OR Manager - June 2020 - 13

COVID-19
Patient care criteria
Continued from page 1
only stayed in the hospital 2 or 3 days, "
she told OR Manager. " At the beginning
of the COVID-19 pandemic, when testing
results took longer, children with
positive results would usually stay in
the hospital for 24 hours, but that time
has been decreasing, " she says.
Children's Hospital Colorado on the
Anschutz Medical Campus, a 320-bed
facility located in Aurora, continues to
run seven of its 17 ORs and nine procedure
rooms daily for emergent and
urgent cases, averaging 15 to 20 patients
per day.
" Because the hospital
is a Level
I
trauma facility, we continue to do urgent
and emergent surgical cases that are
either inpatient or come through the
emergency department, " says Woolley.
All elective surgical procedures that had
already been booked on the OR schedule
were cancelled through April 26.
Woolley says they are following the
American College of Surgeons' " COVID19
Guidelines for Triage of Pediatric
Patients " (sidebar, p 14).
" The surgeon in chief, chair of anesthesia,
and I review the scheduled
emergent and urgent surgical cases
the Friday before the following week. If
there are any questionable cases, we
contact the providers and ask why the
cases need to be done or whether they
can be rescheduled, " she says.
Testing and PAPR use
Surgeons or nurse practitioners place
orders for COVID-19 testing of their pediatric
patients up to 48 hours prior to
their surgical procedures. An old standalone
dental clinic has been converted
into a drive-through testing center.
If surgical patients are admitted to
the hospital without being tested or
come through the emergency department
(ED), they are tested at the time of
admission. In addition, at intubation anwww.ormanager.com
esthesia
providers are doing a nasal aspirate
for a comparative research study.
If test results are not back at the
time of surgery, the patient is treated
as a patient under investigation (PUI)
until the results come back.
Tammy
Woolley,
MS, MBA, RN,
CNOR, CSPM,
NEA-BC
" Our dilemma, " says
Woolley, " is even though
most testing results are
back the day before for
surgical patients, anesthesia
providers believe
the tests are only 70%
effective, and they still
want to wear PAPRs
[powered air purifying
respirators] or N95 respirators
for intubation
and extubation on all cases. "
Woolley says because they have a
limited number of PAPRs for each department,
they had to scramble to get
them for the OR and postanesthesia
care unit (PACU) as well as for the ED
and inpatient units. Perioperative services
now has 10 PAPRs, which are
used mainly by anesthesia personnel
and other providers that cannot be N95
fit tested.
Woolley adds that they have changed
their processes multiple times since the
onset, and currently anesthesia personnel
wear PAPRs or N95s and a face
shield for intubation and extubation on
all patients.
The hospital has one negative-pressure
OR with an anteroom, which is
used for COVID-19-positive patients.
All staff wear N95s for COVID-19positive
patients and PUIs and for aerosolizing
procedures (eg, bronchoscopy,
oropharynx airway cases, dental, ophthalmology).
For
COVID-19-negative patients, all
staff, including anesthesia providers
after intubation, wear standard surgical
masks with a face shield.
Woolley says they used to have staff
wait outside the room after intubation
and extubation for air changes to take
place, but because positive patients are
Reprocessing allows masks to be reused
up to four times. Photo courtesy
Tammy Woolley, MS, MBA, RN, CNOR,
CSPM, NEA-BC.
all done in a negative pressure room,
and all staff are wearing the appropriate
PPE, wait times are no longer required
except for PUIs. Wait times added
about an hour to every case, she says.
New criteria for visitors, patients
Because of the low volume of patients
in perioperative services, inpatient surgical
units, and the ambulatory clinics,
staff have been reassigned to a variety
of other jobs such as:
* employee screening
* patient/visitor screening
* donning and doffing observers
* personal protective equipment (PPE)
protectors
* reprocessing N95 masks with ultraviolet
(UV)-C energy
* cleaning face shields.
All surgery schedulers are working
from home, and surgeons are using
telemedicine almost exclusively for their
clinic and preoperative visits.
Visitors at the hospital are limited to
one per patient on the inpatient units.
Continued on page 14
OR Manager | June 2020
13
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OR Manager - June 2020

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