Starting May 24, patients who've been vaccinated for COVID-19 can skip the virus test before same-day surgeries at Hartford HealthCare.
The seven-hospital Connecticut system is one of several providers that have scrapped COVID test requirements for vaccinated patients as vaccination rates rise and positivity rates drop. Atlanta's Emory Healthcare and UnityPoint Health in Iowa have done the same. Others aren't easing up on preoperative testing, holding that it's necessary to guarantee patient and employee safety.
Hartford's decision comes after Connecticut recently became the first state where more than 70% of adults have had at least one dose of a COVID-19 vaccine. Its daily test positivity rate was below 1.2% as of May 11. A multidisciplinary team of surgeons, anesthesiologists, infectious-disease physicians and others signed off on the change after carefully considering the risks, said Dr. Bret Schipper, director of oncological surgery at the Hartford HealthCare Cancer Institute and chief of surgical oncology for Hartford Hospital.
"It was a very big decision, as you can imagine," he said.
CDC's updated guidance last week that fully vaccinated people no longer need to wear masks and can refrain from testing following a known exposure prompted many state governments, municipalities and businesses to reevaluate their own rules. It pushed some hospital leaders to do the same, although the guidance didn't cover testing before surgeries.
The result is a patchwork of protocols that could be confusing for patients in the absence of a national rule.
"There's no set rules or a lot of data to support any of this, so every healthcare organization kind of comes up with their own, unfortunately," said Dr. Mark Warner, president of the Anesthesia Patient Safety Foundation.
For its part, Stanford Medicine in California isn't changing its preop test rules. Patients—vaccinated or not—must produce a negative test within 72 hours of their operations. The exception is patients who tested positive for COVID-19. They can skip the requirement if has been 30 to 90 days since their positive test, said Dr. Mary Hawn, chair of Stanford's surgery department.
Stanford is constantly evaluating its protocols, Hawn said. The decision is complicated by the fact that not all healthcare providers are vaccinated and undergoing anesthesia produces aerosols that increase transmission risk, she said.
Underscoring hospitals' decisions is the need to prevent surgeries from being delayed or, worse, canceled. Their revenue did a nosedive early in the crisis when governors forced them to suspend elective procedures, the most profitable part of their business. Volumes are now returning on many types of surgeries.
Fortunately for Stanford, the preop test requirement hasn't led to many delayed procedures, but it has required a lot of time keeping track of patients' records, Hawn said.
"It's because we have such a great team reviewing the charts to make sure patients have had their tests done," she said.
After a year of requiring the preop tests, providers might actually find it more challenging to drop the requirement, assuming patients will need to show their vaccination cards, said Warner of the APSF.
"You can imagine how many people in the stress of getting ready for surgery forget to bring it with them and they can't find it and all of a sudden they're at your doorstep and what do you do?" he said.
Hartford HealthCare might have an easier time with that because Connecticut's vaccination records automatically flow into its electronic health records platform, Epic, Schipper said. If a patient's vaccination record isn't in the system, they will have to show their vaccination card in person.
Similarly, Emory Healthcare in Atlanta, which no longer requires preop testing for vaccinated patients undergoing same-day procedures, will be able to verify vaccination status through a state registry. If it's not there, patients will have to show their vaccination cards, Emory spokesperson Janet Christenbury wrote in an email. Emory's policy only applies to patients who are at least two weeks from their second dose or single dose of the Johnson & Johnson vaccine.
The vaccination rollout has not changed Sentara Healthcare's protocol, which is to test all patients for COVID prior to their appointments. The vaccines don't work on everyone and there's no way to tell who will have breakthrough infections, said Dr. Bogdan Neughebauer, vice president of medical affairs at Sentara Leigh Hospital in Norfolk, Va., where Sentara is headquartered.
"Their symptoms might not be as obvious and you might not be a carrier for as long as someone who hasn't been vaccinated, but there is a risk," said Neughebauer, an infectious-disease physician. "We decided that we want to make sure we take all precautions to prevent such a situation."
Before relaxing the policy, Sentara's leaders want to see a local COVID positivity rate of less than 5%. That rate is currently about 8%, Neughebauer said. They would also want to see about 80% of the population vaccinated. That's currently around 50%.
Sentara hasn't caught any positive COVID cases in its preop testing since early March, which is an encouraging sign, Neughebauer said.
"Two weeks from now, we may completely change our policy based on whatever is new in the literature," he said.
Hartford's May 24 policy change applies to patients who are at least two weeks from their second vaccine doses and have no high-risk exposure, Schipper said. Once Connecticut's seven-day average positivity rate falls below 1.5%, Hartford will extend the policy to all surgeries, not just same-day ones.
Ultimately, Hartford's policy leaves it at the discretion of the surgeon performing the procedure, Schipper said. If the patient is higher risk or if there are other concerns, the doctor can order a COVID test.
Similarly, at McLaren Greater Lansing Hospital in Michigan, the decision of whether to require a COVID test is left up to the surgeon, hospital spokeswoman Sarah Barber wrote in an email. That applies to both vaccinated and unvaccinated patients. Barber couldn't say whether the policy applies across Grand Blanc, Mich.-based McLaren Health Care's 15 hospitals, and a McLaren spokesperson did not return a request for comment.
UnityPoint Health, based in West Des Moines, Iowa, dropped its preop COVID test rule for vaccinated patients starting May 17. Patients' vaccination status will be confirmed through the system's EHR or their vaccine cards, spokesperson Christine Zrostlik wrote in an email.
When a preop COVID test is required, health system leaders said they prefer to have patients get them within their own systems. That's mostly so they can have confidence in the reliability of the tests and records of the results and when they were performed.
That's especially true for a system like Minnesota's Mayo Clinic, where the APSF is based. Patients come from all over the world and it's hard to know the quality of their COVID tests, Warner said.
"It's to keep people happy," he said. "It's to keep the logistics working well and, as we learn more and the disease abates, I think we'll get back toward normal life."