OR Manager - June 2020 - 7

COVID-19
PPE and other supplies, workforce availability,
facility readiness, and testing
capacity when making the decision to
re-start or increase in-person care, " according
to the CMS website.
Advice from OR leaders
AORN on April 23 hosted a town hall,
" Roadmap for Resuming Elective Surgery. "
Linda Groah, MSN, RN, CNOR,
NEA-BC, FAAN, chief executive officer
and executive director of AORN, and
Renae Battié, MN, RN, CNOR, VP of
nursing at AORN, highlighted the key
action steps they anticipate will be
needed as facilities begin to perform
elective surgical cases (sidebar, p 6).
On April 29, Chicago-based consulting
firm Surgical Directions hosted
" The Road to Recovery: OR Management
After the COVID-19 Crisis, " a webinar
co-presented by Anne Cole, MSN,
CNOR, NEA-BC, CASC, associate vice
president of perioperative nursing, and
Yvette Stanley, director of consulting
services. They outlined some possible
scenarios and tools to help meet the
new requirements for safe practice.
With regard to the joint statement,
Groah notes that its overarching principle
is the health and safety of patients
and healthcare workers-a goal that is
also reflected in the recommendations
from Surgical Directions.
" Any resumption of surgery at individual
institutions needs to be authorized
by the appropriate group, and in many
cases, the governors are the ones having
input into state and county decisions, "
says Groah. " We sent a copy of
this statement to every governor across
the country. "
Case prioritization and scheduling
It's important to identify essential team
members, including medical device
representatives, and the strategy for a
phased opening of the OR, Groah says.
The roadmap provides some references
for prioritization.
" The multidisciplinary team is really
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important. You must know how many
cases are in the backlog, " says Battié.
The ACS has developed a scoring
method for prioritizing medically necessary
time-sensitive procedures, or
MeNTS, Battié notes. Specialties such
as oncology, cardiovascular, or transplant
surgery, for example, might be
higher level priorities.
" Identify how much available time
you have to perform cases-not only
how many rooms but also how many
staff, " she advises. " Factor in turnaround
times based on whether there's
a non-COVID or presumed COVID approach.
What capacity goals are you
trying to reach at 30 days, 60 days, or
90 days? "
Other considerations include whether
to give case priority to high-volume surgeons
or those who have taken the
most call shifts, and what percentage
of elective cases should be performed
as outpatient. If your facility has been
closed temporarily, what extra duties
and time will be needed to open after
checking for sterility?
Testing
Although some communities have seen
very little COVID-19 disease, images of
worst-case scenarios on television have
made many people reluctant to go to
hospitals and ASCs.
" We know there will be COVID-19
patients in our hospitals, so how do we
communicate that our patients will be in
a safe environment? " asks Cole.
Day-of-surgery processes will look
very different to patients, Cole says.
They will be greeted at the curbside by
staff wearing PPE, and taken immediately
to the preoperative area-most of
them without family members.
" It's recommended that patients be
tested within 48 hours of coming to the
facility, " Cole says. If that's not possible,
they will be tested at the curbside
on the day of surgery and asked screening
questions to ensure that it is safe
for them to enter the hospital.
Some facilities plan to test every
employee when they return to work
and periodically thereafter, Groah says,
whereas other facilities do not have
enough tests. Testing policy needs to
be a facility team decision, she adds.
Preparing staff for workflow
changes
" We have to pay attention to where
the crisis standard of care may have
become normal-the goal is not to compromise
our standard of care unless we
are in crisis, " notes Battié.
CMS has suggested establishing
non-COVID care zones to separate patient
care areas. However, Battié points
out, not everyone has the ability to segregate.
Furthermore, she says, " if you
treat everyone as potentially COVID-19positive,
that will lengthen turnover time
and the time it takes to clean in between
cases. That decreases overall
efficiency and volume and increases the
pressure on PPE usage. It might be a
reason to consider performing elective
surgery only on confirmed COVID-19negative
patients, but that needs to be
a facility-based team decision. "
Cases will take longer because of
the ventilation requirements, Cole says.
Sometimes as much as 18 to 30 minutes
will be needed to allow for enough
air exchanges before OR personnel may
begin cleaning a room. Even though
staff will wear N95 masks during intubation
and extubation, it's important
to wait for the air exchanges to ensure
safety, she says. " Plan on adding 30 to
45 minutes when scheduling cases, "
she advises (sidebar, p 8).
Cole also recommends having one
nurse take care of the patient from
stage 1 of recovery all the way through
discharge. " That's the ideal state, but
it will mean bringing on more nurses to
work through recovery, " she says.
" We need to communicate to our
staff that we've been working on poliContinued
on page 8
OR Manager | June 2020
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OR Manager - June 2020

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