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Maryland Chapter of the
American College of Surgeons

 
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Message from the President

Dear Colleagues,

The COVID19 crisis has affected every aspect of our lives and we are all trying to make the best decisions to safeguard our patients, colleagues, staff, and loved ones. 

For the latest updates on how the American College of Surgeons is responding to this pandemic and what it means for your practice of surgery, please visit the website located here.  The College is constantly updating its guidance and information for this rapidly evolving situation.  For the latest information specific to Maryland’s response, please check the Maryland Department of Health

If you have not done so already, now is the perfect time to pay your dues. The Maryland Chapter provides member value in a number of ways:  

  • a Fall Dinner Meeting with exciting guest speakers
  • an Annual Spring Meeting that includes sessions designed for all practicing surgeons, opportunities for residents to present, ACS updates, networking opportunities, interaction with industry partners
  • representation with state and national legislators
  • representation on the State EMS Council
  • and a strong relationship with Med-Chi

We have recently nominated two members to serve on the Maryland Board of Physicians. This pandemic has certainly shown us that we are stronger together!  

Best regards,
Jose Diaz, MD, FACS
President, Maryland Chapter of the ACS

ACS COVID-19 Update

Issue 12 of the newsletter, ACS COVID-19 Update, is available now. An introduction is on the body of the page and links to every topic specifically are on the left, which should make it easy to find the information that you want quickly.

As the pandemic matures and patterns begin to emerge, this issue stresses the communication pieces that have been working, the financial issues, and well-being concerns that have become a part of our daily surgical lives. 

Literally every aspect of this event is now being represented and reported.

All of the COVID-19 Update information from all sources is searchable on the tab to the left of the main text to assist in finding the exact information you need.

ACS COVID-19 Registry

As an organization that has been dedicated to improving our understanding of the causes of surgical disease and quality improvement, the College has now developed the ACS COVID-19 Registry. This registry is available to all hospitals interested in collecting important clinical patient data for a disease about which little is known. The registry gathers data on surgical and nonsurgical COVID-19-positive patients. The ACS COVID-19 Registry is a quality improvement program and has been officially granted non-human subject research status, which does not require institutional review board oversight. Participation in the registry is free of charge, and all hospitals that provide services to COVID-19 patients are encouraged to share their data.

Contact COVID19Registry@facs.org to join.

Local Resumption of Elective Surgery Guidance

Online April 17, 2020

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In order to focus local resources on managing the new coronavirus (COVID-19) pandemic, “elective” surgery has been largely postponed and stopped. As the COVID-19 rates have already reached their peaks, or will do so over the next week or two (depending on location), the current focus for an increasing number of facilities is toward “ramping up” to prepare for elective operations.

The current document offers a set of principles and issues to help local facilities plan for resumption of elective surgical care.
 
While the effect of the COVID-19 pandemic on local communities or facilities is a spectrum, we suggest facilities use this checklist as a guide to ensure issues have at least been considered. Understanding both the local facility capabilities (e.g., beds, testing, operating rooms [ORs]) as well as potential constraints (e.g., workforce, supply chain), while keeping an eye on potential subsequent waves of COVID-19 will continue to be important.
 
Within the categories of I. COVID-19 Awareness, II. Preparedness, III. Patient Issues, and IV. Delivery of Safe High-Quality Care, there are 10 distinct issues to be addressed locally before elective surgery may be safely reinstituted. Evaluating and addressing each of these 10 issues will help facilities to not only optimally provide safe and high-quality surgical patient care, but also to ensure that surgery resumes, and doesn’t stop again.

New Scoring System Empowers Surgery Departments to Prioritize Medically Necessary Operations That Should Not Be Delayed Because of Concerns About Hospital Resources or Risk Associated With COVID-19

This Journal of the American College of Surgeons article presents an evaluation tool for surgeons to review necessary hospital resources needed for an operation, the effect of treatment delay on a patient’s underlying disease, and risk the procedure poses for the surgical team


CHICAGO (April 14, 2020): A team of investigators at the University of Chicago (Ill.), has devised a new scoring system that helps surgeons across surgical specialties decide when to proceed with medically necessary operations in the face of the resource constraints and increased risk posed by the Coronavirus Disease 2019 (COVID-19) pandemic. The process, called Medically Necessary Time-Sensitive (MeNTS) Prioritization, is published as an “article in press” on the Journal of the American College of Surgeons website ahead of print.

