Access Now: AORN COVID-19 Clinical Support

Archive April 2020 XXI, No. 4

Surviving the COVID-19 Crisis

Surgical professionals are rallying to overcome short-term hardships and remain determined to perform surgery again soon.

Outpatient Surgery Editors

BIO

PERSONAL PROTECTION
PERSONAL PROTECTION The coronavirus has forced facilities to pivot into self-preservation mode until they can return to caring for patients.

The coronavirus has ground outpatient surgeries to a halt. As the nationwide response to the outbreak enters its second month, every possible healthcare resource is being marshalled for the acute treatment of COVID-19 patients.

On March 18, CMS called for the cancellation or postponement of all elective surgeries during the outbreak and released recommendations outlining numerous factors individual providers should consider when deciding whether they should proceed with a procedure as planned or call it off until the coronavirus is contained (osmag.net/Jpw9ZE). The American College of Surgeons (ACS) advised surgeons to curtail elective procedures to preserve necessary PPE and resources for the care of COVID-19 patients. The U.S. surgeon general also asked healthcare systems to halt elective procedures.

ACS joined the American Society of Anesthesiologists (ASA) and the Association of periOperative Registered Nurses (AORN) in calling for surgical facilities to establish Surgical Review Committees consisting of leaders from surgery, anesthesiology and nursing. The committees would serve as administrative bodies that provide "defined, transparent and responsive oversight for triaging surgical cases during the COVID-19 pandemic." The organizations felt it necessary to fill gaps in national guidance on these urgent issues.

WORK IN PROGRESS
Andy Poole, FACHE
WORK IN PROGRESS Monticello Community Surgery Center's Clinical Manager Vicki Brozovich (standing) and Business Office Specialist Dotti Beaton review paperwork in the typically full PACU for the facility's emergency loan application.

There remains a nagging ambiguity behind the term "elective surgery." As of late last month, the Northern GI Endoscopy Center in Glens Falls, N.Y., had voluntarily shut down with the expectation of eventually reopening to perform emergent cases. Beth Hogan, MSN, RN, CASC, CNOR, CGRN, the facility's clinical director of nursing, acknowledges the gray area between cases that must be performed and those that should be postponed.

Ms. Hogan says physicians must document why they decided to proceed or postpone planned procedures, partly to protect themselves against future scrutiny from medical malpractice lawyers or insurers who might question the urgency of a procedure and withhold payment. She's heard of physicians consulting with peers to get a second opinion on whether a procedure should be performed.

"The mandate to cancel elective procedures doesn't mean there aren't still surgeries that need to happen," says Ambulatory Surgery Center Association (ASCA) CEO Bill Prentice. "There's a clear expectation, I think, both on the part of CMS and state governments that patients are still going to require surgery, but physicians need to use their clinical judgment to determine whether those surgeries can be delayed."

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