Six considerations for resuming surgeries after COVID-19

After recommending that hospitals and ambulatory surgery centers postpone surgeries in mid-March in light of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) announced guidelines on April 19 that detail how facilities can begin to resume procedures.¹

According to the White House’s three-phase Opening Up America Again plan, surgeries should be performed as clinically appropriate in accordance with these guidelines. Whether these procedures can be performed in the outpatient and/or inpatient spaces depends on each state’s criteria phase as the spread of the virus slows.²

According to a joint statement from the American College of Surgeons, the American Society of Anesthesiologists, the Association of periOperative Registered Nurses, and the American Hospital Association, patient demand for nonessential surgeries may be immense once the first wave of the COVID-19 pandemic is behind us.³ Therefore, it’s important to consider how your facility will prepare for a potential increase in caseloads. This pandemic has evolved rapidly, so health systems and individual facilities must be ready to adapt as local and national data become available.⁴ 

Each facility will ultimately need to decide when to open based on state and national guidelines. However, here are six important needs to consider before you resume operations. While this list is not a comprehensive breakdown of each facility’s unique needs, it should provide your staff with a starting point to approach post-pandemic care.

1. Case prioritization

Establish a multidisciplinary committee of key stakeholders to monitor developments and make executive decisions around matters like resuming surgeries and prioritizing procedures. According to CMS recommendations, cases should be evaluated based on clinical need, including the complexity of the case and situations where preventative care may be essential.⁵ It’s also wise to consider which procedures are backlogged and the amount of time it will take you to address those backlogs. 

As you evaluate which cases to prioritize, account for factors like the amount of time each surgery will require within the OR, the health care professionals who will need to be present and strategies to mitigate issues associated with increased OR volume.³ Furthermore, key industry players like major medical product distributors are actively tracking regulations and new developments, so connect with your representative for updates and insights.

2. Implementing COVID-19 testing

Multiple associations recommend implementing COVID-19 testing in your facility whenever possible.³ This includes testing for both patients and staff. Availability of testing kits may limit the number of cases you can take and force a more gradual approach to ramping up surgeries, as will the accuracy and turnaround time of your testing kits.³ Ensure that you have a plan in place should a patient or staff member in your outpatient space test positive. Regardless of whether testing is available, incorporate evidence-based infection prevention techniques in your facility. 

3. Managing resources and inventory 

Though many facilities are eager to ramp up, sufficient resources should be available across your health system’s continuum of care without jeopardizing surge capacity.⁵ If your facility continues to actively treat COVID-19 cases, consider utilizing tools like the CDC’s PPE Burn Rate Calculator to estimate your facility’s usage levels once surgeries are resumed. Furthermore, be aware of the supplies, staff and resources that may serve as limiting factors. For example, your case load will depend on the capacity of your sterile processing department, so ensure you are taking a comprehensive approach to scheduling surgeries.⁶ You can also consider engaging outside support for things like sterile processing.

To address inventory issues, leverage your distributor relationship and clearly communicate your surgery plans to ensure that your facility has a solid distribution strategy. Share which surgeries you plan to resume, when you plan to resume them and the rate at which you expect them to increase. In larger facilities, connect with key suppliers, where applicable, to create a comprehensive plan. As this situation is fluid, ensure that you have an atmosphere of visibility and openness with supply chain and clinical staff and that communication is concise and frequent. 

4. Social distancing

Within your facility, continue to maintain social distancing practices. Prohibit the number of visitors, and if possible, pre-screen visitors in the same way that you would evaluate patients.⁵ Limit the capacity of public areas like waiting rooms and ensure that chairs are spaced an appropriate six feet apart.⁷ Utilize telehealth services and maintain low patient volumes whenever possible. If a patient must visit the facility for preoperative or postoperative care, encourage them to wear a surgical mask or cloth face covering brought from home.⁵

5. Proper sanitation

Disinfect public spaces and equipment as frequently as possible. If patient care for COVID-19 was being delivered in your facility, ensure that you have cleaning supplies readily available for use in those care areas.⁶ Communicate these measures as well as any additional steps your facility is taking to address COVID-19 with patients, as there may be contamination concerns from healthy patients about entering medical facilities.

6. Optimization across the three phases of care

Consider the effects that COVID-19 has on your standards of practice for each phase of care and what changes need to be made.

1. Preoperative phase: As mentioned previously, consider telehealth whenever possible. Patients should practice social distancing within the facility and wear face coverings.
2. Intraoperative phase: Evaluate which staff members are required to be present for intubation.⁶
3. Postoperative phase: If necessary, determine where post-acute care is available and if this is a safe option for the patient considering contamination risk.⁶

For more information on how Cardinal Health is addressing COVID-19, and additional resources and tools, visit cardinalhealth.com/covid19. 

¹ https://www.medpagetoday.com/infectiousdisease/covid19/86034

² https://www.whitehouse.gov/openingamerica/#criteria 

³ https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/joint-statement-on-elective-surgery-after-covid-19-pandemic

⁴ https://www.aei.org/research-products/report/national-coronavirus-response-a-road-map-to-reopening/

⁵ https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

⁶ https://www.facs.org/covid-19/clinical-guidance/resuming-elective-surgery

⁷ https://www.medpagetoday.com/infectiousdisease/covid19/86034