Levels of Urgency for Orthopaedic Procedures: Reliability and Adoption of a Consensus-driven Classification.
Journal
The Journal of the American Academy of Orthopaedic Surgeons
ISSN: 1940-5480
Titre abrégé: J Am Acad Orthop Surg
Pays: United States
ID NLM: 9417468
Informations de publication
Date de publication:
01 Nov 2021
01 Nov 2021
Historique:
received:
26
05
2020
accepted:
24
09
2020
pubmed:
1
12
2020
medline:
27
10
2021
entrez:
30
11
2020
Statut:
ppublish
Résumé
The current COVID-19 disease pandemic has delayed nonurgent orthopaedic procedures to adequately care for those affected by the severe acute respiratory syndrome coronavirus 2, resulting in a backlog in orthopaedic surgical care. As the capacity for orthopaedic surgeries expands or contracts, allocation of limited resources in a manner that adequately reflects medical necessity and urgency is paramount. An orthopaedic surgery-specific prioritization schema with proven reliability is lacking. The primary aim of this study was to assess the reliability of a newly developed prioritization list used for the phased reinstatement of orthopaedic surgical procedures during the COVID-19 pandemic and afterward. The secondary aim was to report its implementation. A consensus-based, orthopaedic surgery-specific, tiered prioritization list reflecting various levels of urgency was created by a committee of orthopaedic surgeons covering all subspecialties and representing academic, multispecialty, and private community practices. Reliability was tested for 63 randomized cases representing all orthopaedic subspecialties. Four raters evaluated the cases independently at two separate time points, at least one week apart. Fleiss kappa was used to assess intrarater and interrater agreement. Implementation were assessed by surveying both surgeons and the surgery scheduling administrative personnel at each surgical facility within a large health system for any adoption issues. Case distributions within tiers 1, 2, 3, and 4 were 35%, 14%, 27%, and 24%, respectively. Interrater agreement ranged from 0.63 (95% confidence interval [CI] 0.57 to 0.69) to 0.72 (95% CI 0.66 to 0.78) for the ratings. Intrarater reliability ranged from 0.62 to 1.0. The highest levels of agreement were in tiers 1, 4, and the subspecialties oncology and foot/ankle. The time from development to full scale adoption and implementation by all orthopaedic surgeons was rapid. This tiered prioritization list for orthopaedic procedures is both adoptable and reliable during the phased reinstatement of procedures during the COVID-19 pandemic and afterward. Further refinements may enhance utility. Reliability study: Level I (Evid Based Spine Care J 2014 October;5(2):166. doi: 10.1055/s-0034-1394106).
Identifiants
pubmed: 33252553
pii: 00124635-202111010-00009
doi: 10.5435/JAAOS-D-20-00631
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1078-e1086Informations de copyright
Copyright © 2020 by the American Academy of Orthopaedic Surgeons.
Références
Buggey H, Wheeler T: Cleveland Clinic and SAS share COVID-19 predictive models to help hospitals plan for current and future needs, in Models Help Forecast Bed and Ventilator Needs and Predict Impacts on Critical Supply Chains, Finance and Staffing to Optimize Hospital Preparedness Before, During and After Regional Peaks. Cleveland, OH, Cleveland Clinic, 2020.
American Hospital Association: A compendium of models that predict the spread of COVID-19, in COVID-19 Models: Forecasting the Pandemic's Spread. Chicago, IL, American Hospital Association, 2020.
CMS: Centers for Medicare & Medicaid Services: Non-emergent, elective medical services, and treatment recommendations . Available at: https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf . Accessed Accessed May 17, 2020.
Prachand VN, Milner R, Angelos P, et al.: Medically necessary, time-sensitive procedures: Scoring system to ethicallyand efficiently manage resource scarcity and provider risk during the COVID-19 pandemic. J Am Coll Surg 2020;231:281-288.
American College of Surgeons: COVID-19: Guidance for triage of non-emergent surgical procedures. Available at: https://www.facs.org/covid-19/clinical-guidance/triage . Accessed Accessed March 17, 2020.
Arnett G, Hadorn DC; Steering Committee of the Western Canada Waiting List Project: Developing priority criteria for hip and knee replacement: Results from the Western Canada waiting list project. Can J Surg 2003;46:290-296.
Coleman B, McChesney S, Twaddle B: Does the priority scoring system for joint replacement really identify those in most need? N Z Med J 2005;118:U1463.
Conner-Spady B, Estey A, Arnett G, et al.: Prioritization of patients on waiting lists for hip and knee replacement: Validation of a priority criteria tool. Int J Technol Assess Health Care 2004;20:509-515.
