{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T01:25:01Z","timestamp":1766712301368,"version":"3.37.3"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T00:00:00Z","timestamp":1617753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T00:00:00Z","timestamp":1617753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Syst"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Health systems are struggling to manage a fluctuating volume of critically ill patients with COVID-19 while continuing to provide basic surgical services and expand capacity to address operative cases delayed by the pandemic. As we move forward through the next phases of the pandemic, we will need a decision-making system that allows us to remain nimble as clinicians to meet our patient\u2019s needs while also working with a new framework of healthcare operations. Here, we present our quality improvement process for the adaptation and application of the Medically Necessary Time-Sensitive (MeNTS) toolto gynecologic surgical services beyond the initial COVID response and into recovery of surgical services; with analysis of the reliability of the modified-MeNTS tool in our multi-site safety net hospital network. This multicenter study evaluated the gynecology surgical case volume at three tertiary acute care safety net institutions within the LA County Department of Health Services: Harbor-UCLA (HUMC), Olive View Medical Center (OVMC), and Los Angeles County + University of Southern California (LAC+USC). We describe our modified-Delphi approach to adapt the MeNTS tool in a structured fashion and its application to gynecologic surgical services. Blinded reviewers engaged in a three-round iterative adaptation and final scoring utilizing the modified tool. The cohort consisted of 392 female consecutive gynecology patients across three Los Angeles County Hospitals awaiting scheduled procedures in the surgical queue.The majority of patients were Latina (74.7%) and premenopausal (67.1%). Over half (52.4%) of the patients had cardiovascular disease, while 13.0% had lung disease, and 13.8% had diabetes. The most common indications for surgery were abnormal uterine bleeding (33.2%), pelvic organ prolapse (19.6%) and presence of an adnexal mass (14.3%). Minimally invasive approaches via laparoscopy, robotic-assisted laparoscopy, or vaginal surgery was the predominant planned surgical route (54.8%). Modified-MeNTS scores assumed a normal distribution across all patients within our cohort (Median 33, Range 18\u201352). Overall, ICC across all three institutions demonstrated \u201cgood\u201d interrater reliability (0.72). ICC within institutions at HUMC and OVMC were categorized as \u201cgood\u201d interrater reliability, while LAC-USC interrater reliability was categorized as \u201cexcellent\u201d (HUMC 0.73, OVMC 0.65, LAC+USC 0.77). The modified-MeNTS tool performed well across a range of patients and procedures with a normal distribution of scores and high reliability between raters. We propose that the modified-MeNTS framework be considered as it employs quantitative methods for decision-making rather than subjective assessments.<\/jats:p>","DOI":"10.1007\/s10916-021-01731-w","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T17:03:29Z","timestamp":1617815009000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Prioritizing Surgical Services during on-Going Pandemic Response: Modification and Reliability of the Medically Necessary Time Sensitive Surgery (MeNTS) Scoring Tool"],"prefix":"10.1007","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4858-7715","authenticated-orcid":false,"given":"Erin","family":"Saleeby","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Acree","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia","family":"Wieslander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Truong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Eckhardt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anjali","family":"Hari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laila","family":"Al-Marayati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Greenwell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine H.","family":"Holschneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,4,7]]},"reference":[{"key":"1731_CR1","doi-asserted-by":"crossref","unstructured":"Prachand, V.N., Milner, R., Angelos Posner, M.C., Fung, J.J., Agrawal, N., Jeevanandam, V., Matthews, J.B. Medically necessary, time-sensitive procedures: Scoring system to ethically and