In the midst of the COVID-19 pandemic, hospitals must make sure they can care for the influx of patients who have advanced viral infection and therefore may require intensive care and the use of ventilators. Hospitals also must ensure that physicians, nurses, and other staff are not subjected to unnecessary risk of infection. At the same time, some patients that are not currently hospitalized still need surgical care that should be delayed for an excessive amount of time.

Decisions to proceed with MeNTS surgery at the present time are being made on a case-by-case basis, with surgeons following guidelines developed by individual surgical specialties, such as triaging breast cancer surgery recommendations developed by the COVID-19 Pandemic Breast Cancer Consortium and released on April 14. Prior to that release, ACS released an overall recommendation on March 13 that hospitals, health systems, and surgeons plan to minimize, postpone, or cancel elective operations until it is clear that the health care infrastructure can support critical care needs. This recommendation was followed by another more detailed guidance document released by ACS on March 17 to aid in surgical decision making in triaging operations that features an Elective Surgery Acuity Scale (ESAS) from St. Louis University.

The new methodology described by University of Chicago surgeons addresses what many call “elective” surgical procedures and is designed to guide both surgeons within a specialty and OR leaders across different specialties. “The majority of surgical procedures are done because of disease processes that do not have good nonsurgical treatment options. If you delay these procedures, that itself can lead to problems and complications. If cancer surgery is postponed indefinitely, for example, there is the potential risk that the disease will become more advanced.

“If a patient has pain in the hip or knee, the additional restrictions on mobility, not to mention the pain itself, are real issues. Although we talk about these operations as being ‘elective,’ that doesn’t mean they are optional. It’s just a matter of the surgeon and the patient having the opportunity to elect the time when the operation should take place. The procedures are more aptly called medically-necessary and time-sensitive,” explained Vivek N. Prachand, MD, FACS, lead author of the article, and professor of surgery and chief quality officer at University of Chicago Medicine and Biological Sciences.

The MeNTS Prioritization process was created by a team of six representatives from general surgery, vascular surgery, surgical oncology, transplantation, cardiac surgery, otolaryngology, and surgical ethics. The team reviewed studies of the effect of COVID-19 as well as severe acute respiratory syndrome on hospital resources, health care providers, surgical procedures, and surgical patients in Asia and Europe and identified 21 factors related to outcome, risk of viral transmission to health care professional, and use of resources.
 

“The nice thing about the system is that it applies not only to academic medical centers in big cities. It can be applied anywhere. The same assessment of resources is true wherever you practice.” Vivek N. Prachand, MD, FACS


“We studied how patients undergoing surgery might potentially be at increased risk of postoperative problems if they had COVID-19. We looked at surgical procedures individually and whether these operations routinely require an ICU stay; other currently scarce hospital resources; and/or general anesthesia, which increases the risk for spreading the virus to the health care team. We also thought about the disease process itself: how effective are non-surgical options? Would a wait of two weeks or six weeks make the operation riskier or more difficult to perform and increase the chance a patient might have complications or have to stay in the hospital longer?” Dr. Prachand added.

Each of the 21 factors is scored on a scale of 1 to 5, and the total score, ranging from 21 to 105, is computed for each case. The higher the score, the greater the risk to the patient, the higher the utilization of health care resources, and the higher the chance of viral exposure to the health care team. (See the linked sample MeNTS worksheet for a full list of the factors that are scored.)

University of Chicago surgeons have been using MeNTS for about two weeks, and they have increased the number of medically necessary, time-sensitive operations to about 15 per day, including colon resection for a painful bleeding cancer, removal of an infected hip replacement, urgent stereotactic brain biopsy of a relatively quickly growing diffuse brain tumor, and repair of a lacerated finger tendon.

The scoring system has been welcomed by University of Chicago specialties not originally involved in its creation, such as orthopedics, gynecology, and anesthesiology. “The MeNTS process gives our anesthesiology colleagues more reassurance that we are taking into consideration their risk in the care of certain patients. It also helps surgical trainees understand that decisions are being made in an equitable and transparent way,” Dr. Prachand said.

