Getting Your OR Back on Track After Elective Case Cancellations

Added on May 20, 2020

By Laura Lutz, Senior Associate, Strategic Consulting

Laura LutzThe level of crisis management needed to combat COVID-19 has necessitated widespread cancellation or postponement of elective surgical procedures. As organizations begin to move away from crisis management and resume normal operations, they should start preparing for a shift in their paradigms now.

Planning Phase

To start, organizations must evaluate OR availability, staff availability and health status, and the types of surgical procedures that will be performed. Prioritization of elective surgeries can be guided by standardized tools developed by the American College of Surgeons (ACS). Because of the ongoing demand for inpatient units due to COVID-19, many health systems will need to restrict elective surgeries to outpatient settings. Additionally, many surgery centers will need to modify their hours of operation based on staff availability. Once these plans are in place, organizations can draft a road map for resuming elective surgical procedures. 

Next, leaders should develop a communication plan to disseminate relevant information, including changes in operational processes, to all stakeholders, including surgeons, office staff, hospital associates, and patients. This communication plan also serves to notify staff when the facility will be resuming elective surgical procedures. 

Resuming Operations

When preparing to resume surgical service operations, leadership should do the following.

  • Conduct an inventory assessment to ensure there are enough supplies to perform elective, urgent, and emergent surgeries. Keep in mind that surgical masks and personal protective equipment may still be in short supply due to the high demand created by COVID-19.
  • Conduct an inventory of surgical instruments prior to resuming surgical procedures to ensure all necessary instruments are sterile and ready for use.
  • Follow proper procedures for returning mechanical equipment such as instrument sterilizers to normal operating condition if it had been shut down.
  • Follow rigorous standards for fully cleaning all perioperative areas, including the laundering of curtains. The high contagion risk of COVID-19 will likely require that sterilization protocols extend beyond the OR.
  • Complete a terminal clean of OR suites that have not been in use during the pandemic or have not been terminally cleaned within 24 hours prior to surgery.
  • Implement new-patient screenings that include questions about COVID-19 exposure and illness, such as acute respiratory symptoms, fever, and any travel inside or outside the United States.
  • Rescreen all patients whose surgeries were cancelled or rescheduled due to the pandemic.

Opportunities to Increase Efficiency

Although challenging, going through these steps to safely reopen surgical operations provides organizations with opportunities to evaluate their pre-COVID processes to determine if they were performing at the optimal level and integrate new best practices into their daily work.

Surgical scheduling processes are a good place to start. For example, many organizations measure OR efficiency strictly in terms of room turnover time. In reality, the clock should start the moment a case is scheduled. Redefining this approach will help align efforts to track efficiency with the goal of providing patients with a seamless care experience end to end.

Block scheduling is another example. As part of the surgery restart plan, many organizations are suspending their block schedule and moving to a first-come-first-serve format in order to more efficiently manage available OR time. This is a great time to take a proactive approach to review their block scheduling policies and procedures and redesign them if necessary. Once block scheduling resumes, they will be in a better position than they were pre-COVID to manage the scheduling process efficiently and maximize available OR time.

Restoring surgical services to routine operations will take time, teamwork, and focused planning to ensure a safe environment. It will also require patience. Following this road map can help streamline the journey to surgical services and ensure the continued ability to meet patients’ needs for safe, high-quality surgical care.  

For more information or to speak with a Press Ganey expert for help in restoring surgical function, please contact Marcy Vlachos, Managing Director, Strategic Consulting, at

Visit our dedicated COVID-19 webpage for additional resources.