Video-based Collaborative Learning to Improve Ventral Hernia Repair

PROJECT SUMMARY/ABSTRACT To preserve healthcare resources and capacity for an anticipated but uncertain wave of patients with SARS- CoV2, hospitals across the United States stopped performing non-essential surgery in March 2020. The ability to generate capacity by reducing non-essential surgery comes at significant cost to patients, clinicians, and health systems, particularly small rural hospitals that rely on these services to remain solvent. There is an urgent need to maximize opportunities to perform non-essential surgeries to the extent that is safe under a broad range of systemic demands, for the duration of this pandemic and beyond. Numerous organizations, including the American College of Surgeons (ACS), the American Hospital Association (AHA), and the Centers for Medicare and Medicaid (CMS), have provided broad guidelines for tiering and prioritizing operations to guide this process of modulating non-essential surgical care. While these provide an excellent high-level framework for stopping and resuming non-essential surgery, they have two limitations in that they: 1) rely on individual hospitals to develop an approach appropriate for their individual institutional context without providing tools for doing so; and 2) do not provide guidance on the predicted need for an approach to modulate non-essential surgery as the pandemic fluctuates in upcoming months. In addition, there is an urgent need for data regarding the magnitude of backlogged surgical demand. We propose to fill these gaps by building on existing work with the Surgical Collaborative of Wisconsin (SCW) and the Americas Hernia Society Quality Collaborative (AHSQC) and our extensive experience using discharge data to evaluate the use of best practice in surgery. We will quantify and characterize the impact of COVID-19 on general surgery care in the state of Wisconsin and develop implementation resources that can be used to support individual practices as they contextualize and adapt general best practices. We will then evaluate the knowledge utilization and generalizability of the resulting multi-faceted implementation intervention through our existing partnerships with a regional (SCW) and national (AHSQC) collaborative. Given the broad approach that we propose, results will be scalable across the United States and applicable in future disaster situations.