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Elective Procedures and Surgery During COVID-19

Aug 26, 2020 07:00AM ● By MED Magazine

By COPIC’s Patient Safety and Risk Management Department

There are three areas of preparation a healthcare system, hospital, facility, or provider group should consider as they schedule elective surgeries or procedures, as COVID-19 is still a concern:

1) Review considerations that are outlined from key organizations to establish the background data and information needed to ensure that it is safe to proceed with elective surgeries or procedures.

  • Joint Statement: Roadmap for Resuming Elective Surgery After COVID-19 Pandemic: This is a collaborative statement issued by the American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, and the American Hospital Association. The general categories to consider, with detailed information contained in the statement, are: geographic location, sustained reduction in rate of new COVID-19 cases during the last 14 days, sufficient staff equipped to treat all elective patients, testing capacity for staff and patients, PPE, case prioritization, ability to manage non-COVID-19 patients through the 5 stages of surgical care, collection and management of data with ongoing assessments to re-evaluate policies and procedures, and consideration of  additional waves of COVID-19 cases.
    www.aha.org/system/files/media/file/2020/04/roadmap-from-aha-others-for-safely-resuming-elective-surgery-as-covid-19-curve-flattens.pdf 

  • CMS Recommendations on Re-Opening Facilities to Provide Non-Emergent Non-COVID-19 Health Care: Phase 2: This is a statement issued on June 8, 2020, by the Centers for Medicare and Medicaid to provide recommendations (a previous Phase 1 version was released in April). The statement says "Non-emergent, Non-COVID care (NCC) should be offered to patients, as clinically appropriate, in localities or facilities that have the resources to provide such care, as well as the ability to quickly respond to a surge in COVID-19 cases, if necessary. Decisions should be consistent with Federal, State, and local orders, and CDC guidance and made in collaboration with State and local public health authorities." Providers should consider if there are adequate facilities, adequate viral testing, and an adequate workforce to provide all phases of care. The use of telehealth services, when available and appropriate, continues to be recommended to minimize the need for in-person services. In addition, all individuals at higher risk for severe COVID-19 illness should continue to shelter in place unless their conditions warrant in-person health care.
    www.cms.gov/files/document/covid-recommendations-reopening-facilities-provide-non-emergent-care.pdf 

2) Create a “What You Should Know About an Elective Surgery or Procedure During the COVID-19 Pandemic” patient education document that contains important information for the patient to know. This will be provided to the patient and can be readily amended as circumstances necessitate.

  • This is an informational piece developed by the health care system, hospital, facility, or practice group that contains information the patient should or would want to know. A common document will ensure that providers are giving the same information to patients as generally applied to elective surgeries and procedures, and this allows for amendments to the document as changing circumstances may dictate. This document should emphasize that an elective surgery or procedure may not need to be performed at this time and that there is a risk that the patient could be infected with COVID-19. The document should be referenced in the Special Consent Form highlighted in the next section of this article. A helpful reference for the messaging of the communication is: “Local Resumption of Elective Surgery Guidance” published by the American College of Surgeons.
    www.facs.org/covid-19/clinical-guidance/resuming-elective-surgery 

3) Utilize a “Special Consent Form for an Elective Surgery or Procedure During the COVID-19 Pandemic,” which would be in addition to the usual permit for the surgery or procedure, and would cross-reference the “What You Should Know…” document.  

  • This special consent form would be used in addition to the standard consent form associated with the type of surgery or procedure. Using a special consent form emphasizes the important shared decision of agreeing to, and performing, an elective surgery or procedure. The form should reference the patient education communication and that the communication was, in fact, provided to the patient. Please understand that COPIC provides this sample template only as a suggestion and it should not be considered as providing legal advice under any circumstances. Each provider should consider what information needs to be contained in their own Special Consent Form and patient education communication, then consult with a private attorney to review. A copy of this consent form can be downloaded at www.callcopic.com/covid-19-information-and-resources/coronavirus-risk-management-and-clinical/coronavirus-resuming-elective-procedures 

Please note that the information provided above was current at the time of submission of this article. Due to the ever-changing guidelines and regulations related to COVID-19 and variations on how different states are approaching this issue, please be sure to review the websites of the resources mentioned above to determine if updated information has been posted.