New guidance on restoring pulmonary, sleep services
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An international task force released a new guidance document to aid clinicians in safely restoring elective in-person pulmonary and sleep services as the incidence of COVID-19 declines in their communities.
“This document provides important guidance to health care institutions about when it is reasonable to begin resuming elective in-person clinical services in pulmonary and sleep medicine as well as strategies to mitigate the risk of viral transmission as those services are resumed,” Kevin C. Wilson, MD, chief of guidelines and documents at the American Thoracic Society and professor of medicine at Boston University School of Medicine, said in a press release issued by ATS. “To facilitate implementation of the guidance, we aimed to account for limitations in staff, equipment and space that are essential for the care of COVID-19 patients and provide access to care for patients with acute and chronic conditions.”
In March, the CDC recommended canceling elective medical services in response to the growing COVID-19 pandemic.
‘A dynamic process’
The new guideline, published in the Annals of the American Thoracic Society, lists nine main recommendations for clinicians to follow as the COVID-19 national infection rate decreases and medical services are restored.
A task force of volunteers from the ATS and the Association of Pulmonary, Critical Care and Sleep Division Directors developed plans for resuming elective services in pulmonary and sleep medicine clinics, pulmonary function testing laboratories, bronchoscopy and procedural suites, polysomnography laboratories and pulmonary rehabilitation facilities, based on through discussion and consensus.
“Transmission of SARS-CoV-2 is a dynamic process and, therefore, it is likely that the prevalence of COVID-19 in the community will wax and wane. This will impact an institution’s mitigation needs,” the authors wrote.
Recommendations for clinicians
The main recommendations for resuming outpatient clinical services are:
- Ensure local new case rates have a downward trajectory for at least 14 days before resuming clinical testing, assuming that the volume of testing remains relatively constant.
- Resume elective clinical services when the institution has the capacity for implementing patient prioritization, screening, diagnostic testing, physical distancing, infection control and follow-up surveillance.
- Prioritize outpatient services and tailor services to institutional resources, patient and provider preferences, and community disease prevalence.
- Identify patients with SARS-CoV-2 using multi-phased screening schedules to mitigate viral transmission.
- Use physical distancing strategies, which should vary based on COVID-19 community prevalence, and account for visitor policies.
- Institute appropriate infection control and personal protective equipment protocols, such as requiring that patients wear a mask and cleaning rooms between patient visits.
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- Instruct patients to contact the clinic if new respiratory symptoms develop within 14 days of their visit and/or if they are diagnosed with COVID-19.
- Periodically assess the success or failures of resuming pulmonary and sleep medicine services and adjust accordingly.
- Give staff either COVID-19 or non-COVID-19 assignments, with no rotation through both clinical settings.
The full list of recommendations and details are in the Annals of the American Thoracic Society document.
“The CDC and CMS both indicate the resumption of clinical services can be considered once there is a 14-day downward trajectory of new cases, assuming that institutions have an operational strategy for the mitigation of viral transmission within the healthcare facility,” the task force wrote. “A static plan cannot remain maximally effective in the context of a dynamic process like SARS-CoV-2 transmission; therefore, the operation strategy should be frequently reassessed and modified as needed to emphasize strength and correct faults.”