EXECUTIVE SUMMARY

The American Society of Anesthesiologists and other organizations updated their guidance about surgeries during the COVID-19 crisis.

  • The revised guidance does not recommend a second nationwide shutdown of elective surgeries in the event of another viral wave this fall or winter.
  • The guidance asks healthcare providers and governments to engage in more cooperation as the pandemic continues and as surges in hospitalization occur.
  • Healthcare capacity should match community prevalence of disease.

It might have been the best decision to pause elective surgeries across the nation when the COVID-19 pandemic began earlier this year. However, that may not be the best tactic if another major viral wave strikes this fall or winter, according to updated national guidance.

“There was a total shutdown earlier this year. Our learning from that was we would not do that going forward,” says Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, chief executive officer and executive director of the Association of periOperative Registered Nurses (AORN). “Hospitals and ambulatory surgery centers [ASCs] have learned they can keep doing surgeries, but they have to be very thoughtful about it.”

AORN, along with the American College of Surgeons, the American Society of Anesthesiologists, and the American Hospital Association, released the “Roadmap for Maintaining Essential Surgery During COVID-19 Pandemic,” on Aug. 10. The guide was built on lessons learned throughout 2020 and includes decision-making guidance as surgeons plan for the months ahead.

When COVID-19 was pummeling the United States in March, it was clear the federal government was unprepared, based on the lack of available ventilators and personal protective equipment. Thus, it was important to pause elective procedures to conserve precious medical equipment, treatment space, and staff. Further, ambulatory surgery centers adjusted to slower business by closing altogether or using a combination of cutting hours, staff, and/or procedures.

“The good part about that decision was it helped us with the supply chains, which were very fragile,” says Mary Dale Peterson, MD, MSHCA, FACHE, FASA, president of the American Society of Anesthesiologists.

The updated guidance stresses the importance of regional cooperation in addressing patient capacity and supply chain issues. “Working within the region is really important, as opposed to being isolated,” Groah says. “We need to know what’s going on in the region so resources can be shared, including personal protective equipment.”

The lack of cooperation contributed to hospital bottlenecks during the early days of the crisis, Peterson notes. “Two hours away from New York City, there were hospitals that were not hit hard with COVID patients. They were half empty and had furloughed half their staff,” she explains.

If regional governments and hospital systems had cooperated, then New York City hospitals might have been able to transport some of their COVID-19 patients to other facilities, reducing the burden on the city’s overwhelmed hospitals.

“In Texas, we automatically do that, maybe because we’ve been hit with so many disasters,” says Peterson, who serves as the executive vice president and chief operating officer at Driscoll Health System of Corpus Christi. “We have local, state, and regional cooperation.”

The guidance suggests facilities consider taking various actions, including:

  • “Local, state, and regional cooperation with public health authorities and state hospital associations for effective management of resources and optimal care for patients in the region”;
  • “Any provision of essential surgery should be authorized by the appropriate municipal, county, and state health authorities”;
  • “Healthcare capacity should match community prevalence of disease.”

The collaboration extends to partnering with medical supply and device vendors. “They’re great resources to help find out where somebody might have an excess amount, and we can share those resources,” Groah says.