Resuming Elective Surgery: What Can We Expect?

What is Elective Surgery?

Surgeries are often classified into four categories based on how urgently the procedure needs to be performed.  The most urgent are emergency surgeries which need to be performed as soon as possible in order to avoid permanent disability or death.  Likewise, urgent surgeries need to happen very soon, generally within 48 hours, but not immediately upon diagnosis as for an emergency surgery.  Oftentimes with urgent surgeries, there are other, more urgent, issues that must be addressed before surgery can be safely performed.  Less urgent still are semi-elective surgeries which must be done to ensure the patient stays alive but have longer time windows when the surgery can be successfully performed; for example, the removal of a cancerous tumor can be scheduled days to weeks after it is diagnosed.  The least urgent category of surgery is considered elective because it does not involve medical emergencies and is scheduled at a time that is convenient for the surgeon, facility, and patient.

Elective surgery includes procedures like:

• Hernia surgery
• Cataract removal
• Mastectomy
• Kidney stone removal
• Facelift
• Liposuction
• Implants
• LASIK (currently the most popular elective surgery in the US)
• And more

 

Why Were Elective Surgeries Stopped?

In mid-March, the Surgeon General and Centers for Medicare & Medicaid Services (CMS) recommended that all elective and non-essential surgical procedures be delayed during the COVID-19 outbreak.  The goals of this recommendation are to:  minimize the spread of COVID-19 by allowing patients to, as many state governors are encouraging “Stay Safe, Stay Home,” maximize the number of hospital beds and medical staff available to treat Coronavirus patients, and increase the amount of personal protective equipment (PPE) available to protect health care workers from contracting the disease.  Following these recommendations, most hospitals and surgery centers across the country followed suit by indefinitely delaying these types of procedures until the twin dangers of equipment shortages and disease spread have significantly decreased.  With their caseloads close to zero, many surgery centers have been so generous as to donate their supplies of PPE to local hospitals and allow their nursing staff to join the frontlines of the fight against COVID-19.

When and How are Elective Surgeries Going to Resume?

The $64,000 question!  As of this writing the how has more clarity than the when, which is likely to vary widely from state to state.  Several national healthcare organizations including CMS, the American College of Surgeons, the American Society of Anesthesiologists, the Association of Perioperative Registered Nurses (AORN), the American Hospital Association, and the Ambulatory Surgery Center Association (ASCA) have all released similar statements outlining guidelines around the resumption of elective surgeries.  They each recommend tailoring timelines to local conditions and outline ten necessary factors that need to be considered before a facility, hospital, or surgery center decides to resume elective procedures.

1. Local Conditions. These experts recommend waiting until there has been a decrease in new COVID-19 cases for at least two weeks and continuing to monitor these numbers in case there is a new spike in diagnoses that would necessitate postponing surgeries again.
2. Monitor the availability and result times for COVID-19 tests in their area and develop a testing policy for both patients and healthcare workers.  As certain tests give false negative results up to 30% of the time, it may also be necessary to retest both patients and healthcare workers.
3. Personal Protective Equipment. Facilities should ensure that at least 30 days of PPE are available in order to protect healthcare workers and should consider implementing a policy requiring workers to wear appropriate PPE outside the OR and all patients to wear cloth masks.
4. Local Facility Capacity. Hospitals should ensure that they have the necessary resources not only in the OR but throughout the facility, including departments like peri-anesthesia, critical care, diagnostic imaging, and lab services.  In order to accommodate the spike in elective surgeries they may want to consider expanding OR availability to include nights and weekends.
5. Supplies. Ensure there are adequate levels of supplies and equipment available for the planned cases, along with a stable supply chain to maintain appropriate stock levels.  It is also important to pay extra attention to cleaning supplies, particularly for areas where patients who are diagnosed with, or suspected to have, COVID-19 are cared for.
6. Health Care Workers. Ensure that adequate staffing levels are available in all roles within the facility, particularly for any extended hours, and develop contingency plans in case a staff member tests positive.  It will also be important to assess stress and fatigue levels among staff who have been on the frontlines caring for COVID-19 patients.
7. Governance Committee. Facilities should create a multidisciplinary governance committee that can meet frequently, ideally daily initially, to enable quick facility-wide decision-making on important issues such as safety, PPE, patient backlog, pandemic assessment, etc.
8. Patient Communication. As patients will have many questions and concerns regarding the re-opening of surgical facilities, consider forming a multidisciplinary committee (perhaps the above governance committee) to oversee patient communication on topics such as procedure prioritization, COVID-19 testing policies, PPE use, visitor guidelines, etc.
9. Surgery Prioritization. The development of principles and the framework for the prioritization of procedures should be a collaborative process amongst all facility stakeholders.  It is important that the policies enacted be flexible in order to adjust as necessary to local and national COVID-19 trends and treatment strategies.  These policies will also need to take the facility’s priorities, access to resources and patient needs into account.  Transparency throughout this process will enable the local community (hospitals, health care workers, patients, and the general public) assurance as to the facility’s consistency and reliability and will likewise reduce the potential for ethical dilemmas.  There are myriad factors to consider when developing the prioritization process including previously canceled/postponed cases, OR availability (whether the facility decides to open ORs in phases or all at once), PPE availability, as well as issues that may arise due to increased OR volume, especially if the facility decides to open for extended hours.
10. Delivery of Safe, High Quality Care. Facilities are recommended to consider using telehealth if possible when conducting preoperative patient assessments.  In the immediate preoperative period review nursing, anesthesia and surgery checklists as they may need to be revised due to COVID-19.  Intraoperatively, consider guidelines regarding staff safety during procedures, like intubation or electrosurgery, that have a high risk of creating aerosol droplets.  During the postoperative phase, adhere to standardized protocols as much as possible for increased reliability.  Post-discharge, it will be important to consider not only post-acute care facility availability but also the safety of these facilities as several COVID-19 outbreaks have developed in these types of settings.

 

How Can Soma Tech Intl Help?

Soma Tech is available to help any facility with its capital equipment needs, especially those facilities that are considering resuming their elective surgery caseload.  Soma specializes in refurbished operating room equipment (surgical tables, electrosurgical units, c-arms/mini c-arms, ultrasounds, syringe pumps, etc.) and can normally save their customers roughly 50% off equivalent new equipment.  In addition to the savings they provide, Soma also stands behind their customers with a one-year warranty on most products and a dedicated staff of manufacturer-certified biomedical engineers.  And for those facilities that anticipate only a temporary spike in cases, Soma also has rental or rent-to-own options available.  Contact your dedicated salesperson today to see how Soma can help ensure your facility has everything you need to deal with the increased surgical demand!