Was your elective procedure postponed due to the Covid-19 Pandemic? If it was, you are not the only one who had to deal with putting off a planned procedure due to the pandemic. In March, during a spike in the pandemic numbers in the U.S, experts at the Centers for Disease Control (CDC) and medical associations, such as the American College of Surgeons recommended that healthcare systems and surgeons minimize, postpone or cancel elective surgery because of the burden being placed on the healthcare system. Because of this decision to safeguard patients and not expose them to Covid-19, thousands of surgeries (procedures) were not performed. In a report done by Johns Hopkins University, an orthopedic spine surgeon, Dr. Amit Jain estimated that patient demand was decreased by 50%, which could translate to a backlog of over 400,000 cases.
The decision to postpone these elective cases was mainly to make the best use of medical supplies, such as masks, gowns, and ventilators, and also to help stop the spread of Covid-19 to uninfected patients coming in for these procedures.
Re-Opening for Elective Surgery
Fast-forward to today, we see that there are areas of the U.S. where elective surgery has been re-opened safely based on the number of Covid-19 cases in their community. In the state of New Jersey, for example, the governor set an executive order in May to have elective surgical procedures resume on May 26th barring all the re-open criteria were met in the state, which included the number of new cases identified in the state, deaths, hospital admissions and ICU admissions.
Despite getting the “green light” from the state government and reassurance from hospitals and their surgeons that it is safe to have their procedure, many patients are hesitant to schedule their surgery. Many have voiced concerns over getting Covid-19 in the hospital. Patients are not sure if the hospitals are clean or if the screening protocols are sufficient to avoid Covid-19 exposure. According to guidelines in the Re-Open protocols, hospitals and ambulatory surgery centers need to provide very clear protocols on how they will:
Conduct preoperative Covid-19 testing for patients
Do the daily screening of staff for signs and symptoms of Covid-19
Make sure they have an adequate supply of personal protective equipment (PPE)
Follow the meticulous cleaning and disinfection protocols for patient care, equipment and the environment
Follow social distancing protocols
Questions to ask in preparing for surgery
As a nurse advocate, one of the things I do quite often is to help patients prepare for elective surgery. Recently, I assisted two clients in scheduling and navigating their elective surgery safely during the Covid-19 pandemic. When Covid-19 was not an issue in preparing for surgery, patients usually discussed pre-operative activities that would allow for the best outcomes, such as taking a pre-surgical antiseptic shower to lower bacteria at the surgical site, eating a balanced diet to enhance wound healing and smoking cessation to prevent issues with anesthesia and possible pneumonia. Since the Covid-19 pandemic, preoperative questions for the surgeon have included topics related to testing and self-quarantine. Here is a list of questions and answers that should be considered when you are planning to have elective surgery based on the recommended Re-Open protocols for elective surgery:
When and where should I be tested for Covid-19? Most of the time the surgeon’s office will provide you with directions on where to get tested. Your test results will be sent directly to your physician. In most cases, patients should be tested 72-96 hrs. before their scheduled surgery. This result should be known prior to surgery to safeguard the healthcare workers and other patients.
Should I be self-isolating once I have my pre-surgical Covid-19 test? Yes, once you have your pre-surgical Covid-19 test, you should be self-isolating at home and avoid going out if possible.
Should I report if I have been in contact or exposed to anyone with Covid-19? Yes, if you were exposed to someone with known Covid-19 or suspected Covid-19, with signs and symptoms, such as coughing, sneezing, fever, or shortness of breath, report this to your surgeon’s staff. This may delay or post-pone your surgical procedure.
Can my family come into the hospital with me? This depends on hospital policy. Some hospitals may allow one family member or no family members, depending on their Covid-19 policy and the current CDC Guidelines. If a family member is permitted, their temperature will be taken prior to coming into the facility. Your temperature will also be taken and you both will be checked for signs and symptoms of Covid-19.
What can I bring with me to the hospital? Hospitals are advising that you limit personal items and clothing, especially for “same day” surgical procedures. In most cases, you are advised to wear comfortable loose clothing and will change into a hospital gown at the facility. You should also bring identification, your insurance card, your cell phone, and a charger.
Is the staff at the hospital being screened for Covid-19 on a regular basis? Yes, the hospital or ambulatory surgery center is required to screen staff daily by taking their temperature and screening them for signs and symptoms of Covid-19. They are also asked about any known contact with a person who has Covid-19.
Are hospitals cleaning and disinfecting patient equipment and rooms regularly? Yes, hospitals or surgery centers must follow the cleaning protocols set by the CDC and use approved disinfectants.
Has the staff been educated on the protocols to prevent the spread of Covid-19? Yes, the hospital or surgery center must educate its staff on the CDC infection prevention protocols that prevent the spread of Covid-19, such as meticulous handwashing for 20 seconds, using personal protective equipment for contact with patients, universal masking, social distancing, and cleaning and disinfecting patient care equipment between use.
Healthcare providers and accreditation agencies have worked hard to follow the current CDC and CMS protocols for re-opening elective surgery. Planned surgery has resumed safely in many states. As a patient and a healthcare consumer, be familiar with your states Re-Open protocols for Elective Surgery at the following website: https://www.acr.org/-/media/ACR/Files/COVID19/States-With-Elective-Medical-Procedures-Guidance-in-Effect.pdf?la=en
References:
https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf