OR Manager - June 2020 - 9

COVID-19
ASCs following new rules for safety during pandemic
C
oronavirus Disease 2019
(COVID-19) is a global pandemic
that led the United States to declare
a national emergency and implement
a ban on all elective diagnostic
and therapeutic procedures, as well as
elective surgery in inpatient and outpatient
settings.
On March 19, the Ambulatory Surgery
Center Association (ASCA) released
guidance for ambulatory surgery
centers (ASCs) with respect to what
might constitute a " necessary surgery "
during the COVID-19 pandemic.
The guidance states that " [a] surgery
may be deemed urgent and necessary
if the treating physician decides that a
months-long delay would increase the
likelihood of significantly worse morbidity
or prognosis for the patient, " and
ASCA provides examples of cases that
might need to be performed during the
COVID-19 pandemic (sidebar, p 10).
ASCA also noted that ASCs should
be prepared in case hospitals need to
shift necessary surgical procedures to
ASCs or ASC resources otherwise become
necessary to support community
efforts to address the COVID-19 pandemic.
Here's
how the new requirements
have played out at one Midwestern
facility.
What is considered urgent?
Andrey
Ibragimov,
MSN, RN,
CNOR
At UChicago Medicine
Ingalls Same Day Surgery,
in Tinley Park, Illinois,
all elective procedures
were stopped on
March 19, but urgent
and emergent cases
continue, Andrey Ibragimov,
MSN, RN, CNOR,
assistant director, Ingalls
Same Day Surgery
Center, told OR Manager.
" We have a clinical committee that
determines if a case is appropriate for
the center to do during the pandemic, "
says Ibragimov. " Surgeons who are on
staff send their requests to do cases to
this committee. "
The center, which has four ORs, has
been doing four or five cases per week,
but more were anticipated. In some
ACS guidance for triage of nonemergent
surgical procedures
On March 24, the American College of
Surgeons released COVID-19 guidance
for triage of nonemergency surgical procedures.
Decision making for elective
surgery follows an acuity scale from St
Louis University and includes hospital
outpatient departments (HOPDs) and
ambulatory surgery centers (ASCs):
➤ Tier 1a: Low acuity surgery/healthy
patient, outpatient surgery, not lifethreatening
illness. Locations: HOPD,
ASC, hospital with low/no COVID-9
census. Action: Postpone surgery or
perform in ASC.
➤ Tier 1b: Low acuity surgery/unhealthy
patient. Locations: HOPD, ASC, hospital
with low/no COVID-9 census. Action:
Postpone surgery or perform in ASC.
➤ Tier 2a: Intermediate acuity surgery/
www.ormanager.com
healthy patient, not life threatening
but potential for future morbidity and
mortality, requires in-hospital stay. Locations:
HOPD, ASC, hospital with low/
no COVID-9 census. Action: Postpone
surgery if possible or consider ASC.
➤ Tier 2b: Intermediate acuity surgery/
unhealthy patient. Locations: HOPD,
ASC, hospital with low/no COVID-9
census. Action: Postpone surgery if
possible or consider ASC.
➤ Tier 3a: High acuity surgery/healthy
patient. Location: Hospital. Action:
Do not postpone.
➤ Tier 3b: High acuity surgery/unhealthy
patient. Location: Hospital. Action: Do
not postpone.
https://www.facs.org/covid-19/clinicalguidance/triage
cases,
the surgeons scheduled procedures
but the patients were afraid they
would be exposed to the coronavirus
and refused to come to the center. The
surgeons told them they needed the
procedures and that it was not beneficial
for them to wait, but they elected to
wait anyway, he says.
Ibragimov notes that most ambulatory
surgery facilities in his area that are
not affiliated with hospitals have closed
until further notice.
Expansion plan
The center is part of an expansion plan
for ICUs if the nearby main hospital,
Ingalls Memorial Hospital, becomes
overloaded. Ingalls Memorial, which is
8 miles away, is part of University of
Chicago Medicine. " This would be easy
for us because all of our preoperative
and postoperative rooms are private
and have doors, not just curtains, " says
Ibragimov. " We had to take inventory of
all of our equipment also, and we were
told they might use our anesthesia machines
as ventilators, " he says.
Currently, Ibragimov says they are
doing ambulatory cases that would normally
have been done at the center and
some that have come over from the
main hospital in accordance with COVID19
guidance from the American College
of Surgeons, which includes triage of
nonemergency surgical procedures and
an acuity scale for hospital outpatient
departments (HOPDs) and ASCs (sidebar
at left).
He says many of the cases they
are doing are pain procedure patients
who need regular injections. " These patients'
physicians were concerned that
if they didn't receive their injections at
the center, they would seek emergency
care and risk being exposed to COVID19
or overwhelm the emergency department. "
Urgent
and emergent cases are
screened over the telephone for any
COVID-19 symptoms, and patients are
Continued on page 10
OR Manager | June 2020
9
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OR Manager - June 2020

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