Expanding Surgical and Procedural Care Access for Patients

 

UMMS established the Expanding Surgical and Procedural Care Access for Patients policy to support hospital leaders and clinical providers in making decisions about the types of surgical procedures to perform based on System status, the volume of cases that can be scheduled, and infection prevention considerations. The UMMS CMO Council also plays a critically important role in monitoring and managing the impact of surgical volume decisions at the System level.

This policy includes additional infection prevention considerations for peri-operative personnel when performing any operating room procedure with potential for aerosol generation. These infection prevention recommendations can be found in the appendix at the bottom of the policy and were updated on August 1, 2022, to include the following:

• Updated recommendations for pre-op patient testing during periods of low-moderate (UMMS Level Yellow) and substantial-high community transmission (UMMS Level Orange and Level Red):
  • In Levels Orange and Red, universal pre-procedure testing should be conducted for all patients who require general anesthesia and all procedures on the upper respiratory tract, including the upper airway.
  • In Level Yellow, routine pre-procedure testing prior to ambulatory procedures is not recommended. Similarly, repeat testing of inpatients with a negative COVID-19 test at admission is not recommended prior to subsequent invasive procedures.
  • Regardless of current level of community COVID-19 transmission, all patients should undergo pre-procedure screening for exposure and symptoms of COVID-19 and be tested if indicated by that screening.
  • Pre-procedure testing to reduce SARS-CoV-2 transmission should not be based on the patient’s vaccination status.
  • Please note: UMMS is currently operating under Level Orange.
• Use of SARS-CoV-2 antigen testing is now allowed for pre-procedure testing prior to ambulatory procedures only, including same-day surgeries; SARS-CoV-2 antigen testing must be done on the day of the procedure, or within ~ 12 hours before the procedure. This can be accomplished through antigen testing provided by the surgical center or through at-home over-the-counter antigen testing done by the patient.
• Considerations for procedures on COVID-19-positive patients; COVID-19 status and perceived risk of transmission should not be the sole determinants of timing for procedures, and time-sensitive procedures on COVID-19-positive patients should not be delayed.

Click here to view the policy for Expanding Surgical and Procedural Care Access for Patients.

See appendix to this policy – Infection Prevention Considerations for Peri-Operative Personnel During COVID-19

 

FAQs

What factors drive decisions about the types of surgical cases to schedule?
This policy allows UMMS to maximize a safe volume of surgical and procedural cases while maintaining access to supplies, equipment, and adequate bed capacity. Depending on the System’s current Level (according to the UMMS Tiered Approach (i.e., Red, Orange, Yellow, Green), surgical cases that are emergent and time sensitive may be prioritized, with the flexibility to add cases to our operating room (OR) schedules that are less urgent and time sensitive. Additionally, decisions about the number of cases we can schedule must account for bed capacity status, specifically post-anesthesia care unit (PACU) capacity, staffing, and the availability of equipment or supplies critical to patient care.

Who makes decisions about the types of surgical cases to schedule and the appropriate volumes that can be managed at each hospital?
Review of medical appropriateness for all scheduled and non-emergent surgical cases in all categories are conducted locally, in accordance with the governance structure outlined in this policy, to make these decisions. Whenever possible, a seven-day-per-week schedule is considered.

Which patients are tested for COVID-19?
Pre-operative or pre-procedure patient testing recommendations are based on community COVID-19 transmission rates, and are intended to reduce risk of patient-to-HCP transmission.

• In Levels Orange and Red, universal pre-procedure testing is in place for all patients who require general anesthesia and all procedures on the upper respiratory tract, including the upper airway.
• In Level Yellow, routine pre-procedure testing prior to ambulatory procedures is not recommended. Similarly, repeat testing of inpatients with a negative COVID-19 test at admission is not recommended prior to subsequent invasive procedures.

Each hospital has identified a process to conduct COVID-19 testing for all required surgical patients. Pre-procedure testing to reduce SARS-CoV-2 transmission should not be based on the patient’s vaccination status. Regardless of current community transmission, all patients should undergo pre-procedure screening for exposure and symptoms of COVID-19 and be tested if indicated by that screening.

What happens if a patient tests positive prior to their surgical procedure?
COVID-19 status and perceived risk of transmission should not be the sole determinants of timing of procedures for patients who are confirmed to be COVID-19 positive. Most procedures can be conducted safely with appropriate use of PPE and environmental controls. There are several factors to take into consideration, including whether the procedure is time sensitive (i.e., a delay of more than 1-6 weeks would negatively affect outcome). Time-sensitive procedures on COVID-19-positive patients should not be delayed.

Due to the potential for patient medical complications from COVID-19, planned procedures that are not time sensitive should be delayed until the patient is considered COVID-19 Recovered at the discretion of the surgical and anesthesiology teams to avoid cardiorespiratory complications.

Follow the Duration of Transmission-Based Precautions for Patients Suspected or Confirmed to Have COVID-19 guidance for considering a patient COVID-19 Recovered.

Is the use of PPE for surgical staff different during COVID-19?
Yes. Staff should reference the color-coded UMMS Tiered Approach in addition to the appendix outlining infection prevention considerations attached to this policy to determine the type of PPE that should be worn by surgical staff.