Like a lot of major health systems, CommonSpirit Health is making strides to reopen elective procedures canceled due to COVID-19.
Some facilities have already resumed some surgical procedures, and others are going to start scheduling such procedures as soon as Monday.
To get started, officials say, the health system giant recently created a toolkit that they sent to its 137 hospitals that stretch across more than 20 states outlining testing, screening and supply protocols. CommonSpirit’s toolkit builds on a framework put out in recent weeks by the American Hospital Association, the American College of Surgeons and other provider groups.
A key message: Hospitals must also make sure to keep one eye on the virus and its ongoing spread in the community on a daily basis and be ready to respond accordingly. CommonSpirit says that facilities need to coordinate with local and state authorities.
“The virus isn’t going away because we reopened,” Barbara Pelletreau, senior vice president for patient safety at CommonSpirit, told FierceHealthcare.
Here's a look at what else the health system's new toolkit advises:
1. Assess: The toolkit offers five phases of surgical care, Pelletreau said. In the first phase, a facility must look at how to reassess the health status of patients since the cancellation of their procedure, she said.
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Hospitals must adhere to the Centers for Medicare & Medicaid Services’ requirement that there is a physical examination and history of a patient within 30 days of any procedure. “This will verify if there has been no significant interim change in patient’s health status,” the toolkit said.
Hospitals can rely on telehealth for part of this evaluation.
Testing is also a critical part of the restart. Facilities should test patients before surgical procedures and tell patients to remain at home before the results come in to limit any new potential exposure.
A hospital must also create a process to determine next steps if patient testing is not available or results haven’t come back in time for the surgery.
2. Designate leadership and coordinate: As they prepare to get going again, facilities should establish a prioritization policy committee that has members from surgery, anesthesia and nursing.
The committee should examine which types of procedures should get priority to resume.
3. Ensure they have enough PPE: They also need to make sure they have enough personal protective equipment (PPE) to handle not just any new procedures but also another wave of COVID-19 cases.
For instance, one part of the toolkit recommends a facility to have a minimum of four days of PPE on hand and projection of new inventory arriving for the next two weeks.
As facilities ramp up, they must ensure they have enough primary and adjunct personnel. A hospital must also put out guidelines for who is present during intubation and extubation of the patient and how to use PPE.
Communication
However, a key element is harder to address: confidence among patients.
“In the end, you can have all the clinical facts. But it is, 'How do you feel about your safety?'” Pelletreau said. “How do you feel about going to the grocery store or a hospital that delivers amazing medical care?”
Pelletreau said that CommonSpirit is now also working on messaging to its own employees and to the community to assure patients it is safe to return to the hospital for needed medical care. That includes several communication resources to show examples of the work it is doing, from ramped-up testing to more stringent cleaning protocols, to ensure surgical procedures can be performed safely.
“Consider a proactive approach to communicating with staff, patients, physicians and the community,” the toolkit said. “Recognize the significant interest and questions from our key audiences.”