OR Manager - June 2020 - 6

COVID-19
Elective surgery
Continued from page 1
Stepwise surgical care
Fine-tuning the decision to delay
After CMS announced its elective surgery
ban, the American College of Surgeons
(ACS), Ambulatory Surgery Center
Association (ASCA), and AORN issued
a joint statement with decision-making
criteria for which types of procedures
could be safely delayed.
Although healthcare organizations
widely agreed that some procedures
could and should be postponed until
after the pandemic abated, ASCA said
it concurred with the ACS position that
" the risk to the patient should include
an aggregate assessment of the real
risk of proceeding and the real risk of
delay, including the expectation that a
delay of 6 to 8 weeks or more may be
required to emerge from an environment
in which COVID-19 is less prevalent. "
As part of this statement, a tiered
acuity scale was devised as a basis for
elective surgery decision making.
Roadmap with new rules
On April 17, the ACS, AORN, American
Society of Anesthesiologists (ASA), and
the American Hospital Association developed
a roadmap for resuming elective
surgery (https://www.ormanager.
com/briefs/acs-aorn-asa-aha-developroadmap-for-resuming-elective-surgery/).
Some
of the main recommended steps
include:
* Implementing a policy for testing
staff and patients for COVID-19, including
a response for when a staff
member or patient tests positive.
* Forming a committee, which includes
surgery, anesthesiology, and
nursing leadership, to develop a surgery
prioritization policy. The policy
should factor in previously cancelled
and postponed cases and allot block
time for priority cases.
* Adopting COVID-19 informed policies
for five phases of surgical care,
6
OR Manager | June 2020
The roadmap developed by the ACS,
AORN, the American Society of Anesthesiologists
(ASA), and the American Hospital
Association for resuming elective
surgery includes specific considerations
for each phase of surgical care. These
are summarized briefly below.
Preoperative phase:
➤ virtual or phone-based preoperative
screening of patients
➤ collection of data such as updated H&Ps
➤ remote education for staff, such as online
classes and instructional videos
Immediate preoperative phase:
➤ possible repeat testing due to
changes in the patient's condition
since the last time tests were done
➤ revisions to the surgical checklist to
include COVID-19 related concerns
Intraoperative phase:
➤ designating which staff are present
during intubation and extubation
from preoperative to postdischarge
care planning.
* Collecting and assessing COVID-19
data and using it to reevaluate and
reassess policies and procedures.
* Creating and implementing a social
distancing policy for staff, patients,
and visitors in nonrestricted areas.
In a separate statement, ASCA outlined
its criteria for resuming elective
procedures. First, it says, there must be
a low or declining prevalence of COVID19
in the community, and there must
be enough beds and personal protective
equipment (PPE) for infected patients.
Second, ASCs should follow these principles
to ensure patient health and prevent
the virus from spreading:
* Screen patients before visits and
monitor their health preoperatively.
* Require staff to self-monitor and
screen for viral symptoms daily.
* Continue to use PPE per the latest
➤ decisions about who should wear PPE
and what type
➤ decisions about who should be in the
OR during the procedure (eg, students)
➤ possible training for surgical services
staff, vendors, and staff from other
departments who may not have been
working during the COVID-19 crisis
➤ possible need for increased staffing
to match increased caseload
Postoperative phase:
➤ actions to ensure that standardized
protocols are being followed
➤ policies for appropriate social distancing
➤ assessment of which patients can
move quickly to Phase 2 in order to
minimize their time in the postanesthesia
care unit
Postdischarge care planning:
➤ attempt to discharge patients to
home rather than skilled nursing
facilities if possible
Centers for Disease Control and Prevention
(CDC) recommendations for
all procedures.
* Follow waiting room spacing guidelines,
social distancing, face masking,
and other recommended procedures
for patients and visitors.
* Ensure heightened disinfection to
prevent and mitigate risk of spread.
* Ensure patients have been medically
cleared by their primary care physician
where applicable.
In addition, CMS on April 19 issued
new guidelines for the reopening of
healthcare facilities in communities with
relatively low and stable incidence of
COVID-19 cases. The new guidelines
update previous guidelines for limiting
non-essential procedures and " recommend
a gradual transition and encourage
healthcare providers to coordinate
with local and state public health officials,
and to review the availability of
www.ormanager.com
https://www.ormanager http://www.ormanager.com
OR Manager - June 2020

Table of Contents for the Digital Edition of OR Manager - June 2020
