This is the third in our series on practice adaptations during the Covid-19 pandemic. If you missed the first two articles, click the links below to get caught up.

COVID-19 Impact Part 1: Readiness Assessment

COVID-19 Impact Part 2: Response Framework

You’ve set up your office for telehealth visits, which addresses care for some of your patients. Now it’s time to address those patients scheduled for elective surgery. You may be wondering: How do you schedule elective surgeries during Covid restrictions?

In this article, we’ll look at how to continue to provide elective surgery for patients that qualify under state restrictions. 

Before we start, another huge thank you to my fellow healthcare providers who are fighting this pandemic daily. It is an absolute privilege to be working alongside you as you demonstrate your dedication to keep our communities as safe and healthy as possible. We are incredibly indebted to all of you. Thank you for all you’re doing. 

-Lukasz Kowalczyk MD

CEO and President of ProSkedge

Summary 

Welcome to our third article in our series: COVID19  Readiness and Action Plan. It covers how to continue safely scheduling cases under COVID 19 elective surgery restrictions. Topics addressed include: state criteria for elective surgery, developing a clinical pathway and communicating it to all stakeholders. It also proposes ways to screen patients and protect your practice in the case of audit. Finally, the article goes over the steps to take on the day of scheduled surgeries that have met all state restriction criteria to ensure staff, physicians and patients to safely complete a scheduled surgery. 

Why Are There Restrictions on Elective Surgeries?

The simple answer: To preserve PPE for frontline healthcare workers who need protection against COVID19. We need to ensure PPE gets to the people who need it the most.

What is my State’s Criteria for Elective Surgery?

As of April 13th, 35 states and Washington D.C. implemented elective surgery restrictions. Each state issues these orders individually, typically by the state governor. Start with your governor’s office to find your state’s restrictions. In Colorado, where I practice, we have 5 key criteria. 

  • Surgery can’t be delayed for more than 3 months
  • The patient is facing imminent loss of life, limb or permanent organ dysfunction
  • There is a risk a malignant process will progress to a higher stage

A patient must meet one or more of these criteria to be eligible to schedule an elective surgery. 

Other requirements attached to these orders include: obtaining appropriate personal protective equipment and observing social distancing guidelines.

Knowing your state’s order and the criteria will enable you to move on to the next phase; developing your clinical pathway.

How to Develop a Clinical Pathway to Surgery

To develop your clinical pathway, gather your relevant stakeholders together. This typically includes your Chief Medical Officer, Nurse Manager, ASC admin, and possibly board members and evaluate the appropriate procedures that you can do right now and the criteria needed to complete them. 

Audit Protection

In your pathway, cite your state’s order as the basis for your clinical pathway. Reference the key criteria for your scheduling process. In the event of an audit for cases completed during this restrictive period, you can show clear documentation of the selection criteria process. Finally, to ensure compliance, seek advice from your legal counsel to make sure your pathway interprets the language correctly and ensures compliance.

Communicating the Surgery Pathway to Stakeholders

Next, communicate the scheduling criteria with staff, physicians and physicians offices. Your staff may not be aware of the restrictions. They may be wondering why you’re doing cases at all…or why you’re not doing more.

What to Communicate to Your Team

Make sure that staff understand scheduling criteria and the clinical pathway. 

Ensure all scheduled cases fall within the guidelines including the provision of appropriate PPE and social distancing measures. . 

What to Communicate to Physicians and Physicians Offices

Send a copy of your scheduling pathway to physician offices and a copy to the scheduling department. Clearly state the criteria for scheduling a case and place a contact number prominently so that you can resolve confusion quickly. 

To ensure proper justification of procedures in the physician H&P, include a template text block thay physicians can include in their note. 

What Screening Process Should We Implement?

As schedule requests come filtering in, make sure to set up a screening to quickly triage cases. H&P’s containing the template text will make filtering appropriate cases much easier unambiguous. Additionally, this documentation will help ensure you can provide justification for the procedure during an audit.  That will make it easy to pick out the cases that are appropriate. 

When to Turn Cases Away

Honestly, this may be more black and white than usual.  Conservative approach will win the day. Turning a case away rather than taking it if you are not 100% clear it falls within the state guidelines will serve you better in the long term.  Consult legal counsel as we expect facility audits particularly around this timeframe. You should have the justification to refuse cases, but come up with a clear dispute mechanism.

Get Ready for Scheduled Surgery Cases

You’re finally ready to do a scheduled case. What pre-launch items need reviewing?

  1. Communicate clearly with staff and physicians. Review the reasons for scheduling this case, emphasizing the specific restriction exceptions that pertain to it. 
  2. Make sure you possess all the necessary PPE required to keep your staff, physicians and patients safe. 
  3. Follow all social distancing guidelines as required by the state order. 

Thank You for Caring for Your Community

This checklist may serve as a stand alone or a good cross reference against already in-process plans. Each state may vary its surgery criteria so check your state’s regulations and consult your attorney to ensure proper interpretation and compliance with all regulations. 

Thank you for all that you’re doing for your own local community providing healthcare in an urgent time and keeping your friends, family, and community as safe as possible. We look forward to hearing from you. 

Please connect with us via our website and/or LinkedIn. Best of luck.