Oren Gottfried, MD, is professor of neurosurgery and clinical vice chair of quality in the department of neurosurgery at Duke University School of Medicine in Durham, N.C. He is also past-president of the North Carolina Spine Society,
Here, Dr. Gottfried discusses how COVID-19 will affect spine and how his practice is preparing for the ramp-up period when elective surgeries resume.
Note: Responses are lightly edited for style and clarity.
Question: How has your practice been affected by the coronavirus pandemic?
Dr. Oren Gottfried: The Duke combined orthopedic and neurosurgery spine division has followed national and state recommendations about performing elective surgeries, as well as those from the American College of Surgeons and infectious disease groups. Surgeons initiated the process by postponing truly elective, non-urgent cases. Urgent, nonemergent and cases initially designated as elective — with patients experiencing progression of neurological symptoms or signs — are reviewed by a board of peer spine surgeons to agree on consensus of need to proceed now and/or be considered for the future.
We paid close attention to potential national, community and hospital capacity issues and future surges. We worked closely with hospital leadership and administration to never burden the hospital, health system or community with our more urgent spine cases. We realize that while the utmost attention should be on the care of the many sick COVID-19 patients, there is a population of spine patients suffering from progressive diseases that still need urgent surgeries during this difficult time.
On the clinic side, we have adapted to social distancing with telemedicine. We dramatically increased and continue to increase the number of visits performed by video or phone. Patient satisfaction with our availability in this safe and convenient format for patients has been great. Our Clinician & Group Consumer Assessment of Healthcare Providers and Systems scores have remained stable, despite many of these visits being transitioned to the virtual format.
Q: How is your practice preparing for the elective surgery ramp-up period?
OG: We are very cognizant of the potential impact of our spine care, including surgeries on future capacity issues and the overall focus on care of COVID-19 patients. Additionally, we are aware that many of our patients have significant comorbidities and may not feel comfortable having surgery until there has been a significant decline in new coronavirus cases or deaths. We are gradually assessing proceeding with some of the cases that were postponed by patients at the onset of COVID-19. We believe a slow, gradual increase is safest. Starting at lower volume and keeping a close observation on safety issues for our patients needing elective surgeries will be key.
Q: What cost-saving measures is your practice taking during the current crisis?
OG: I feel appropriate spine patients attending their visits from the comfort and safety of their homes with virtual clinics is a win-win for everyone. The patient has saved time and the expense of traveling to and from the clinic, and clinic overhead is reduced.
Q: How will COVID-19 change spine care?
OG: I feel the coronavirus pandemic has shown us how to successfully incorporate telehealth into our practices and it will remain an important adjunct to our care. The situation has also further emphasized the importance of value-based care. We have remained very focused on improving outcomes, reducing costs and following evidence-based guidelines. Pre-coronavirus, we embraced weekly spine surgery indications conferences. In these times, this group was very well suited to make recommendations on which cases needed to proceed and which could be safely scheduled in the future. Peer review will continue to guide our management.