Amid Ongoing COVID-19 Uncertainty, Elective Surgeries Slowly Resume
Focus on testing, securing PPE, and scheduling OR time
EXECUTIVE SUMMARY
As the United States prepares for the next phase of the COVID-19 pandemic, surgery leaders should do what they can to protect their patients, staff, and business.
• Infectious disease physicians recommend testing staff regularly for COVID-19 infection and screening patients.
• Keeping the center stocked with personal protective equipment and knowing where the facility can obtain more, quickly and when needed, is critical.
• Surgery leaders can prepare for the next outbreak as they would for a terrorist attack; while recovery is underway from the first attack, they must prepare for a second one, sometime soon.
As surgery centers slowly resume elective surgery cases, even as they brace for potential additional COVID-19 outbreaks this fall, there are several ways they can meet the challenge of the next phase of the pandemic.
Surgery center leaders and physicians should prioritize testing staff and screening patients; disinfecting operating rooms (ORs), waiting rooms, recovery rooms, and other areas more frequently; ensuring they have ample personal protective equipment (PPE) and the supply chain is fluid; helping staff maintain their mental and physical health; and reducing stress and anxiety.
“Our biggest enemy is complacency and cutting corners,” says Richard Beers, MD, chair of the American Society of Anesthesiologists Committee on Occupational Health. “We need to put in the proper precautions to protect the patients and healthcare workers.”
As surgery centers reopen, leaders will need to make decisions about triaging patients. They will need to weigh risks with public health concerns and ensure there is a procedure for allotting OR time. Leaders also will need to make ensure they have adequate staff, supplies, housekeeping, and processing, says Beers, professor of anesthesiology at the State University of New York Upstate Medical University.
The virus will not completely disappear in the near term, and there likely will be additional waves of cases, says David Urbach, MD, MSc, professor of surgery at the University of Toronto. “We had a terrible time in March, but come August, September, and when things are starting to open up, you’ll see additional cases in the community. We might be back to where we were in March 2020 again,” Urbach predicts. The idea that the pandemic is over and everything can return to normal functioning is inaccurate, he adds.
“We think we’ve entered a period of stability where we can catch our breath,” Urbach says. “But we don’t know how this will evolve over the next four to six months or year.”
The good news is surgeons and staff already know how to handle crisis management. “In surgery, we sort of are used to things that are a little closer to crisis management,” said Joseph A. Dearani, MD, president of the Society of Thoracic Surgeons. Dearani spoke at a Newswise media web conference on May 21 about surgeons and other health professionals during the pandemic’s post-crisis phase.
“When we’re in the operating room, we interface with technology. When things malfunction, it does require people to rally together, have coordinated efforts,” Dearani said.
The difference is this pandemic provides a relentless crisis to manage, and there are new stressors. “The pandemic has really tested our physical and our emotional well-being and our communication skills because it adds pressure to the situation,” Dearani said. “It’s brought the medical specialties and the surgical specialties much closer together because we have to rely, for example, on the infectious diseases people to let us know if the screening process is satisfactory and if it is OK for someone to go to the OR.”
Dearani added that he believes the overall medical profession has answered the call under difficult circumstances. “Personally, I feel proud to be part of a profession that the higher the pressure, the better the performance,” he said.
With a lull in the pandemic, surgery center leaders can present this current situation to staff as one that requires counterterrorism measures, according to Gilberto Montibeller, professor of management services at Loughborough University in the United Kingdom. Montibeller also spoke at the May 21 Newswire web conference.
After a major terrorist attack, everyone is on high alert, working to prevent another attack. This is the way healthcare workers should view the COVID-19 pandemic. The first attack, which hit in the spring, is over, but now is the time to prepare for a second attack.
“In the long term, I would like to see something that is similar to counterterrorism analysis in which we use more intelligently the resources available, building up capabilities,” said Montibeller, a senior research fellow at the University of Southern California in Los Angeles. “If you build up your protections, terrorists are aware and do not attack; if you build up your protections in the same way with health, the virus might not attack.”
With surgery centers returning to full staffing levels and caseloads, leaders must be aware of their employees’ emotional health and how the pandemic has affected them. Administrators can help staff deal with personal and professional grief and trauma by screening for depression and anxiety. Also, offer tips on resilience and coping with the emotional impact.
Surgeons can use a single-entry model that makes it faster and more efficient to reschedule the elective procedures postponed during the pandemic’s first phase, Urbach suggests.
“Instead of the usual way that referrals get to surgeons, where a primary care physician sends out a request to patients and tries to find a surgeon, you can put all the patients on a list and get the next available surgeon,” he explains.
This method works well in Canada, where healthcare providers do not compete with one another, but it can be executed anywhere, he argues. “In Canada, the waits for surgery is a significant problem, and there’s a long wait to see a surgeon,” Urbach reports. “In the United States, access is not as much about the wait as it is about insurance and whether you’re eligible.”
The COVID-19 crisis has made scheduling and longer waits for surgery an issue in the United States, too. “Now, you have hundreds of people who have joint pain and can’t walk and are waiting for joint replacement,” Urbach observes. “All surgeons are waiting for OR time, and there might be less OR time available.”
The single-entry method could help surgery centers use their OR time more efficiently as they schedule postponed procedures. For example, a surgery center might work with one surgeon who has 50 total joint procedures that were postponed between March and June. Another surgeon might have only 10 total joint procedures and a third surgeon has five procedures that were postponed. The surgery center may have decided to not schedule new patients until the backlog is at least halfway complete.
In this scenario, the surgery center has two available ORs, and the surgeon with 50 postponed procedures might take weeks to get through the backlog. “Does that mean one surgeon, all of a sudden, gets all of the OR time for the next few months, and other surgeons are out of luck?” Urbach asks. “Some would say that’s not entirely fair to surgeons who still need to maintain their skills and practice.”
The surgeons’ primary responsibility is to provide care to patients in an ethical way, Urbach says. Leaders could ask surgeons to pool their patients and distribute the procedures evenly between their center’s surgeons. This would use the OR time efficiently and fairly and help schedule people as quickly as possible.
“Put all of the patients on a list to get the next available surgeon,” Urbach suggests.
As the United States prepares for the next phase of the COVID-19 pandemic, surgery leaders should do what they can to protect their patients, staff, and business. This includes rigorous screening and testing, as well as a dedicated effort to restock essential critical personal protective equipment.
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