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Urology Practice in the Post-COVID Era: Backlog Management, Shift to Same-Day Discharge, Efficiency Improvement, and More
Amy Krambeck MD discusses urology practice in the post-COVID era. She examines backlog management, shift to same-day discharge, efficiency improvement, health care expenditures, and more.
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Learn more about Amy Krambeck, MD
Amy Krambeck, MD
Dr. Amy Krambeck is a Professor of Urology at Northwestern Medical in Chicago, Illinois. Her Urology residency was completed at the Mayo Clinic in Rochester, Minnesota in 2008. Subsequently, from 2008 to 2009 she participated in an Endourology fellowship at the Methodist Institute for Kidney Stone Research in Indianapolis, Indiana.Learn more about Amy Krambeck, MD
Transcription:
Urology Practice in the Post-COVID Era: Backlog Management, Shift to Same-Day Discharge, Efficiency Improvement, and More
Melanie Cole: Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And today, we're examining urology practice in the post-COVID era: backlog management, shift to same-day discharge, efficiency improvement, healthcare expenditures and so much more.
Joining me is Dr. Amy Krambeck. She's the Chief of the Division of Endourology and Stone Disease and a Professor of Urology at Northwestern Medicine. Dr. Krambeck, it's a pleasure to have you join us again. Thank you so much for being with us. So tell us a little bit how the COVID-19 pandemic affected patient and physician attitudes towards same-day discharge. Tell us a little bit about that.
Dr. Krambeck: Prior to the pandemic, people were hesitant to go home the same day. They felt like they had better care staying in the hospital overnight, wanted to spend the time in the hospital to get the care that was necessary after any type of procedure. And then COVID hit and with COVID, as everyone knows, healthcare was turned upside down. So there's not enough room in the hospital for patients that have elective surgery to be cared for. The hospitals were really overran with very sick people suffering from COVID. Furthermore, hospitals themselves were losing money because they could not do elective procedures and surgical procedures that generate funds for the hospital to run on and take care of very sick patients.
Furthermore, patients themselves did not want to come into the hospital. They did not want to catch COVID. They wanted to spend as little time as possible in the hospital to avoid getting infected and coming in contact with other people.
So our desire to connect and be together and to be cared for basically broke down and we wanted to have our point of contact, get our treatment and go back home. And hospitals wanted us to get patients out of the hospital quickly as well to save that bed space for the really sick patients who needed it.
Melanie Cole: Well, certainly that's true. So tell us a little bit about how the minimalistic changes that occurred secondary to the pandemic affected the healthcare expenditures, such as you mentioned, same-day surgery and early discharge, same-day discharge, telehealth, cancellations of elective care. And obviously, people were canceling even their screenings and medical procedures because of the pandemic. So they delayed care they otherwise would have received. Speak about some of those changes that occurred secondary to the pandemic.
Dr. Krambeck: The pandemic hit and all of the problems we had prior to the pandemic did not disappear. People still had difficulty urinating. They still had catheters in, they still had kidney stones. They had all of these issues that they had before the pandemic, but we then just started focusing on COVID-19 and everything else went to the wayside.
So patients were avoiding their kidney stone pain. They were coming in extremely sick, septic with bad infections, which we really saw before the pandemic, but people were waiting to seek care. Hospitals stopped allowing elective surgeries because they couldn't risk wasting the bed space. They needed every available bed in the hospital for the COVID patients. And so healthcare in general took a nosedive. Patients stopped having their screening exams, as you listed before, stopped doing the regular maintenance follow-up and we all just were in survival mode trying to get through it.
But then it became apparent that the pandemic was not just a few months. The pandemic is probably a two-year process and we needed to come up with a way to treat people's conditions that they were still having despite the COVID infection, which then led to this idea of same-day discharge and trying to get patients treated, but minimize their time at the hospital.
Melanie Cole: Well, we saw that with heart attack and stroke too, didn't we? I mean, people were reticent about coming into the ER during the pandemic. So as all of this has shifted and changed, as you've just described, what are some examples of changes that have occurred in your practice due to the pandemic and why are these changes possible at this time?
