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.