Feature December 21, 2020 John Bernot, MD

Cutting through the orthopedic backlog with a virtual perioperative assistant

Doctor communicating with patients.

As COVID cases surge across the United States, our healthcare system has been forced to postpone or cancel elective surgeries. Orthopedic practices have been hit particularly hard by this, with Becker’s Hospital Review reporting that over 100 hospitals have postponed surgeries due to the resurgence of COVID1. The rising occurrences of postponed or cancelled surgeries have significantly impacted patient care and the financial well-being of the healthcare system, as well.

Orthopedic practices and hospitals need innovative and creative approaches to address these challenges. The most promising approach being adopted by both large and small scale healthcare practices is the use of a virtual perioperative assistant. Before getting into why that is, allow me to elaborate on the consequences of postponed elective surgeries.

Patient management and care

Very little has been published about the impact of postponed elective surgeries and appointment cancellations on patients’ health and wellbeing; however, we can look to previous studies to understand the impact on patients. Research conducted in the UK has shown that delays to orthopedic surgeries are more common due to “rationing,” and the efficiency of healthcare in general has been reduced due to the time it takes to move through the National Health Service. This research specifically shows that delays in hip replacement surgeries cause several deleterious effects to patients, namely:

  • Increases in pain and physical disability
  • High levels of psychological distress
  • Overall deterioration in quality of life

Healthcare system finances

The healthcare system has become increasingly reliant on elective surgeries for operating income with a disproportionate reliance on orthopedic surgeries. In fact, elective orthopedic and musculoskeletal procedures account for a staggering 13 percent of all hospital reimbursement, and 23 percent of all hospital net income. An analysis from the 2nd quarter of 2020 showed losses of $10.9-$11.9 billion in reimbursement and $2.6-$3.5 billion in net income to the US hospital system2.

Increasing efficiency in healthcare with a virtual perioperative assistant

Now that you know the underlying research behind the consequences of postponed or cancelled elective surgeries, you’ll appreciate what a virtual perioperative assistant can bring to the table. Let’s start with addressing the elective surgery backlog.

In July 2020, the Harvard Business Review published an article entitled “COVID-19 Created an Elective Surgery Backlog. How Can Hospitals Get Back On Track?” Several of the authors’ recommendations support the use of a virtual assistant. Specifically, they call for the healthcare system to:

  1. Expand surgical capacity by transitioning to outpatient care; and
  2. Focus on simplifying patients’ surgical care experience.

Considering these recommendations as well as other long-standing inefficiencies within perioperative care, the use of a virtual assistant should be considered as a top solution. It can improve the quality and efficiency of healthcare by automating engagement between patients and clinicians in the pre- and post-operative periods. The possibilities with a virtual perioperative assistant are numerous, but I’ll share with you a few key features that will directly cut into the surgical backlogs.

Personalized and timely patient engagement

Properly preparing a patient for surgery and promoting a successful recovery is a time intensive process, which requires numerous activities to be completed by the patient and case manager. An effective perioperative solution, such as those laid out by enhanced recovery after surgery (ERAS) protocols, will improve outcomes and reduce costs. The challenges lie in the ability of a practice or hospital to effectively engage with large populations of patients with the right message at the right time. A virtual perioperative assistant can ensure not only timely and consistent delivery of materials to a patient, but it will also allow you to customize that patient’s surgical journey. This can automate the process at scale and notify the case manager or surgical navigator about patients who need help at that moment in time.

Patient receives personalized care from a virtual perioperative assistant.

Patient receives personalized care from a virtual perioperative assistant.

Reduce last-minute cancellations and missed surgeries

When the system begins to resume and ultimately expands the number of surgeries, it needs to take measures to avoid operating room downtime. Some of the primary reasons for missed surgeries are:

  • Medication management problems
  • Uncontrolled chronic diseases
  • Lack of transportation to the surgery center
  • Patient getting “cold feet” and backing out

A virtual perioperative assistant can help in each of these instances. When integrated appropriately, it will form a nurturing relationship with the patient and can designate more time and personalized care to each patient as well. The assistant can educate and comfort a patient on the upcoming procedure and reinforce their preparedness for it. It can also ensure that medications, appointments, and other important tasks are completed on time.

Facilitate transition to an outpatient setting and home-based care

A significant reason for the recent postponement of surgeries is to ensure availability of hospital beds for COVID patients. One way to address this is to perform more surgeries in the outpatient setting. To do this, the surgical team needs to know that the patient is prepared for their discharge well in advance of surgery. This includes patients readying their homes, establishing a support team, and having the confidence to adopt self-care.  From the provider side, the team needs to have confidence that the patient is being monitored remotely and knows when to contact the surgical team for further evaluation.

A virtual perioperative assistant for orthopedic care starts this process weeks before the patient ever sets foot in an operating room. It provides a trusted platform for the patient education materials as well as two-way communication with the surgical team. It serves as a remote patient monitoring device and alerts the surgical team in real-time when a patient experiences any sort of concerns at home. This, in turn, increases efficiency and transparency by streamlining the communication processes.

Ayva Ortho is a new virtual perioperative assistant software.

Ayva Ortho is a new virtual perioperative assistant software.

Wrapping up

COVID has brought all sorts of challenges to the world, and has especially caused disruptions to our healthcare system. Namely, it has caused a dramatic increase in the amount of postponed and cancelled elective surgeries. Being prepared to overcome these challenges buds from being aware of where the challenges are coming from, and what healthcare technology is available to suppress them.

We’ve discussed the negative impacts on patient care and healthcare system finances, and how a virtual perioperative assistant like Ayva can help to mitigate these issues. Efficiency in healthcare is becoming increasingly important, so arming hospitals with the right tools to make sure patients are getting the care they need is paramount for our system to get back to the state it was in before COVID.

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