Executive brief: What to consider as you resume elective procedures in the COVID-19 era

In March 2020, most electively scheduled surgery and other procedures (ESS) were postponed in the U.S. as the outbreak of COVID-19 gripped our health care system. As hospitals begin to resume non-emergent procedures, they must consider many factors to assure optimum surgical outcomes, safety, supply status and capacity management while balancing the ongoing presence of the pandemic in their communities. 

The following guidance can help health care organizations develop a strong surgical governance structure. 

Although ESS should ideally be resumed when infection rates are very low, organizations may choose to resume ESS prior to preferred epidemiologic benchmarks. Organizations must work closely with infectious disease experts, epidemiologists and public health departments to monitor community infection rates, ventilator usage and other factors in order to manage surgical quality and determine the best screening protocols for surgical patients.

Point-of-care testing is the most prudent way to know the infection status of any patient entering the hospital, mitigating a significant risk factor for adverse surgical outcomes. Health care personnel should also be screened via temperature checks and periodic testing to assure safety for patients, the public and providers themselves. 

Organizations will benefit from having modeling capabilities to anticipate the health care requirements associated with increased infection rates and make informed decisions regarding reducing or suspending ESS in the event of secondary surges.

As organizations begin to address significant backlogs that resulted from the recent suspension or reduction in ESS, capacity, supply and resource constraints are likely to occur. Leaders must establish protocols for clinical patient prioritization, as well as pharmaceutical and supply utilization, so that procedures can be accomplished first for those patients with the most critical and/or time-sensitive needs. Reaching consensus on a prioritization strategy and its implementation will require broad clinical leadership.

Patient education and engagement have long been considered best practices in health care; but during a pandemic, they are even more compelling. COVID-19 is an additional, significant risk factor that should be directly addressed in the context of the original indication for surgery. 

It’s vital that consumers have trust in the hospital’s strategy and communications. A three-point shared decision-making model – introduce choice, describe option, and explore preferences and make decisions – can be a critical component of facilitating trust between patients and providers.

Health care providers who can effectively communicate information about their procedure as well as the disease can help reduce uncertainty as well as promote equity in disadvantaged populations in their community. Many hospitals are employing telemedicine to a higher degree than ever before in conducting preoperative consultation and evaluation. 

As a benefit to the institution, following these principles can also lead to a competitive market advantage.

Infection prevention — Universal infection prevention precautions are essential in maintaining surgical patient and staff safety. As with all elective procedures, routine patient preoperative screening measures for infections should be followed.

Setting expectations for safety, productivity — For the safety of patients, staff and physicians, capacity and throughput may be diminished from the pre-pandemic benchmarks. Modified testing, PPE and cleaning considerations as well as social distancing requirements will impact productivity. Leaders will need to hold all staff accountable regarding behaviors that might complicate an already stressful environment.

Scheduling — Procedural booking processes and forms, comorbidity lists, and supply and personnel considerations should be modified to contemplate COVID-19 factors and will help determine optimal location and time of surgery.

Preparedness — Each day, a multidisciplinary team should assess system capabilities to perform elective procedures that day and look ahead to potential impacts on cases to be performed in the next 72 hours. A list of factors to be considered appears in a new report: Vizient/Sg2 guidance for resumption of electively scheduled surgery and procedures in the COVID-19 era.

Patient preparation areas, preoperative holding and PACU — Physical capacity and workflow design of preoperative areas should be assessed to maximize the use of the preoperative bed area and throughput to the operating room. Appropriate and timely evaluation of recovery and discharge from the PACU will be important to maintain throughput.

Room turnover and cleaning — Heightened cleaning of rooms and equipment may result in increased time required to turn a room. 

While COVID-19 has presented unique and extraordinary challenges to health care, knowledge and practices are emerging daily to help providers incorporate creative solutions alongside established protocols. Vizient can provide expertise, experience, data-driven insights and a wide array of resources and tools to help you as we build the future of health care. 
 

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