Pediatric Modification of the Medically Necessary, Time-Sensitive Scoring System for Operating Room Procedure Prioritization During the COVID-19 Pandemic.
Betacoronavirus
COVID-19
Child
Coronavirus Infections
/ epidemiology
Cross Infection
/ prevention & control
Decision Making
Elective Surgical Procedures
Humans
Infection Control
/ methods
Infectious Disease Transmission, Patient-to-Professional
/ prevention & control
Operating Rooms
Pandemics
Patient Selection
Personal Protective Equipment
/ supply & distribution
Pneumonia, Viral
/ epidemiology
SARS-CoV-2
Surgery Department, Hospital
/ organization & administration
Journal
Journal of the American College of Surgeons
ISSN: 1879-1190
Titre abrégé: J Am Coll Surg
Pays: United States
ID NLM: 9431305
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
23
04
2020
revised:
14
05
2020
accepted:
14
05
2020
pubmed:
31
5
2020
medline:
31
7
2020
entrez:
31
5
2020
Statut:
ppublish
Résumé
The COVID-19 pandemic forced surgeons to reconsider concepts of "elective" operations. Perceptions about the time sensitivity and medical necessity of a procedure have taken on greater significance during the pandemic. The evolving ethical and clinical environment requires reappraisal of perioperative factors, such as personal protective equipment conservation; limiting the risk of exposure to COVID-19 for patients, families, and healthcare workers; preservation of hospital beds and ICU resources; and minimizing COVID-19-related perioperative risk to patients. A scaffold for the complex decision-making required for prioritization of medically necessary, time-sensitive (MeNTS) operations was developed for adult patients by colleagues at the University of Chicago. Although adult MeNTS scoring can be applied across adult surgical specialties, some variables were irrelevant in a pediatric population. Pediatric manifestations of chronic diseases and congenital anomalies were not accounted for. To account for the unique challenges children face, we modified the adult MeNTS system for use across pediatric subspecialties. This pediatric MeNTS scoring system was applied to 101 cases both performed and deferred between March 23 and April 19, 2020 at the University of Chicago Comer Children's Hospital. The pediatric MeNTS scores provide a safe, equitable, transparent, and ethical strategy to prioritize children's surgical procedures. This process is adaptable to individual institutions and we project it will be useful during the acute phase of the pandemic (maximal limitations), as well as the anticipated recovery phase.
Sections du résumé
BACKGROUND
The COVID-19 pandemic forced surgeons to reconsider concepts of "elective" operations. Perceptions about the time sensitivity and medical necessity of a procedure have taken on greater significance during the pandemic. The evolving ethical and clinical environment requires reappraisal of perioperative factors, such as personal protective equipment conservation; limiting the risk of exposure to COVID-19 for patients, families, and healthcare workers; preservation of hospital beds and ICU resources; and minimizing COVID-19-related perioperative risk to patients.
STUDY DESIGN
A scaffold for the complex decision-making required for prioritization of medically necessary, time-sensitive (MeNTS) operations was developed for adult patients by colleagues at the University of Chicago. Although adult MeNTS scoring can be applied across adult surgical specialties, some variables were irrelevant in a pediatric population. Pediatric manifestations of chronic diseases and congenital anomalies were not accounted for. To account for the unique challenges children face, we modified the adult MeNTS system for use across pediatric subspecialties.
RESULTS
This pediatric MeNTS scoring system was applied to 101 cases both performed and deferred between March 23 and April 19, 2020 at the University of Chicago Comer Children's Hospital. The pediatric MeNTS scores provide a safe, equitable, transparent, and ethical strategy to prioritize children's surgical procedures.
CONCLUSIONS
This process is adaptable to individual institutions and we project it will be useful during the acute phase of the pandemic (maximal limitations), as well as the anticipated recovery phase.
Identifiants
pubmed: 32473197
pii: S1072-7515(20)30430-0
doi: 10.1016/j.jamcollsurg.2020.05.015
pmc: PMC7251404
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
205-215Informations de copyright
Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Références
J Clin Med Res. 2015 Apr;7(4):232-41
pubmed: 25699119
Ann Surg. 2020 Jul;272(1):e27-e29
pubmed: 32221117
Acta Paediatr. 2020 Jun;109(6):1088-1095
pubmed: 32202343
JAMA. 2019 May 14;321(18):1788-1798
pubmed: 31087023
Anesth Analg. 2017 Aug;125(2):593-602
pubmed: 28682951
Acta Obstet Gynecol Scand. 1998 Oct;77(9):923-8
pubmed: 9808381
Pediatr Pulmonol. 2015 Sep;50(9):878-88
pubmed: 25651820
Health Technol Assess. 2010 Oct;14(46):131-172
pubmed: 20923611
Lancet Oncol. 2020 Mar;21(3):335-337
pubmed: 32066541
PLoS One. 2010 May 19;5(5):e10717
pubmed: 20502660
Int J Cardiol. 2020 Jun 15;309:70-77
pubmed: 32248966
PLoS One. 2012;7(4):e35797
pubmed: 22563403
Anesth Analg. 1981 Jan;60(1):46-52
pubmed: 7006464
Ann Surg. 2020 Aug;272(2):e161-e162
pubmed: 32675526
J Med Virol. 2020 Jul;92(7):747-754
pubmed: 32232980
BMC Anesthesiol. 2018 Nov 2;18(1):137
pubmed: 30384855
J Am Coll Surg. 2020 Aug;231(2):281-288
pubmed: 32278725