Conner-Spady B, Estey A, Arnett G, et al.: Determinants of patient and surgeon perspectives on maximum acceptable waiting times for hip and knee arthroplasty. J Health Serv Res Policy 2005;10:84-90.
Conner-Spady BL, Arnett G, McGurran JJ, Noseworthy TW; Steering Committee of the Western Canada Waiting List Project: Prioritization of patients on scheduled waiting lists: Validation of a scoring system for hip and knee arthroplasty. Can J Surg 2004;47:39-46.
Conner-Spady BL, Johnston G, Sanmartin C, et al.: Patient and surgeon views on maximum acceptable waiting times for joint replacement. Healthc Policy 2007;3:102-116.
Desmeules F, Dionne CE, Belzile ÉL, Bourbonnais R, Frémont P: The impacts of pre-surgery wait for total knee replacement on pain, function and health-related quality of life six months after surgery. J Eval Clin Pract 2012;18:111-120.
Conner-Spady BL, Sanmugasunderam S, Courtright P, McGurran JJ, Noseworthy TW; Steering Committee of the Western Canada Waiting List Project: Determinants of patient satisfaction with cataract surgery and length of time on the waiting list. Br J Ophthalmol 2004;88:1305-1309.
Ma Quintana J, Escobar A, Bilbao A; IRYSS-Appropriateness Cataract Group: Explicit criteria for prioritization of cataract surgery. BMC Health Serv Res 2006;6:24.
Ackerman IN, Bennell KL, Osborne RH: Decline in health-related quality of life reported by more than half of those waiting for joint replacement surgery: A prospective cohort study. BMC Musculoskelet Disord 2011;12:108.
Desmeules F, Dionne CE, Belzile E, Bourbonnais R, Frémont P: The burden of wait for knee replacement surgery: Effects on pain, function and health-related quality of life at the time of surgery. Rheumatology (Oxford) 2010;49:945-954.
Pitt DF, Noseworthy TW, Guilbert J, Williams JR: Waiting lists: Management, legalities and ethics. Can J Surg 2003;46:170-175.
Déry J, Ruiz A, Routhier F, et al.: Patient prioritization tools and their effectiveness in non-emergency healthcare services: A systematic review protocol. Syst Rev 2019;8:78.
Kottner J, Audige L, Brorson S, et al.: Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. Int J Nurs Stud 2011;48:661-671.
Donner A, Eliasziw M: Sample size requirements for reliability studies. Stat Med 1987;6:441-448.
Ranganathan P, Pramesh CS, Aggarwal R: Common pitfalls in statistical analysis: Measures of agreement. Perspect Clin Res 2017;8:187-191.
Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977;33:159-174.
Gwynne-Jones DP, Iosua EE, Stout KM: Rationing for total hip and knee arthroplasty using the New Zealand Orthopaedic Association score: Effectiveness and comparison with patient-reported scores. J Arthroplasty 2016;31:957-962.
Parvizi J, Gehrke T, Krueger CA, et al.; The International Consensus Group (ICM) and Research Committee of the American Association of Hip and Knee Surgeons (AAHKS): Resuming elective orthopaedic surgery during the COVID-19 pandemic. Guidelines developed by the International Consensus Group (ICM). J Bone Joint Surg Am 2020;102:1205-1212.
Prada C, Chang Y, Poolman R, Johal H, Bhandari M: COVID-19 evidence based scoping review. Available at: https://myorthoevidence.com/ . Accessed May 17, 2020.
Sarac NJ, Sarac BA, Schoenbrunner AR, et al.: A review of state guidelines for elective orthopaedic procedures during the COVID-19 outbreak. J Bone Joint Surg Am 2020;102:942-945.
DePhillipo NN, Larson CM, O'Neill OR, LaPrade RF: The orthopaedic forum guidelines for ambulatory surgery centers for the care of surgically necessary/time-sensitive orthopaedic cases during the COVID-19 pandemic. J Bone Joint Surg Am 2020;102:933-936.
American College of Surgeons: Create a surgical review committee for COVID-19-related surgical triage decision making. Chicago, IL: American College of Surgeons; 2020. Available at: https://www.facs.org/covid-19/clinical-guidance/review-committee . Accessed March 24, 2020.
Henley MB: ICD 10: “What orthopedic surgeons should know, how it will affect them and the cost of implementation?” Sports Med Arthrosc Rev 2013;21:142-147.
Carroll CT, Aziz KT, Humbyrd CJ: Elective reconstructive surgery during a pandemic: A moral dilemma. J Bone Joint Surg Am 2020;102:e51.