12 Strategies for Addressing an Elective Surgery Backlog

Some areas of the U.S. experiencing a third wave of COVID-19 cases still have a surgical backlog; advanced practice professionals are key to increasing access to care.

“The surgical PA has been shown to not only help increase access with pre-op and helping in the recovery stage, it helps hospitals and surgeons see more patients,” said Gerald Simons, MPAS, DFAAPA, PA-C, clinical assistant professor in the department of PA education at Stony Brook School of Health Technology and Management in Southampton, New York.

Physician assistants and certified registered nurse anesthetists (CRNAs) can help healthcare systems return to a more normal surgical schedule.

“CRNAs can absolutely help address the elective surgery backlog, particularly when allowed to work to the full extent of their education, training and licensure,” said Brett Morgan, DNP, CRNA, senior director of education and practice, American Association of Nurse Anesthetists. “As elective surgeries resume, CRNAs can step in as a full-service anesthesia provider.” 

The return of elective surgeries also will help hospitals financially. The American Hospital Association released an analysis in February 2021 that hospital and health system revenues could be down as much as $122 billion in 2021, as people have delayed care, including surgeries. That is in addition to an estimated loss of at least $323 billion in 2020. 

Surgical volumes are not expected to return to 2019 levels for months to come, according to a McKinsey & Company report released in October 2020. And it may take more than a year to burn through the backlog, even by increasing output by 10 percent. 

Many people remain hesitant to access medical care. The Centers for Disease Control and Prevention reported in September 2020 that “41 percent of U.S. adults had delayed or avoided medical care” due to concerns about COVID-19. Many people have lost their health insurance along with their jobs or part-time status. Delays in care can adversely affect outcomes.

12 strategies for restarting elective surgery

The American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses and the American Hospital Association issued a “Roadmap for Resuming Elective Surgery after COVID-19 Pandemic.” The guidance, released in April 2020 and updated in November 2020, includes: 

1. Testing patients and staff for COVID-19.
 
2. Ensuring adequate personal protective equipment (PPE) is available.  
3. Prioritizing immediate patient needs. For instance, cancer, transplant, cardiac and trauma cases should take priority. 
4. Collecting and managing data, including quality of care metrics and bed, PPE and COVID-19 statistics.  
5. Taking part in regional cooperation (added to updated November 2020 guidance) 
6. Addressing supply-chain issues (added to November 2020 guidance) 

Additional issues and strategies that may help address the surgical backlog: 

7. Bringing
locum tenens physician assistants, nurse practitioners or CRNAs on board can help hospitals, surgery centers and practices catch up on any backlog. 
8. Data analytics can help in prioritizing what surgeries should take place first.  
9. Availability of operating rooms, surgical inpatient beds and intensive-care beds pose challenges to resuming surgeries, but so do workforce issues, according to the McKinsey report.  
10. Extending the workweek to include weekends and evenings may help in chipping away at elective surgery backlogs, but that will require more skilled professionals, peri-operative clinicians and nurses on units as the patients recover. At the same time, hospital workforces may be unstable, due to postponed paid time off, childcare needs, COVID-19 infections, and provider burnout, per the McKinsey report.   
11. Optimizing OR and inpatient throughput could allow for more cases to be performed, McKinsey states, even with the additional sanitization between cases that is now required.  
12. Surgical navigators can help patients with preparing for surgery and answer their questions. Calling patients to discuss rescheduling procedures could prove helpful in speeding up a return to in-person care. Providers also may need to focus on bringing patients back during periods of low COVID-19 activity, according to McKinsey’s report. 

Deploying advanced practice locum providers

Surgical PAs talk with the patient preoperatively, perform minor procedures, assist surgeons, write orders for post-op care and often follow the patient while in the hospital, writing new orders as needed, and in private practice after discharge in office practices.

“The big selling point of the surgical PAs is their ability to participate through the entire perioperative experience,” Simons said. “You see a lot of them in the OR, but for most of us, it is a package deal, where they are doing the whole perioperative experience.” 

Surgical PAs may run the wound-vac team in some settings, Simons said. They may perform biopsies. Studies have shown that surgical PAs can improve access to care and allow surgeons to see more patients and handle more complicated cases. 

“In offices that use a surgical PA, patients are getting easier appointments,” Simons said. 

Surgical nurse practitioners can provide some of that care, at times serving as a first assistant during the surgery, with some states requiring an additional certification. But NPs can definitely follow the patient pre- and post-operatively. 

CRNAs provide anesthesia to millions of surgical patients and those undergoing procedures, such as a colonoscopy, in a variety of settings. 

“CRNAs are qualified to make independent judgments regarding all aspects of anesthesia care based on their education, licensure and certification,” Morgan said.

“CRNAs are also trained to deliver care in a way that is particularly respectful of resources and cost.”

In 2001, the Centers for Medicare & Medicaid Services (CMS) allowed states to eliminate the requirement for physician supervision of CRNAs, and 19 states have opted out. However, in 2020, CMS suspended the supervision requirement to boost CRNA capacity during the pandemic. 

“Many states passed emergency orders during the pandemic, removing a significant roadblock toward ensuring states have the necessary workforce capacity during the COVID-19 crisis and in the future,” Morgan said.  

What do locum advanced practice providers need to work in surgery

Surgical physician assistants must graduate from an accredited, surgically-focused PA program and, usually, complete a surgical residency, which provides an opportunity to gain experience to manage patient care during the 12 to 16 month program. Physician assistant locums work with a supervising physician.

Employers seeking surgery physician assistant locums require licensure in the state where the care is provided, physician assistant certification or being board certified or eligible, and recent experience. 

CRNAs must have critical care experience before beginning formal anesthesia education, Morgan said. Locum CRNAs can find numerous opportunities, and must also be licensed in the state where they wish to practice. Your locum tenens agency can help with job searches, licensing and other onboarding issues.

Returning to surgical schedules reminiscent of 2019 will take time, but advanced practice providers offer a way to speed up the process.   

Learn more: 
Locum Tenens Physician Assistant Jobs and Salaries 
Locum Tenens CRNA Jobs and Salaries 
Locum Tenens Nurse Practitioner Jobs and Salaries 

Staff Care, an AMN Healthcare company, specializes in placing locum tenens physicians and advanced practitioners in part-time and full-time assignments across the U.S. 

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