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2020 ; 231
(2
): 205-215
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English Wikipedia
Pediatric Modification of the Medically Necessary, Time-Sensitive Scoring System
for Operating Room Procedure Prioritization During the COVID-19 Pandemic
#MMPMID32473197
Slidell MB
; Kandel JJ
; Prachand V
; Baroody FM
; Gundeti MS
; Reid RR
; Angelos P
; Matthews JB
; Mak GZ
J Am Coll Surg
2020[Aug]; 231
(2
): 205-215
PMID32473197
show ga
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.
|*Decision Making
[MESH]
|*Elective Surgical Procedures
[MESH]
|*Operating Rooms
[MESH]
|*Patient Selection
[MESH]
|Betacoronavirus
[MESH]
|COVID-19
[MESH]
|Child
[MESH]
|Coronavirus Infections/*epidemiology
[MESH]
|Cross Infection/prevention & control
[MESH]
|Humans
[MESH]
|Infection Control/*methods
[MESH]
|Infectious Disease Transmission, Patient-to-Professional/prevention & control
[MESH]
|Pandemics
[MESH]
|Personal Protective Equipment/supply & distribution
[MESH]