Dr. Krambeck: Prior to the pandemic, we had gotten newer laser technology available to us that it had allowed us to do a fairly significant prostate surgery called holdup, where we go in and core out the inside of the prostate so that men are able to urinate and it works for any size prostate. So people who would have normally spent, you know, three days in the hospital after a big surgery, had a minimally invasive procedure with a quick recovery.
So prior to the pandemic, we noticed that with the newer lasers and the holdup procedure, the patients really weren't bleeding and they probably could go home the same day, but it really had not been the culture to do that and patients were kept overnight for monitoring. But when the pandemic occurred, we can send these patients home and the patients were ready for this too. Mentally, they had accepted the idea that, "It's probably in my best interest to not spend the night in the hospital." So the COVID crisis gave us an opportunity to invoke a significant change in the way we treat patients, especially with big prostates who need a deobstruction. And we started sending them home the same day and it was highly successful.
Melanie Cole: Well, I'm glad you said that it was highly successful because I was going to ask you how were the outcomes and obviously your patients liked it better. But as far as you physicians, the outcomes were good, yes?
Dr. Krambeck: Yes. We recently did a survey on this and found that, you know, at the beginning of doing this, the healthcare providers, the nurses, the techs, the residents, the physicians, we were all very hesitant and concerned. And after sending patients home, you know, even just after a month, we realized the benefits and that concern went down.
So we found that by sending patients home the same day, very few of them bounced back to the emergency room. So we weren't seeing a high rate of complications. We saw that patient satisfaction was extremely high and we saw that the hospital actually was saving money by doing that. When we looked at change from cost of care prior to sending patients home the same day to cost of care after sending patients home the same day, the hospital was saving about $800 a case. And so it basically was benefitting healthcare on all fronts.
Melanie Cole: Well, then, how is your practice managing and addressing the accumulated backlog from delayed elective surgeries as we were just speaking about?
Dr. Krambeck: As soon as we opened up, we had to find more operating time. So we started operating on the weekends. We started extending our time into the evening just to try to get as many patients treated as possible. With the newer laser technology and being able to send patients home the same day, we actually could do more cases in a day. So we have been able to successfully address the backlog by giving us more operating time and sending patients home.
We also started taking their catheters out the same day because they're not bleeding as much. And that avoided another trip to the hospital and using more healthcare resources by just getting their catheter out before they left. So by limiting the number of contact points with healthcare By also maximizing the interaction, we've definitely made improvements.
We've also started doing quite a bit of telehealth. So many times pre-COVID, patients would come in for a 5- or 10-minute visit. We would talk to them, make sure they're doing okay and send them home. Now, those visits really don't exist. We do most of that either via video visits or a telephone call. So we've become exceptionally efficient with healthcare delivery because of the COVID pandemic.
Melanie Cole: Dr. Krambeck, as we've seen this pandemic encouraging healthcare systems to be creative and innovative in their ability to deliver essential non-COVID care, can you speak about the role of innovative technology such as the Moses 2.0 in leveraging capabilities to perform procedures and improve efficiencies?
Dr. Krambeck: So the Moses 2.0 technology started its development really in 2017, but really became commercially available right when the pandemic hit. So the reason that laser was developed was at first to improve efficiency in the operating room, so that surgeons were faster with their prostate surgeries. But then it became highly apparent that it also controlled bleeding so much better than prior lasers.
So we became able to treat exceptionally large prostates that were causing blockage and difficulty urinating. And we could treat them and send them home the same day because they just didn't have the bleeding complications that we saw before. The surgeries were fast, so the patient didn't have a long anesthetic. And they felt good. They wanted to go home when they woke up. And we were able to do that because this laser is so efficient and effective.
Melanie Cole: Thank you so much, Dr. Krambeck, for being with us. Do you have any final thoughts for other providers regarding urology practice in the post-COVID era and what you're doing at Northwestern Medicine.
Dr. Krambeck: My final thoughts is that healthcare providers should realize that patients are ready for minimalizing their care. So they want it to be efficient. They want to limit the number of times they come into the hospital or see physicians and they want to limit the time in the hospital. And we can do that safely and effectively with the current technology that we have. It dose cause a little bit of anxiety when you first start sending patients home. But once you realize that it can be done safely and effectively with good communication, it really is a successful process and should be considered.
