AHA, ACS and others release guidelines for resuming elective surgeries

WITH PROVIDERS EAGER TO RESUME elective surgical procedures as COVID-19 cases begin to decline in some regions, a group of prominent trade associations released joint guidelines April 17 that are intended to help them assess their readiness to do so.

The guidelines from the American Hospital Association, American College of Surgeons, American Society of Anesthesiologists and Association of periOperative Registered Nurses say cases should only resume when the region has seen a reduced rate of new COVID-19 cases for at least 14 days, and that such a move is first cleared by local and state governments. President Donald Trump’s guidance on reopening the economy, issued April 16, left a lot up to governors and included the return of outpatient elective surgeries in the first part of a three-phase strategy.

Elective surgeries are many hospitals’ bread and butter, so the halt has been financially devastating for some, especially with the “double whammy” of COVID-19 patients being expensive to treat. The head of Livonia, Mich.based Trinity Health’s Michigan market, for example, projected an up to 60% monthly revenue decline starting in March. Peoria, Ill.-based OSF HealthCare projects a $330 million operating decline over the next six months.

Aside from the 14day recommendation, the guidelines intentionally leave a lot up to providers.

The guidelines say providers should establish testing policies, but don’t say patients have to be tested for COVID-19 before having a procedure and don’t preclude providers from performing procedures on patients who have the virus.

Providers are running into significant challenges with not only having enough tests, but with respect to their reliability and specificity, said ASA President Dr. Mary Dale Peterson. The important thing is now making sure providers use adequate personal protective equipment and that it’s worn throughout the hospital, she said.

“We can protect staff and patients by practicing good infection control,” Peterson said. “It’s not a perfect answer.”

Surgeons, anesthesiologists, nurses and others are committed to bringing back elective surgeries, but it has to be done safely, said Dr. David Hoyt, executive director of the ACS. “Most of them will start slowly, increase their capacity and then they will probably extend hours or operate partly on the weekend to catch up,” he said.

While some providers have discussed potentially extending surgery center hours to accommodate pent-up demand, Peterson said she thinks patients will be reluctant to come in, especially if they are still under stay-at-home orders, adding, “I hope I’m wrong on that.” ●