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The Opportunity Cost of Changing Clinical Practice in Anticipation of a Surge of Covid-19 patients – A Convergent Mixed Methods Study Protocol

Veena Manja, James Wiedeman, Jeffrey S Hoch, Diana Lee Farmer


Background: The rapid rise of COVID-19 infections has strained the capacity of healthcare systems worldwide. Many organizations are changing practice to make room for a surge in patients with COVID-19 infections. Cancelling and rescheduling elective procedures is one strategy advocated and used by many. This process may result in negative consequences for the patients who need procedures and have negative teaching and economic implications.

Rationale and Study Design: This convergent mixed-methods study includes analysis of surgical databases to evaluate differences in case-volume and case-mix before and after the emergence of COVID-19 pandemic (quantitative phase), prospective observational study of patients impacted by the delayed scheduling of surgical procedures (quantitative phase) and 1:1 semi-structured interviews with patients, physicians and administrators to understand the impact of operational changes as a result on COVID-19 infection on patient care, teaching and learning and fiscal outcomes.

Methods: The quantitative phase will consist of a review of the surgical database to quantify the differences in case-volume and case-mix during 2019 and 2020. In addition a prospective cohort of patients impacted by the delay in these procedures will be followed for 6 months to assess changes in patient important outcomes due to changes in scheduling procedures. The qualitative phase will consist of 1:1 semi-structured interviews to gain a depth of understanding of the trade-offs due to a change in practice related to COVID-19. The interviews will be analyzed using qualitative description.

Discussion: The COVID-19 pandemic has caused worldwide disruption in the practice of healthcare, current focus on increasing capacity in preparation for a COVID-19 surge may have unforeseen consequences for patients who need non-COVID-19 related care. Studying the impact prospectively will provide information on the trade-offs associated with change in healthcare priorities. These results may be helpful in informing optimal healthcare practices and resource allocation in the future. 

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del Rio, C. & Malani, P.N. (2019). Novel Coronavirus - Important Information for Clinicians. Journal of the American Medical Association 323 (11) 1039-1040.

Ramelli, S. & Wagner, A. (2020). What the stock market tells us about the consequences of COVID-19. Nature Human Behaviour

Lipsitch, M., Swerdlow, D.L. & Finelli, L. (2020). Defining the epidemiology of Covid-19 - studies needed. New England Journal of Medicine 382 (13) 1194-1196.

CDC. (2020). Cumulative total number of COVID-19 cases in the United States by report date. (Updated March 26, 2020). Available from: Last accessed March 26, 2020.

CDC. (2020). How Coronavirus Spreads. Available from:

World Health Organization (2020). Rational use of personal protective equipment for coronavirus disease (COVID-19): interim guidance, 27 February 2020. Available at:

Wang, J., Zhou, M. & Liu, F. (2020). Exploring the reasons for healthcare workers infected with novel coronavirus disease 2019 (COVID-19) in China. Journal of Hospital Infection doi: 10.1016/j.jhin.2020.03.002.

CDC. (2020). Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States. Available from: Last accessed March 26 2020.

Luthi, S. (2020). Surgeon General advises hospitals to cancel elective surgeries. Available at:

ACS. (2020). COVID-19: Elective Case Triage Guidelines for Surgical Care. Available At: Last accessed March 26 2020.

Lupkin, S. (2020). Coronavirus Pandemic Brings Hundreds Of U.S. Clinical Trials To A Halt. National Public Radio Available at:

Palmer, S. & Raftery, J. (1999). Opportunity cost. British Medical Journal 318 (7197) 1551-1552.

Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health 23 (4) 334-340.

Colorafi, K.J. & Evans, B. (2016). Qualitative Descriptive Methods in Health Science Research. Health Environments Resrearch & Design Journal 9 (4) 16-25.

Hsieh, H.F. & Shannon, S.E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research 15 (9) 1277-1288.

Creswell, J.W. & Clark, V.L.P. (2017). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage Publications.



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