Melanie Cole: Thank you again for joining us. What an informative episode. It gave us a lot to think about. And to refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/urology to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern medicine podcast for physicians. For updates on the latest medical advancements and breakthroughs, please follow us on your social channels. I'm Melanie Cole.
Urology Practice in the Post-COVID Era: Backlog Management, Shift to Same-Day Discharge, Efficiency Improvement, and More
Melanie Cole: Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And today, we're examining urology practice in the post-COVID era: backlog management, shift to same-day discharge, efficiency improvement, healthcare expenditures and so much more.
Joining me is Dr. Amy Krambeck. She's the Chief of the Division of Endourology and Stone Disease and a Professor of Urology at Northwestern Medicine. Dr. Krambeck, it's a pleasure to have you join us again. Thank you so much for being with us. So tell us a little bit how the COVID-19 pandemic affected patient and physician attitudes towards same-day discharge. Tell us a little bit about that.
Dr. Krambeck: Prior to the pandemic, people were hesitant to go home the same day. They felt like they had better care staying in the hospital overnight, wanted to spend the time in the hospital to get the care that was necessary after any type of procedure. And then COVID hit and with COVID, as everyone knows, healthcare was turned upside down. So there's not enough room in the hospital for patients that have elective surgery to be cared for. The hospitals were really overran with very sick people suffering from COVID. Furthermore, hospitals themselves were losing money because they could not do elective procedures and surgical procedures that generate funds for the hospital to run on and take care of very sick patients.
Furthermore, patients themselves did not want to come into the hospital. They did not want to catch COVID. They wanted to spend as little time as possible in the hospital to avoid getting infected and coming in contact with other people.
So our desire to connect and be together and to be cared for basically broke down and we wanted to have our point of contact, get our treatment and go back home. And hospitals wanted us to get patients out of the hospital quickly as well to save that bed space for the really sick patients who needed it.
Melanie Cole: Well, certainly that's true. So tell us a little bit about how the minimalistic changes that occurred secondary to the pandemic affected the healthcare expenditures, such as you mentioned, same-day surgery and early discharge, same-day discharge, telehealth, cancellations of elective care. And obviously, people were canceling even their screenings and medical procedures because of the pandemic. So they delayed care they otherwise would have received. Speak about some of those changes that occurred secondary to the pandemic.
Dr. Krambeck: The pandemic hit and all of the problems we had prior to the pandemic did not disappear. People still had difficulty urinating. They still had catheters in, they still had kidney stones. They had all of these issues that they had before the pandemic, but we then just started focusing on COVID-19 and everything else went to the wayside.
So patients were avoiding their kidney stone pain. They were coming in extremely sick, septic with bad infections, which we really saw before the pandemic, but people were waiting to seek care. Hospitals stopped allowing elective surgeries because they couldn't risk wasting the bed space. They needed every available bed in the hospital for the COVID patients. And so healthcare in general took a nosedive. Patients stopped having their screening exams, as you listed before, stopped doing the regular maintenance follow-up and we all just were in survival mode trying to get through it.
But then it became apparent that the pandemic was not just a few months. The pandemic is probably a two-year process and we needed to come up with a way to treat people's conditions that they were still having despite the COVID infection, which then led to this idea of same-day discharge and trying to get patients treated, but minimize their time at the hospital.
Melanie Cole: Well, we saw that with heart attack and stroke too, didn't we? I mean, people were reticent about coming into the ER during the pandemic. So as all of this has shifted and changed, as you've just described, what are some examples of changes that have occurred in your practice due to the pandemic and why are these changes possible at this time?
Dr. Krambeck: Prior to the pandemic, we had gotten newer laser technology available to us that it had allowed us to do a fairly significant prostate surgery called holdup, where we go in and core out the inside of the prostate so that men are able to urinate and it works for any size prostate. So people who would have normally spent, you know, three days in the hospital after a big surgery, had a minimally invasive procedure with a quick recovery.
