American College of Surgeons releases guidance for resuming elective surgery after COVID-19 peaks
The American College of Surgeons has released a new surgical resource document that offers a set of principles and issues to guide health care facilities preparing to resume elective surgery once the COVID-19 pandemic has peaked in their areas.
Titled “Local Resumption of Elective Surgery Guidance,” the ACS suggests facilities use the guidance document to ensure several pertinent issues have been considered and to check compliance with individual state executive orders and regulations before resuming with elective surgeries, according to a press release. Within the document, the release noted the ACS presents 10 distinct issues that need to be addressed at the local level before elective surgery may be safely resumed. These 10 issues are broken into four categories, that include COVID awareness, preparedness, patient issues and delivery of safe high-quality care.
According to the release, the document addresses knowing the prevalence, incidence and isolation mandates of COVID in the community, as well as knowing COVID diagnostic testing availability and policies for patients and health care workers. It also addresses policies related to personal protective equipment and health care facility capacity, including expansion plans, adequate operating room supply chain/support areas, workforce staffing issues and the role of a governance committee, the release noted. Finally, the release noted the document addresses patient communication and prioritization of a protocol/plan, as well as ensuring safe, high quality, high value care of the surgical patient across a continuum of five phases of care.
Although the guidance document provides principles to help local facilities safely resume procedures after COVID-19 peaks locally, the ACS noted in the release that little is still known about the etiology and progression of the disease.
“To address this problem, the ACS has developed the ACS COVID-19 Registry, which is now available to all hospitals willing to capture meaningful data about the COVID-19 patients they treat,” according to the release. “The ACS has a long history of developing and maintaining clinical data registries, including decades of experience with data collection and improving patient care. The overarching priority of the ACS COVID-19 Registry is to collect meaningful patient data for a disease that is largely unknown.”
Reference:
www.facs.org/media/press-releases/2020/resuming-surgery-041720
Perspective
Back to TopThe ACS resource document is helpful for institutions to think through their COVID-era workflow and process. As always, the goal of any guidance is to simply lay out the categories that need to be addressed prior to restarting elective surgery.
Free-standing surgery centers are typically the safest place to take straight forward surgical cases with minimal comorbidities. Surgeons should not “push the envelope” and try to do too much, as patient safety should still be paramount. If a surgeon has no experience operating in a surgery center or if a surgery center has never done orthopedic surgical cases, starting with small cases and building up to more involved procedures is a wise approach.
If the surgery center is physically attached to a hospital, it makes sense to limit staff and supplies from “co-mingling.” Hospital administration should have strong committee-driven process to ensure that ASC side is essentially functioning independently and walled off from the main institution.
Hospital-based elective surgical care has to be focused on creating COVID-free spaces and pathways for elective surgery. This can be a challenge for many institutions as they battle this pandemic, but it will be necessary to provide safety for staff and patients. The ACS guidelines are most helpful for these major medical centers with a focus on COVID testing and understanding each specific hospitals COVID load, ICU status, ER load, personal protective equipment status and staffing. Without a real-time assessment of these factors, a system stands at high risk of exposing a patient or staff member to COVID. Even though many states are now starting to allow elective cases, it is still important to remember that those patients who are at higher risk and can wait for surgery are still better off waiting as the risks may outweigh the benefits.
Chair, Center for Minimally Invasive Surgery
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