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Prioritising surgical cases deferred by the COVID-19 pandemic: an ethics-inspired algorithmic framework for health leaders
  1. Amit Jain1,
  2. Tinglong Dai2,
  3. Christopher G Myers2,
  4. Punya Jain3,
  5. Shruti Aggarwal4
  1. 1 Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Johns Hopkins University Carey Business School, Baltimore, Maryland, USA
  3. 3 Jain Ventures, Baltimore, Maryland, USA
  4. 4 Cornea and Refractive Surgery, Katzen Eye Institute, Baltimore, Maryland, USA
  1. Correspondence to Dr Amit Jain, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; AmitJain{at}


Elective surgical suspension during the COVID-19 pandemic resulted in a sizeable surgical case backlog throughout the world. As we ramp back up, how do we decide which cases take priority? Potential future waves (or a future pandemic) may lead to additional surgical shutdown and subsequent reopening. Deciding which cases to prioritise in the face of limited health system capacity has emerged as a new challenge for healthcare leaders. Here we present an ethically grounded and operationally efficient surgical prioritisation framework for healthcare leaders and practitioners, drawing insights from decision analysis and organisational sciences.

  • clinical leadership
  • data
  • improvement
  • management system
  • operating system

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  • Twitter @AmitJainSpine, @ChrisGMyers

  • Contributors All authors contributed to the development of the ideas in this article. AJ wrote the initial draft, and all authors reviewed and made material contributions to subsequent drafts.

  • Funding This work was supported by the Hopkins Business of Health Initiative (Johns Hopkins University).

  • Competing interests None declared.

  • Patient and public involvement statement This article does not contain any personal or medical information about an identifiable individual; all patient cases mentioned are fictional.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.