The Safe Return To Elective Surgeries During The COVID-19 Pandemic

It is the ultimate irony that health care professionals on the front lines of the COVID-19 pandemic are among the highest risk, not only for exposure to the deadly virus, but economically. Whether they are inundated with COVID-19 patients or still awaiting the surge, hospitals are struggling financially because they are not able or allowed to provide elective care. The number of people seeking routine and even emergency care has plummeted, and elective surgeries have been canceled or postponed indefinitely. I might argue that some of these “elective” surgeries are not so elective- they include surgeries for cancer, heart disease, and congenital conditions that are time-sensitive. This has led to unprecedented furloughs and layoffs in the very industry that our nation is relying on during this time of crisis.

That’s why it is vital that hospitals and health systems safely return to providing this service, while continuing to care for critically ill COVID-19 patients. The good news is that in some of the hardest-hit areas, the curve has flattened. Partnering with other associations, the American Society of Anesthesiologists (ASA) developed a roadmap of eight principles and considerations to help health care organizations safely resume elective surgeries by assessing readiness, prioritization, and scheduling. Highlights of the guidance:

Cases are decreasing: There should be a sustained reduction in the rate of new COVID-19 cases in the area for at least 14 days, as also recommended by the Centers for Medicare & Medicaid Services (CMS).

Patients and providers are tested. The facility should develop a policy addressing testing and screening of elective surgery patients and health care workers. If patients test positive, the surgery should be delayed until the patient is no longer infectious. A new ASA statement on perioperative testing for COVID-19 provides further explanation.

Personal protective equipment (PPE), staff, and medical supplies are adequate. The facility should ensure staff levels and supplies are adequate – including PPE, beds, ICU, and ventilators – to treat elective surgery patients without resorting to a crisis-level standard of care.

Development of a surgery prioritization policy. Facilities should form a committee – including surgery, anesthesiology and nursing leadership – to develop a policy that factors in previously canceled and postponed cases, and allot block time for priority cases, such as cancer and living donor organ transplants.

Creation of a COVID-19 surgical care plan. The ASA recommends health care facilities adopt COVID-19-related policies that address the five phases of surgical care, from preoperative to post-discharge care planning.

Clearly, the ability to resume these procedures will vary by outbreak activity in the geographic location as well as the health care system capacity. The many health care professionals who have been furloughed in the midst of COVID-19 are ready to come back to work and safely provide surgical care that has been deferred. The CARES Act provides a number of mechanisms to help bridge between the national health emergency and resumption of elective procedures. Although these funding bridges provide some relief for many in health care, including physician anesthesiologist practices that employ people in a wide variety of roles, more must be done to ensure that relief funds reach the breadth of physician practices. Ensuring the viability of these practices will safeguard our workforce who deliver the vital anesthesia and critical care services that our patients depend on. All of these steps are essential to ensure the viability of health care providers and systems and, ultimately, safeguard patients while helping them receive the care they need.

Mary Dale Peterson is president, American Society of Anesthesiologists

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