Towards transparent prioritisation of surgical patients in times of COVID-19

COVID-19 has put a lot of pressure on healthcare systems worldwide, leading to a backlog of patients waiting for surgery as operating rooms (OR) are reassigned to other areas of critical care. This reduced OR capacity means that physicians are forced to make difficult decisions about which patients to treat first, so-called Triage, but this decision-making process is currently neither objective nor transparent, often leading to conflicts of interest across hospital departments. As part of the Convergence collaboration between Delft University of Technology (TU Delft), the Erasmus Medical Centre in Rotterdam (Erasmus MC) and Erasmus University Rotterdam (EUR), Erasmus MC Ear, Nose and Throat (ENT) researcher, Anouk van Alphen, MD teamed up with TU Delft’s human-computer interaction specialist Dr Oana Inel to try to improve the way these decisions are made.

“With COVID-19 the healthcare system worldwide was disrupted and likewise many surgeries in Erasmus MC were postponed,” says van Alphen, “but the process of deciding which patients should have priority was far from transparent.” Part of the problem was that each department made decisions based only on information about that particular department: “In my own department, for example, you would only look for an OR spot within ENT, but then we realised that if you looked across all departments there would often be more OR capacity. So this was the bigger aim of our project – to think about interdisciplinary and transparent triage.”


Together with colleagues at the Erasmus MC, van Alphen developed a dashboard enabling physicians to see waiting lists from other departments, which included more comparative information e.g. how many patients were waiting for hip surgery compared to ENT surgery. But while most clinicians liked the dashboard, they often didn’t use it in practice: “At that point we realised we needed more than just clinical expertise.”

Van Alphen was put in touch with Oana Inel at TU Delft’s Faculty of Engineering, Mathematics and Computer Science, a specialist in human-computer interaction. “I joined the project from a human-centric perspective, keen to understand how professionals perceive, accept, and use technology,” says Inel. “So I provided input on standardised questionnaires and models to try to understand the factors influencing how and why the physicians at Erasmus MC used the dashboard.”

Computer science meets ENT

Ultimately this Convergence project had two objectives: to quantify the waiting lists and to integrate the outcome of the decision model into the dashboard, enabling physicians to get an overview of the expected health loss due to surgical delay for certain patient groups. Six months later, what have the researchers gained from their collaboration? “For me, it was definitely a reassurance that the most rewarding and necessary research is one that has impact, addressing pitfalls and gaps in current practices,” says Inel. “Of course, interdisciplinary research comes with challenges, but we need to be open and committed to listening and understanding other fields’ languages,” and van Alphen agrees – learning to speak each other’s professional language was a major challenge in the beginning.
And the dashboard? “People were very positive and liked the clear overview of the waiting-lists,” says van Alphen. “But it’s clear that each department has it’s own way of organising its lists for each surgical speciality – and that’s what this project showed us: that there are different silos and people work differently within these different silos.”

Societal impact and the future

But both researchers agree that such decision models will be vital in the future. Van Alphen: “COVID challenged our healthcare systems quite dramatically and looking forward there will be other disruptions leading to long-term scarcity of resources. So hopefully this project gives us some ideas about how to deal with those scarcities.” Inel agrees: “We ran our project in such stressful and challenging times, where resource scarcity showed time after time that critical reflection of prioritisation is crucial for taking control of the situation. We showed just how important it is to gather knowledge and perspectives from every stakeholder – to break the knowledge gap between professionals from different fields by taking full advantage of every solution offered by digitalisation.”