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Introduction: The coronavirus disease 2019 (COVID-19) pandemic has impacted health care organizations throughout the world. The Southwest Minnesota Region of Mayo Clinic Health System, a community-based health care system, was not immune, and in March 2020, our outpatient services were deferred and decreased by 90%. Method: This article is a review of the approach we used to safely reactivate outpatient care, the tools that we developed, and the outcomes of these reactivation efforts. A novel Outpatient Practice Reactivation Framework was established and used that included Outpatient Clinic Appointment Dashboard, Decision Matrix, Access Management, Virtual Care, and Patient Safety. This framework was guided by patient demand for care and by safety principles, as recommended by state and federal agencies and our internal infectious disease department guidelines. Results and Conclusions: Over the course of 9 weeks, ambulatory visit volumes and clinic utilization rates returned to pre-COVID levels (Pre-COVID fill rate range: 87% to 94%, post-COVID fill rate range: 86% to 89%) exceeding target fill rate of 80%, as a result of establishing the initiative as a shared priority, committing to a robust schedule and decisive actions, creating and maintaining a well-defined structure, taking an inclusive approach, overcommunicating and providing sufficient data for transparency, developing guiding principles, and training and educating staff. [ABSTRACT FROM AUTHOR]

Surgical removal of the uterus is one of the most performed procedures in women, with >600,000 hysterectomies performed per year in the United States alone, most for benign indications. Over the past decade, laparoscopy has become the more popular approach for completion of the hysterectomy globally. The increased uptake of minimally invasive approaches played a role in the adoption of outpatient hysterectomy with estimated volume ranging between 200,000 and 300,000 cases per year. And with more surgeries done in a same-day-discharge setting, screening for iatrogenic surgical injuries would be of paramount importance. The risk of iatrogenic injury to the bladder or ureters during the hysterectomy was estimated to be 0.21%. The rate of injury varied significantly between the different routes, with the highest being for total laparoscopic hysterectomy (0.31%), followed by laparoscopic assisted vaginal hysterectomy (0.29%), total vaginal hysterectomy (0.24%), total abdominal hysterectomy (0.2%), and laparoscopic subtotal hysterectomy (0.14%). Even though the risk of urinary tract injury is extremely low, the consequences related to additional repair, prolonged recovery, resulting disability, and loss of employment, especially if not immediately recognized, could be substantial. The most common risk factors for urinary tract injury are pelvic malignancy, history of pelvic radiation, history of cesarean delivery, prior abdominal surgery, endometriosis, adhesions, broad ligament leiomyomas, and low-volume surgeons (<10 per year). Prompt intraoperative recognition and repair of iatrogenic injuries reduce the risk of significant morbidity (e.g., fistulae formation, deep pelvic infections, and possible deterioration of kidney function). Although cystoscopy may be used intraoperatively to detect such an injury, the question of how often it should be used remains controversial. Although the value of routine cystoscopy per case may be low, the value of routine cystoscopy for the patient and the low-volume surgeon could be high. So, although universal cystoscopy is not required, surgeons early in their career might wish to adopt universal cystoscopy until surgical fortitude is established and experience in assessing level of risk is possible. At that stage, selective cystoscopy could be utilized more appropriately in a cost-effective manner. When index of suspicion is high, or when injury is detected, timely consultation with a urologist may help alleviate the long-term complications by prompt diagnosis and repair when needed. Practice environments that foster collegiality and surgical mentorship for young surgeons optimize outcome and expedite their progress to proficiency, similar to what surgical fellowship programs offer their trainees. (J GYNECOL SURG 37:190) [ABSTRACT FROM AUTHOR]

Background: Appropriate use of available inpatient beds is an ongoing challenge for US hospitals. Historical capacity goals of 80% to 85% may no longer serve the intended purpose of maximizing the resources of space, staff, and equipment. Numerous variables affect the input, throughput, and output of a hospital. Some of these variables include patient demand, regulatory requirements, coordination of patient flow between various systems, coordination of processes such as bed management and patient transfers, and the diversity of departments (both inpatient and outpatient) in an organization. Methods: Mayo Clinic Health System in the Southwest Minnesota region of the US, a community-based hospital system primarily serving patients in rural southwestern Minnesota and part of Iowa, consists of 2 postacute care and 3 critical access hospitals. Our inpatient bed usage rates had exceeded 85%, and patient transfers from the region to other hospitals in the state (including Mayo Clinic in Rochester, Minnesota) had increased. To address these quality gaps, we used a blend of Agile project management methodology, rapid Plan-Do-Study-Act cycles, and a proactive approach to patient placement in the medical-surgical units as a quality improvement initiative. Results: During 2 trial periods of the initiative, the main hub hospital (Mayo Clinic Health System hospital in Mankato) and other hospitals in the region increased inpatient bed usage while reducing total out-of-region transfers. Conclusion: Our novel approach to proactively managing bed capacity in the hospital allowed the region's only tertiary medical center to increase capacity for more complex and acute cases by optimizing the use of historically underused partner hospital beds. [ABSTRACT FROM AUTHOR]