So prior to the pandemic, we noticed that with the newer lasers and the holdup procedure, the patients really weren't bleeding and they probably could go home the same day, but it really had not been the culture to do that and patients were kept overnight for monitoring. But when the pandemic occurred, we can send these patients home and the patients were ready for this too. Mentally, they had accepted the idea that, "It's probably in my best interest to not spend the night in the hospital." So the COVID crisis gave us an opportunity to invoke a significant change in the way we treat patients, especially with big prostates who need a deobstruction. And we started sending them home the same day and it was highly successful.
Melanie Cole: Well, I'm glad you said that it was highly successful because I was going to ask you how were the outcomes and obviously your patients liked it better. But as far as you physicians, the outcomes were good, yes?
Dr. Krambeck: Yes. We recently did a survey on this and found that, you know, at the beginning of doing this, the healthcare providers, the nurses, the techs, the residents, the physicians, we were all very hesitant and concerned. And after sending patients home, you know, even just after a month, we realized the benefits and that concern went down.
So we found that by sending patients home the same day, very few of them bounced back to the emergency room. So we weren't seeing a high rate of complications. We saw that patient satisfaction was extremely high and we saw that the hospital actually was saving money by doing that. When we looked at change from cost of care prior to sending patients home the same day to cost of care after sending patients home the same day, the hospital was saving about $800 a case. And so it basically was benefitting healthcare on all fronts.
Melanie Cole: Well, then, how is your practice managing and addressing the accumulated backlog from delayed elective surgeries as we were just speaking about?
Dr. Krambeck: As soon as we opened up, we had to find more operating time. So we started operating on the weekends. We started extending our time into the evening just to try to get as many patients treated as possible. With the newer laser technology and being able to send patients home the same day, we actually could do more cases in a day. So we have been able to successfully address the backlog by giving us more operating time and sending patients home.
We also started taking their catheters out the same day because they're not bleeding as much. And that avoided another trip to the hospital and using more healthcare resources by just getting their catheter out before they left. So by limiting the number of contact points with healthcare By also maximizing the interaction, we've definitely made improvements.
We've also started doing quite a bit of telehealth. So many times pre-COVID, patients would come in for a 5- or 10-minute visit. We would talk to them, make sure they're doing okay and send them home. Now, those visits really don't exist. We do most of that either via video visits or a telephone call. So we've become exceptionally efficient with healthcare delivery because of the COVID pandemic.
Melanie Cole: Dr. Krambeck, as we've seen this pandemic encouraging healthcare systems to be creative and innovative in their ability to deliver essential non-COVID care, can you speak about the role of innovative technology such as the Moses 2.0 in leveraging capabilities to perform procedures and improve efficiencies?
Dr. Krambeck: So the Moses 2.0 technology started its development really in 2017, but really became commercially available right when the pandemic hit. So the reason that laser was developed was at first to improve efficiency in the operating room, so that surgeons were faster with their prostate surgeries. But then it became highly apparent that it also controlled bleeding so much better than prior lasers.
So we became able to treat exceptionally large prostates that were causing blockage and difficulty urinating. And we could treat them and send them home the same day because they just didn't have the bleeding complications that we saw before. The surgeries were fast, so the patient didn't have a long anesthetic. And they felt good. They wanted to go home when they woke up. And we were able to do that because this laser is so efficient and effective.
Melanie Cole: Thank you so much, Dr. Krambeck, for being with us. Do you have any final thoughts for other providers regarding urology practice in the post-COVID era and what you're doing at Northwestern Medicine.
Dr. Krambeck: My final thoughts is that healthcare providers should realize that patients are ready for minimalizing their care. So they want it to be efficient. They want to limit the number of times they come into the hospital or see physicians and they want to limit the time in the hospital. And we can do that safely and effectively with the current technology that we have. It dose cause a little bit of anxiety when you first start sending patients home. But once you realize that it can be done safely and effectively with good communication, it really is a successful process and should be considered.
Melanie Cole: Thank you again for joining us. What an informative episode. It gave us a lot to think about. And to refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/urology to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern medicine podcast for physicians. For updates on the latest medical advancements and breakthroughs, please follow us on your social channels. I'm Melanie Cole.