enable patients to access the surgeries or procedures they are waiting for, without compromising quality of care. To achieve this, we need to get to the root of the problem – inpatient capacity planning — which includes hospital admissions, discharges, and transfers, as well as staffing and operating-room utilisation. For example, a significant step would be to move from electronic versions of analog processes to digitalfirst processes, where healthcare providers can then realise the full potential of digital workflows that are bolstered by artificial intelligence, machine learning and other technologies poised to transform healthcare delivery, operations and more.
The backlog of appointments resulting from suspending non-urgent procedures and screenings during COVID-19 waves has become a major side effect of the pandemic. However, the healthcare sector can boost patient access using some creative approaches. There are five opportunities healthcare leaders and decision-makers can consider:
1) Optimise patient access and bed management
Adopting bed management technology can enable fast, accurate patient placement. With visibility into transfer and discharge activities, hospitals can rely on the data to match patients to beds under the right service lines more quickly, expediting patient throughput.
2) Eliminate environmental services inefficiencies to prioritise patient safety
Eliminating manual processes and ensuring environmental services tasks are completed safely and efficiently will minimise hospital-acquired infections which require lengthened hospital stays.
3) Effectively manage the porter pool
To optimise the porter service and limit delays, many organisations centralise the transport workload. Streamlining transport processes with a mobile application maximises staff productivity by optimising task allocation with batching and barcodes
4) Harness the power of predictive analytics for proactive decisionmaking
From an operational perspective, organisations can leverage predictive analytics to make actionable staffinglevel decisions based on history and predicted demand and ensure that they have the capacity to effectively manage volumes during any given shift. When staffing decisions are aligned with demand, a foundation for improved patient access is created. Powerful predictive analytics can optimise capacity planning and discharge forecasting.
5) Deploy a single command and control team
This provides an integrated patient flow solution that incorporates bed management, portering, environmental services, transfer management, surgical flow and predictive analytics, ensuring communication, efficiency and patient throughput are maximised.
While optimising in-person care experiences is a worthy endeavour, there is no denying that remote care is on the rise. During the pandemic, telehealth enabled patients with everything from behavioural health to post-surgical care needs to engage with clinicians flexibly and comfortably. The possibilities for telecare will only expand as connected device technologies advance, where the smart thermometers and sleep trackers of today suggest that more comprehensive and efficient care is within reach. Patients can get visibility into their progress and useful information to help improve their health along the way. Managing the volume of data collected in our personal environments will thus be key to actualising this vision.
John Lee-Bartlett is VP International Solutions Management & Managing Director Canada and Americas (non US). Originally from the UK, John has a 20-year growing passion for healthcare transformation. Having worked for many years in the NHS and then for various healthcare IT companies, he provides a clear and passionate approach to improving the ways healthcare IT can enable clinical transformation. For the last several years, John has worked in Canada providing leadership across the Allscripts business for existing clients and growing the business to provide innovative solutions to organizations and patients
Allscripts (NASDAQ: MDRX) is a leader in healthcare information technology solutions that advance clinical, financial and operational results. Our innovative solutions connect people, places and data across an Open, Connected Community of HealthTM. Connectivity empowers caregivers and consumers to make better decisions, delivering better care for healthier populations. To learn more, visit www.allscripts.com, Twitter, YouTube and It Takes A Community: The Allscripts Blog.
As of 6 May 2022, the Allscripts Healthcare Solutions’ Hospitals and Large Physician Practices business segment has since been acquired by N. Harris Computer Corporation (“Harris”), a wholly-owned subsidiary of Constellation Software Inc. (TSX:CSU). The segment is now operating as Altera Digital Health, a business unit of Harris Healthcare. To learn more, visit www.alterahealth.com.
References:
1 Canadian Institute for Health Information (CIHI). Overview: COVID-19’s impact on health care systems. Available at: https://www.cihi.ca/en/covid-19- resources/impact-of-covid-19-on-canadas-health-care-systems/overview-covid-19s-impact-on Accessed on: May 25, 2021.
2 British Journey of Surgery, COVIDSurg Collaborative: Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans
3 World Economic Forum: 28 million elective surgeries may be cancelled worldwide: how non-COVID-19 medical care is suffering
4 Eskander et al. Access to Cancer Surgery in a Universal Health Care System During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(3):e211104. Available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777399?resultClick=1#zld210019r1. Accessed on: May 25, 2021.
