The recent resurgence of COVID-19 has many states near or at bed and intensive care unit capacity, and healthcare facilities' ability to meet the ongoing needs of surgical patients may be stressed by new influxes of coronavirus patients admitted to healthcare facilities.
To ensure healthcare organizations, physicians and nurses remain prepared to meet these demands to care for patients who undergo recommended essential operations, the American College of Surgeons, the American Society of Anesthesiologists, the Association of periOperative Registered Nurses and the American Hospital Association have developed a road map for maintaining essential surgery during the pandemic.
The joint statement provides a list of principles and considerations to guide physicians, nurses, hospitals and health systems as they provide essential care to their patients.
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The statement builds on the Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic released by ACS, ASA, AHA and AORN on April 17.
WHAT'S THE IMPACT?
The new Roadmap for Maintaining Essential Surgery During COVID-19 Pandemic includes a number of considerations and principles for hospitals.
First, facilities should engage in regional cooperation to address capacity and new patient needs. This is to ensure facilities have an appropriate number of ICU and non-ICU beds, personal protective equipment, testing reagents and supplies, ventilators and trained staff to treat all nonelective patients without resorting to a crisis standard of care.
Daily forecasting of COVID-19 demand on all resources should be the baseline for determining the ability to add non-coronavirus cases, according to the guidance.
Hospitals, medical professional societies and government agencies should work together to ensure adequate supplies of vital equipment and medications, the guidance states. And facilities should use available testing to protect staff and patient safety, and should implement a policy addressing requirements and frequency for patient and staff testing in accordance with current CDC guidelines.
Another recommendation from the groups is that hospitals should not provide non-emergent essential surgical services unless they have adequate PPE and medical surgical supplies appropriate to the number and type of procedures to be performed.
Facilities should establish a case-prioritization policy committee consisting of surgery, anesthesia and nursing leadership to develop a case prioritization strategy appropriate to the immediate patient needs, the groups said. And hospitals should also adopt policies addressing care issues specific to COVID-19 and the postponement of surgical scheduling.
Lastly, hospitals should reevaluate and reassess policies and procedures frequently, based on coronavirus-related data, resources, testing and other clinical information.
The groups also recommend having a face-covering and social-distancing policy for staff, patients and patient visitors in nonrestricted areas in the facility that meets current local and national recommendations for community isolation practices.
THE LARGER TREND
In a recent HIMSS20 digital presentation, Reenita Das, a senior vice president and partner at Frost and Sullivan, said that during the pandemic, plastic surgery activity declined by 100%, ENT surgeries declined by 79%, cardiovascular surgeries declined by 53% and neurosurgery surgeries declined by 57%.
It's hard to overstate the financial impact this is likely to have on hospitals' bottom lines. In late July, American Hospital Association President and CEO Rick Pollack, pulling from Kaufman Hall data, said the cancellation of elective surgeries is among the factors contributing to a likely industry-wide loss of $120 billion from July to December alone. When including data from earlier in the pandemic, the losses are expected to be in the vicinity of $323 billion, and half of the nation's hospitals are expected to be in the red by the end of the year.