Surgical Case Prioritization Process
The surgical case prioritization process during the COVID-19 pandemic for the entire otolaryngology department is shown in Figure 1. All divisions, including head and neck oncology, facial plastics and reconstructive surgery, laryngology, otology and neurotology, pediatric otolaryngology, rhinology and skull base surgery, and sleep surgery follow a similar process. Each division has created case prioritization criteria for their specific sub-specialty.
The process begins with the surgeon identifying a patient with an urgent clinical need requiring surgical intervention. The surgeon will then refer to the priority criteria for head and neck surgery during the COVID-19 pandemic (Table 2) and classify the case accordingly. All patients are discussed at the weekly head and neck oncology division case review conference, which is remotely attended by all head and neck faculty. If there is lack of agreement within the division on whether the case is urgent, the patient will be discussed at our head and neck tumor board, where a multidisciplinary recommendation is rendered. For urgent cases that are recommended to proceed, the surgeon will provide documentation of urgency in the patient’s electronic medical record, to be shared with anesthesia or any provider taking care of the patient to access. A summary paragraph documenting urgency is also sent to the division chief and the department chair, who reviews the request and submits all cases to the preoperative anesthesia team for screening.