As the COVID-19 surge wanes in different parts of the country, patients’ pent up demand to resume their elective surgeries will be immense. To ensure patients can have elective surgeries as soon as safely possible, a roadmap to guide readiness, prioritization and scheduling has been developed by the American College of Surgeons (ACS), American Society of Anesthesiologists (ASA), Association of periOperative Registered Nurses (AORN) and American Hospital Association (AHA).
In response to the COVID-19 pandemic, the groups joined the Centers for Medicare and Medicaid Services (CMS) and praised their thoughtful tiered approach to postponing elective procedures, ranging from cancer biopsies to joint replacement, that could wait without putting patients at risk.
Readiness for resuming these procedures will vary by geographic location depending on local COVID-19 activity and response resources. A joint statement, developed by ACS, ASA, AORN and AHA, provides key principles and considerations to guide health care professionals and organizations regarding when and how to do so safely.
The statement notes facilities should not resume elective procedures until there has been a sustained reduction in the rate of new COVID-19 cases in the area for at least 14 days. The facility also should have adequate numbers of trained staff and supplies, including personal protective equipment (PPE), beds, ICU and ventilators to treat non-elective patients without resorting to a crisis-level standard of care.
The timing for resuming elective surgery is one of the eight principles and considerations to guide physicians, nurses and facilities in their resumption of elective surgery care, for operating rooms and all procedural areas, factoring in: timing, testing, adequate equipment, prioritization and scheduling, data collection and management, COVID-related safety and risk mitigation surrounding a second wave and other issues including the mental health of health care workers, patient communications, environmental cleaning and regulatory issues.
- Implement a policy for testing staff and patients for COVID-19, accounting for accuracy and availability of testing and a response when a staff member or patient tests positive.
- Form a committee – including surgery, anesthesiology and nursing leadership – to develop a surgery prioritization policy, which factors in previously canceled and postponed cases, and allot block time for priority cases, such as cancer and living donor organ transplants.
- Adopt COVID-19-informed policies for the five phases of surgical care, from preoperative to post-discharge care planning.
- Collect and assess COVID-19 related data that will be used to frequently re-evaluate and reassess policies and procedures.
- Create and implement a social distancing policy for staff, patients and visitors in non-restricted areas in anticipation of a second wave of COVID-19 activity.
ACS, ASA, AORN and AHA continue to monitor COVID-19 to evaluate and manage its impact on members, the health care community, patients and staff. Additional important information on patient care in the COVID-19 pandemic will be regularly updated on ACS, ASA, AORN and AHA websites.