MeNTS may be used by any facility that is performing medically necessary, time-sensitive operations. “The nice thing about the system is that it applies not only to academic medical centers in big cities. It can be applied anywhere. The same assessment of resources is true wherever you practice. The factors are not hospital- or practice-environment-specific. These factors are fundamental and straightforward and can help surgeons and hospitals provide the surgical care that patients need both now in the thick of the pandemic as well as when we get to the other side of the peak,” Dr. Prachand said.

Dr. Prachand’s coauthors are Ross Milner, MD, FACS; Peter Angelos, MD, FACS; Mitchell C Posner, MD, FACS; John J Fung, MD, FACS; Nishant Agrawal, MD, FACS; Valluvan Jeevanandam, MD, FACa; and Jeffrey B Matthews, MD, FACS, all from the University of Chicago’s Department of Surgery.

The authors report no disclosures.

“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.
Citation: Medically-Necessary, Time-Sensitive Procedures: Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic. Journal of the American College of Surgeons. DOI: https:/doi.org/10.1016/j.jamcollsurg.2020.04.011

___

  1. COVID-19 Pandemic Breast Cancer Consortium. Expert Medical Societies Release Multidisciplinary Recommendations for Breast Cancer Patient Care During COVID-19 Pandemic. Press release. Available at: https://www.facs.org/media/press-releases/2020/covid-breast-cancer041320. Accessed Aril 14, 2020.
  2. American College of Surgeons. COVID-19: Recommendations for Management of Elective Surgical Procedures. Available at: https://www.facs.org/covid-19/clinical-guidance/elective-surgery. March 13, 2020. Accessed April 3, 2020.
  3. American of Surgeons. COVID-19: Guidance for Triage of Non-emergent Surgical Procedures. Available at: https://www.facs.org/about-acs/covid-19/information-for-surgeons/triage. March 17, 2020. Accessed April 3, 2020.

COVID-19 Legislative & Regulatory Updates!

ACS recently posted a wealth of new information on Legislative and Regulatory Updates! 

Some of the topics include:
  • Congress Replenishes Funds for Federal Loan Relief Programs
  • HHS Makes Second Round of Disbursements from the Public Health and Social Services Emergency Fund
  • Practice Protection Committee Continues to Address Financial Effects of COVID-19
  • Surgical Coalition Sends Letter Outlining Payment Issues Affected by COVID-19
  • ACS Supports Federal Liability Protections
  • Medical Malpractice and COVID-19: A Comparative Law Review
Click here to get the latest updates! 

Maryland Chapter, ACS Weekend A Great Success

The Maryland Chapter of the American College of Surgeons enjoyed a great weekend filled with advocacy, education and fun.

First on Friday, March 6, 2020 Chapter members attended the second annual MD-ACS Advocacy Day at the Capitol in Annapolis.  Special thanks to the Maryland Medical Society, Med-Chi for sharing their physical space and their expertise.  If you are not a member of Medi-Chi, please consider joining. They are great strategic partners.

Thanks also to Senator Clarence Lam, MD for welcoming the group to the Capitol and Delegate Terri L. Hill, MD for recognizing the group from the floor of the Maryland House of Delegates.

Following Advocacy Day, the Maryland Spring Meeting commenced on Saturday, March 7, 2020. Attendees gathered for a day of medical education and professional networking that concluded with Surgical Jeopardy, when the Anne Arundel Medical Center team again took home the win.

Pictured Above: Immediate Past President, Jonathan E. Efron, MD, FACS presented with President’s Plaque by newly installed MD-ACS President, Jose J. Diaz, Jr., MD, FACS. 

Pictured above: Winner of the MD-ACS 2020 Resident General Surgery Abstract Competition, Mitchell Huang, BA, Johns Hopkins University, along with newly installed MD-ACS President, Jose Diaz, MD, FACS

It’s Time to Pay Your Dues! 

If you have already paid your Maryland Chapter ACS dues for 2020, THANK YOU!  If you haven’t, why not click here and do it now. And ask your colleagues to join and support Maryland Chapter ACS.  We are stronger together.

Do You Have News? 

Send your news items to Kathy Browning (kathy@marylandacs.org)

#SurgTweeting

Do you participate in #SurgTweeting? Don’t forget to follow your MD-ACS Chapter on Twitter at @MarylandACS Follow and mention us in your tweets! We will retweet! We are also on Facebook and LinkedIn
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