From March to December 2020, surgeons in the Department of Gynecology and Obstetrics performed more than 2,500 surgeries that needed to be strategically prioritized to ensure patient and staff safety, says Amanda Fader, vice chair of gynecologic surgery and director of the Center for Rare Gynecologic Cancers.

“During the first phase of the pandemic, there was much uncertainty about COVID-19, and we needed to keep patients safe and preserve staffing, PPE and ventilators. It was challenging to decide objectively in our department which patients should get surgery right away versus those who could potentially wait a few weeks without harm,” says Fader. “So we created a committee of surgeons representing all of the Gyn/Ob divisions in our department, used a hospitalwide tiering system to categorize emergent, urgent and nonurgent essential procedures, and developed a novel surgical prioritization tool to further aid us in decision-making.”

In the Journal of Minimally Invasive Gynecology, Fader; Mostafa Borahay, director of minimally invasive gynecologic surgery at Johns Hopkins Bayview Medical Center; Stephanie Wethington, director of clinical operations for the Kelly Gynecologic Oncology Service; and team recently published on the tool, called the Johns Hopkins Gynecologic Prioritization System (JH-GPS). The system, one of the only published gynecologic-specific and patient-centered prioritization tools, was created to help Gyn/Ob departments navigate surgical decision-making and patient prioritization during the COVID-19 pandemic. The tool itself is a table that assigns scores to three areas: resource utilization, acuity/complexity and patient-centered criteria, which includes mental health, daily comfort, impending insurance loss and if the patient prefers to delay surgery.

Fader sees potential use for it in future pandemics and non-pandemic situations such as natural disasters.