Resuming elective procedures will depend on testing, PPE, decline of COVID-19 cases, providers say

Cutting elective procedures was a costly step health systems around the country took as they sought to preserve personal protective equipment (PPE) and bed capacity in recent weeks.

While many are eager to get back to business, resuming elective procedures will depend on whether a hospital can quickly test patients and show a steady two-week decline in COVID-19 cases, several provider groups said on Friday.

They will also have to ensure they have enough protective equipment and staff, said the American Hospital Association and American College of Surgeons, as they laid out a potential roadmap Friday for resuming the procedures vital to a hospital’s bottom line. A number of hospitals and health systems have been forced to furlough workers to compensate for the lack of revenue from elective procedures and low patient volume.

Their comments come on the heels of an announcement by the White House Coronavirus Task Force laying out steps states should follow to reopening the economy. Among the recommendations is guidance about when elective procedures should begin on an outpatient and inpatient basis.

Resumption of the procedures, which have been called off due to the COVID-19 outbreak, could vary widely by region and testing capacity, they caution. “When the first wave of this pandemic is behind us, the pent-up patient demand for surgical and procedural care may be immense, and health care organizations, physicians and nurses must be prepared to meet this demand,” according to the roadmap which was also developed with the American Society of Anesthesiologists and the Association of periOperative Registered Nurses.

A major part of the roadmap is that no facility should resume elective surgeries until they have had at least 14 days of sustained reduction of COVID-19 cases in the geographic area. The facility also needs to have an appropriate number of intensive care unit and non-ICU beds, PPE, ventilators and staff to treat any non-elective patients.

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Local and state health authorities should also authorize the resumption of elective procedures.“Given the known evidence supporting healthcare worker fatigue and the impact of stress, can the facilities perform planned procedures without compromising patient safety or staff safety and well-being?” the roadmap said.

Facilities also need to establish a prioritization policy committee that has surgery, anesthesia and nursing leaders to prioritize which patients need the elective procedures.

Hospitals and health systems also need to put together a guideline for when to reassess a patient’s health status. The systems should use telemedicine as well as nurse practitioners or physician assistants to help with preoperative patient evaluation too.

Testing is going to be another major pillar of any plan to resume elective surgeries, officials said. A facility should account for the time and frequency of testing patients, and to make the testing fast.

“Tests will have to be a PCR test that can be turned around within a day,” said Ross McKinney, chief scientific officer for the Association of American Medical Colleges during a call with reporters Friday.

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Some hospital systems could return to elective procedures in a matter of weeks and others in months, said Jan Orlowski, chief health care officer for the AAMC, on the call. She gave an example of two widely different regions in Florida.

“Our institutions down in Miami are really having a significant number of cases,” she said. “I talked to an institution in Tampa and [they have] less than 20 cases in their institution.”