The increased layer of uncertainty that the COVID-19 coronavirus has added to an already ambiguous diagnosis is a challenge for patients with cancer. Many have had to pause, delay, or change treatment plans to prevent risk of exposure to COVID-19 in healthcare facilities, including elective surgery.
As the United States rolls out a plan to reopen the country’s nonessential businesses and services safely, hospitals and healthcare facilities are also developing strategies to resume elective surgeries. To help facilities guide their readiness assessment, prioritization, and scheduling, on April 17, 2020, the American College of Surgeons, American Society of Anesthesiologists, Association of Perioperative Registered Nurses, and American Hospital Association released a joint statement roadmap for elective surgeries following the COVID-19 pandemic.
The statement addresses concerns about a significant influx in demand for elective surgeries once the procedures are resumed after COVID-19. It offers strategies for prioritizing the patient backlog without overtaxing the facility or increasing risk of COVID-19 transmission.
According to the statement, facilities should not resume surgeries until the community has seen a sustained reduction in the rate of new COVID-19 cases for at least 14 days. “Facilities also must have adequate numbers of trained staff and supplies, including personal protective equipment, beds, intensive care unit resources, and ventilators to treat nonelective patients without resorting to a crisis-level standard of care,” the organizations wrote in the statement.
Other recommendations included:
- Implement a policy for COVID-19 testing among staff and patients and the response for positive results.
- Form an interprofessional committee that includes nursing leadership to develop a surgery prioritization policy that includes patients with cancer.
- Adjust policies for the five phases of surgical care to account for COVID-19 considerations.
- Collect and assess COVID-19–related data to frequently re-evaluate and modify policies and procedures.
- Create and implement a social distancing policy for staff, patients, and visitors in non-restricted areas in anticipation of a second wave of COVID-19 activity.
The statement contains eight principles and considerations to guide physicians, nurses, and facilities in their resumption of elective surgery care: timing; testing; adequate equipment; prioritization and scheduling; data collection and management; COVID-related safety and risk mitigation surrounding a second wave; and other issues such as healthcare workers’ mental health, patient communications, environmental cleaning, and regulatory issues.
The organizations said that facilities’ readiness to resume elective surgeries will vary based on geographic location and the trajectory of the virus’s course in that area. They also empowered each institution to use its discretion to determine the right timing: “Given the known evidence supporting healthcare worker fatigue and the impact of stress, can the facility perform planned procedures without compromising patient safety or staff safety and well-being?”