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Three Foundational Steps to Restart Elective Cases

As states and hospitals announce plans to reopen and reintroduce elective surgeries, addressing the backlog in an efficient manner while minimizing COVID-19 risks will require thorough planning and coordination.

Testing access and plans will likely dictate providers’ next moves, as will the ability to forecast potential surges in bed and supply capacity. As healthcare organizations establish their testing plans and predict supply chain needs, they can simultaneously stand up a workstream to develop criteria for assessing operating room (OR) priorities, evaluating hospital flow plans and equipping secondary parties such as schedulers with the tools they need.

A multidisciplinary committee to undertake this work can include viewpoints from surgeons, anesthesiologists, specialists, infection prevention, nursing, ancillary staff, administration and leadership from the OR.

For providers, these three steps will help found a comprehensive strategy that restores operations without compromising trust and efficiency.

1. Schedule safe and efficient OR time based on patient priority

Addressing the elective case back log could be a herculean task that will hinge on how efficiently the OR can operate and the number of clinical cases that providers and surgeons designate as high priority. Providers may prioritize patients’ clinical needs on a case-by-case basis or create tiered groupings that rank cases by acuity or urgency. Providers should also pull in surgeons who have privileges at the hospital to understand their prioritization criteria and needs to address expired histories and physicals, labs, diagnostics and/or pre-operative payer authorizations.

Relationships between affiliated physicians and hospitals may affect the recovery time. Alignment strategies to retain and improve these relationships will become important in the short term. Premier expects proactive specialists who have stayed in contact with patients throughout this period using telehealth, referral management or other patient engagement tools will likely see faster increases in volume.

Surgery planning may incorporate the American College of Surgeons’ triage criteria and hinge on access to personal protective equipment, COVID-19 diagnostic testing and other key supplies. Premier’s latest survey found that hospitals’ testing needs will need to expand by 211 percent to accommodate elective surgeries, while another recent Premier survey found blood supply needs may increase as much as 50 percent as providers manage both elective procedures and COVID-19 cases.

To provide flexibility and minimize COVID-19 exposure risks to patients, providers can create alternative or extended schedules with surgeons, anesthesiologists and staff that incorporate weekend surgeries or early/late surgical days. Reengage physicians or staff, including those who have been furloughed, to support a full schedule that also accommodates time away to prevent burnout. To the extent possible, providers should aim for the same staff and surgeons to work the same shifts, to minimize the risk of COVID-19 exposure.

Similarly, providers can stage patients during the surgical day based on recovery time and resource use, while minimizing room or equipment overlap. As needed, build in extra time for enhanced cleaning or sterilization when turning the OR and surgical instruments.

2. Ensure throughput and capacity across both the facility and continuum.

Integrated delivery networks may shift same-day surgeries to ambulatory surgery centers based on capacity, exposure risk and patient preference.

In the acute care setting, providers are designating spaces with COVID-19 patients as “hot zones” and creating throughput plans that separate them from COVID-19-free “cold zones.” Hospitals will need to designate units for elective surgical patients to minimize exposure to hot zones. Surgical planning should leverage visual management tools to assess bed and staff availability to accommodate potential observation placements or inpatient admissions. Ideally, this ancillary staff will already work in a cold zone, dedicated to the surgical department and avoiding contact with COVID-19-designated units.

Likewise, if providers schedule procedures on the weekend or before or after normal business hours, they should coordinate with unit leaders to ensure adequate staff and beds for unplanned observation patients or admissions.

Continue revamped visitor and vendor policies to minimize unnecessary foot traffic within the facility, including in the OR. Fifty-four respondents in Premier’s survey said they will continue to bar any family members or other visitors from the facility in order to reduce the risk of spreading infection and conserve testing capacity. For vendors, alternatives could include a virtual meeting or a strict tracking policy that limits the care sites and physicians with whom the vendor interacts.

Some elective procedures will require patients to recover in a post-acute care setting. If post-acute needs are identified prior to surgery, coordinate with physicians and have a preferred list of local home health agencies and skilled nursing facilities that have training in infection control and COVID-19 spread prevention.

3. Accommodate patient concerns and safety.

Even if local COVID-19 cases are declining, patients and their families may hesitate to proceed with surgeries.

Equip schedulers with talking points that explain the rigorous COVID-19 screening and testing policy so patients are put at ease and so that they can ask questions in advance. Messaging should also explain visitor restrictions, changes to parking or valet services, and wayfinding directions so patients can easily find the surgical site without getting lost. Staff should also be prepared to speak to pre-, peri- and post-operative COVID-19 prevention plans, including assurances on physician and staff testing.

Eighty-seven percent of respondents to Premier’s survey plan to proactively administer COVID-19 tests to any patient admitted for an elective procedure, and the majority intend to screen all employees for symptoms of COVID-19, including temperature and other symptom checks before resuming non-emergency procedures.

Providers’ screening and testing plans should include:

  • A schedule that delineates when physicians and staff will be screened or tested
  • Instructions on how to proceed in the event of a COVID-19 positive test, including a process for contact tracing
  • Technology to monitor for an uptick in symptoms correlated with COVID-19, to serve as an early warning system for a potential second wave
  • A protocol for how to test patients coming in for pre-operative evaluation. Depending on testing and supply availability, this may include testing for patients at least 72 hours in advance of surgery and retesting them up to 24 hours before the procedure if they have not self-isolated in the interim.

Unwavering Support and Partnership

Operating in the post-pandemic reality requires strong coordination between the healthcare provider, physicians, OR staff and non-OR staff. Access the Premier Safety Institute’s After the Crisis webpage for further guidance on resuming deferred procedures, testing, surge preparedness and more.

During and beyond COVID-19, Premier continues to act as a trusted connection point across the industry. Learn more.


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