efficiently manage resource scarcity and provider risk during the COVID-19 pandemic. J am Coll Surg 2020. Epub ahead of print. www.journalacs.org. Pre-proof accessed 23 April 2020","DOI":"10.1016\/j.jamcollsurg.2020.04.011"},{"key":"1731_CR2","unstructured":"American College of Surgeons clinical guidance for COVID-19. https:\/\/www.facs.org\/covid-19\/clinical-guidance\/triage. Accessed 30 April 2020"},{"key":"1731_CR3","unstructured":"Joint statement on re-introduction of hospital and office-based procedures in the COVID-19 climate for the practicing Urogynecologist and Gynecologis. SGS, AAGL, ASRM, AUGS, IGCS, Society of Family Planning, SGO and SRS. 28 April 2020. https:\/\/www.sgsonline.org\/joint-statement-on-re-introduction-of-hospital-and-office-based-procedures-in-the-covid-19-climate. Accessed 28 April 2020"},{"key":"1731_CR4","doi-asserted-by":"crossref","unstructured":"Ross, S.W., Lauer, C.W., Miles, W.S., Green, J.M., Christmas, A.B., May, A.K., Matthews, B.D. Maximizing the calm before the storm: A tiered surgical response plan for COVID-19. Am J Coll Surg. 2020. Epub ahead of print","DOI":"10.1016\/j.jamcollsurg.2020.03.019"},{"key":"1731_CR5","doi-asserted-by":"publisher","unstructured":"Underwood, P., Askari, R., Hurwitz, S., Chamarthi, B., Garg, R. Response to comment on underwood et al. preoperative A1C and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures. Diabetes care 2014;37:611-616. Diabetes care. 2014;37(8):e191. DOI: https:\/\/doi.org\/10.2337\/dc14-0738","DOI":"10.2337\/dc14-0738"},{"key":"1731_CR6","unstructured":"Center for Disease Control Defining Adult Overweight and Obesity. Available at: https:\/\/www.cdc.gov\/obesity\/adult\/defining.html"},{"key":"1731_CR7","doi-asserted-by":"crossref","unstructured":"Thomsen, T., Villebro, N., M\u00f8ller, A.M. Interventions for preoperative smoking cessation. Cochrane database Syst rev 2014 Mar 27;2014(3):CD002294","DOI":"10.1002\/14651858.CD002294.pub4"},{"key":"1731_CR8","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1213\/ANE.0000000000001416","volume":"123","author":"F Chung","year":"2016","unstructured":"Chung F, Memtsoudis SG, Ramachandran SK, Nagappa N, Opperer M, et al. Society of Anesthesia and Sleep Medicine Guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesth Analg 2016;123:452\u201373","journal-title":"Anesth Analg"},{"key":"1731_CR9","unstructured":"http:\/\/support.sas.com\/kb\/25\/031.html author: Robert M. Hamer, Ph.D., research professor of biostatistics, School of Public Health, University of North Carolina - Chapel Hill, 08-01-2009. Copyright (C) 1990 by Robert M. Hamer, all rights reserved"},{"issue":"4","key":"1731_CR10","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1037\/1040-3590.6.4.284","volume":"6","author":"DV Cicchetti","year":"1994","unstructured":"Cicchetti, D. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological assessment, 6(4), 284\u2013290. https:\/\/doi.org\/10.1037\/1040-3590.6.4.284","journal-title":"Psychological assessment"},{"issue":"7","key":"1731_CR11","doi-asserted-by":"publisher","first-page":"e0219854","DOI":"10.1371\/journal.pone.0219854","volume":"14","author":"D Liljequist","year":"2019","unstructured":"Liljequist D, Elfving B, Skavberg Roaldsen K (2019) Intraclass correlation \u2013 A discussion and demonstration of basic features. PLoS ONE 14(7): e0219854. https:\/\/doi.org\/10.1371\/journal.pone.0219854","journal-title":"PLoS ONE"}],"container-title":["Journal of Medical Systems"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10916-021-01731-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10916-021-01731-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10916-021-01731-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,17]],"date-time":"2021-04-17T06:13:08Z","timestamp":1618639988000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10916-021-01731-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,7]]},"references-count":11,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["1731"],"URL":"https:\/\/doi.org\/10.1007\/s10916-021-01731-w","relation":{},"ISSN":["0148-5598","1573-689X"],"issn-type":[{"type":"print","value":"0148-5598"},{"type":"electronic","value":"1573-689X"}],"subject":[],"published":{"date-parts":[[2021,4,7]]},"assertion":[{"value":"31 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was waived by the IRB for this exempt study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"All authors declare no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"59"}}