Elective Surgery Ramp-up Revelations: Anesthesiologists & CRNAs Respond to Survey

Summary: 

With the approach of mid-May, we felt it important to get a snapshot of what anesthesia practices are experiencing and expecting as it concerns the resumption of pre-COVID surgery volumes. To facilitate this, we asked our clients to participate in a survey. The results are in, and some are quite interesting.

One of the things that never changes is that there will always be change. Nothing stays the same; and that remains true when it comes to the current national nightmare we have all been enduring. The new normal we have been living in these past few months, with its school closings and store shutdowns and unprecedented joblessness and increasing hopelessness, will change; and it will change for the better. We are already seeing signs of a return to normalcy, with governments easing lockdown rules and travel restrictions in many areas. But what about the healthcare sector—the industry most affected by the COVID crisis? To what extent are we seeing change there?

As an industry leader with a national footprint, we are in a unique position to learn from our clients. With that in mind, we submitted a survey to our extensive client base of over 15,000 anesthesiologists and CRNAs to gauge the state of anesthesia and elective surgery in mid-May. Specifically, we were seeking to determine where our groups are in the ramp-up process to pre-COVID case volumes, what their expectations are in this regard and what they anticipate going forward. Nine questions were submitted. Below, we have provided a summary of these questions and your responses. Some of them are surprising.

The Current State

The first two questions sought to measure where anesthesia practices are at the present time with regard to elective cases. When asked in Q1 if they were still providing COVID-related care outside of regular anesthesia cases, nearly 72 percent responded "no," indicating that only 28 percent were still engaged in COVID-specific care (e.g., emergency intubations for COVID patients, critical care, proning, etc.).

We asked in Q2: "What is the timetable for your primary facility to begin elective surgeries?" We were encouraged to see that over 79 percent of respondents had already begun to perform elective surgeries. A little more than 9 percent said they would begin elective surgeries within a week, and 6 percent anticipated moving to elective surgeries within the next 8 to 14 days. A little over 5 percent were unsure.

Ramp-up Period

We were interested to determine what our groups had heard or already seen concerning the pace toward pre-COVID case levels. Would there be a ramp-up period? If so, how long would it last and what would it look like? Based on these interests, we formulated the next three survey questions. The first of these, Q3, asked: "Once elective surgeries begin, will there be a gradual ramp-up period before resuming a normal pre-COVID case load or will a normal case load be reached almost immediately?" Some 81 percent indicated there would be a ramp-up period. That is, there would be a gradual increase in elective cases. Interestingly, 15.5 percent felt the change back to normal would begin almost immediately, with 3.5 percent being unsure.

In Q4, we asked: "If there is a ramp-up period for elective surgeries, how long will this period last before reaching normal pre-COVID case volume?" Here's where it gets interesting. The results indicated a fairly equal split between three of the four listed options, which are represented below:

Interestingly, well over half believed that the ramp-up to pre-COVID volumes would be complete within a month. When asked in Q5 about the specific percentage of anticipated pre-COVID case levels within the first week of elective surgery ramp-up, our respondents indicated the following:

All of these ramp-up questions provide excellent insight into the pace at which our clients are anticipating case volumes to return to "normal" levels.

Other Insights

The remaining questions in the survey dealt with assorted concerns within the general realm of COVID and the practice of anesthesia. The specific inquiry in Q6 revolved around the issue of decision-making. We asked: "If there is a ramp-up period for elective cases, who will determine the types of cases that can be performed during such period?" A plurality of 45.61 percent said it would be a hospital committee or administrator. Some 26.32 percent felt it would be a clinical director (e.g., chief clinical officer, director of nursing), with another 28.07 percent feeling it would be some other person or group.

Our aim in Q7 was to determine if PPE availability would determine the number of cases performed in the ramp-up period. A sizable 55.26 percent said "yes," with 27.20 percent indicating "no," and 17.54 percent being unsure. This would seem to indicate that, for the time being, the ramp up to normal caseloads is still not in normal territory. The wearing of special protective gear—even with restrictions easing—will continue to be the standard protocol for the foreseeable future, at least for a good portion of our clients.

Our query in Q8 was as follows: "Does your facility have new protocols to follow for all OR cases (e.g., OR turnover decontamination procedures, revised intubation procedures, etc.)?" A resounding 80.17 percent responded in the affirmative, with only 11.21 percent saying "no." Our final question dealt with the non-hospital setting. In Q9, we asked: "When will your surgery center location(s) be opened?" The responses were as follows:

That is surely a good sign that nearly 71 percent of the surgery centers may already be back in operation, with more to follow within the next few weeks.

In summation, it appears that we are seeing the light at the end of the tunnel, at least as to this first wave of coronavirus cases. Our providers have remained steadfast and strong in the midst of an unprecedented health crisis, and we are proud to be standing with you. We hope these survey results will lead to better planning on the part of all. Obviously, these responses come from practices located throughout the country, with each experiencing its own unique circumstances as it pertains to COVID. We, therefore, understand that these results may not mirror what's happening where you are—especially for those in a current "hot zone." Nevertheless, these findings generally indicate a rather rapid return to some form of normalcy in the very near future. For that, we can be grateful.

Please let us know if you have further insights you would like to share with us. You can always contact your account executive or reach us at info@anesthesiallc.com.