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Archive COVID-19 2021

How to Master Your Pandemic Response

A proven, three-step strategy for increasing your business and protecting your patients and staff from COVID-19.

Robert Bray

Robert Bray


DISC Sports & Spine Center
SAFE SPACE To ensure distancing, DISC Sports & Spine Center requires employees to spend no more than five minutes next to one another whenever possible.

COVID-19 has wreaked havoc on the entire country, altered our daily lives and brought once-thriving industries to their knees. And yet, our ASC has increased case volume by more than 30% during the pandemic. How have we done it? It's actually a very simple process that comes down to three things: following established facility-specific protocols, supporting staff and letting patients know it's still safe to undergo surgery.

1. Create protocols and stick to them

When the pandemic first hit, we immediately reduced our pain management cases, routine ortho procedures and non-emergent spine surgeries. When you're faced with an unknown, take a step back to figure out what you're dealing with and determine the best path forward.

Start by following the science, which should be the basis of documented response protocols you create:

  • Proper use of PPE. During the pandemic's initial wave, everyone at our facility began wearing masks as a precautionary measure because it was a proven safeguard against virus spread. What we didn't try to do, however, was burn through our PPE too quickly.

Maintaining an adequate supply of PPE was one of the major issues early on during the pandemic. Facilities panicked and used PPE irrationally. Masks were being changed every 10 minutes before supply chains were filled out. Obviously, proper PPE is critical, but you have to use it on a rational basis.

Make sure your main supply chain provides adequate PPE levels, but also have a few back-up options available so you're not buying from a single vendor.

  • Reduced contact and distancing protocols. Last spring, we made a conscious effort to limit staff contact and increase our distancing. We created a protocol that stated employees could spend no more than five minutes next to one another whenever possible. That obviously doesn't work in the OR, but the five-minute rule was strictly enforced in our pre-op, PACU and common areas.
  • Upgraded air exchange system. Fortunately, when our center was constructed, the air system was built to exchange the air in the entire facility between four and six times every hour. The system runs air exchanges through a HEPA filter and treats them with high-intensity UV light.

We were already positioned to protect against the spread of the virus with this air exchange system in place, but I also bought a fleet of industrial-strength air handlers for our clinics and office spaces. These handlers treat 300 cubic feet of airflow per minute with high-intensity UV light purification. Each unit can handle 3,000 square feet of space. Granted, at $6,000 per unit, they're certainly not cheap. But safe care is our ultimate goal, and COVID-19 can be transmitted through aerosolization. Spread can occur if your facility's air isn't treated correctly or efficiently.

  • Adequate testing. Thanks to an arrangement we set up with a lab down the street from our facility, we're able to test all patients for COVID-19 the day before their scheduled procedures. The lab works on an eight-hour turnaround or a four-hour turnaround if we have an emergency case. Family members who want to enter the facility when their loved ones are undergoing surgery must be tested the day before, just like patients.

We also routinely test every clinical staff member, physician, vendor and other visitors who enter the facility. We created a bubble and put in a protocol that says simply: If you don't have a test, you're not allowed in.

Creating comprehensive testing and screening protocols is only one part of the equation, though. You have to adhere to the protocols — even at the expense of your practice. I performed 27 spine cases in one week last month, but it would've been 29 if we didn't cancel two procedures due to patients and family members who tested positive for COVID-19.

2. Support your staff

It doesn't matter how many protocols you have in place if your staff doesn't feel supported and safe working in your facility. Your staff are ultimately the face of your facility. Whatever they feel about the culture, conditions and safety of the workplace will ultimately be translated to your patients. If your staff projects the image that they're being taking care of, patients will instantly feel safe in their care.

As soon as the pandemic hit, I let my staff know that if they got the coronavirus while working, they would be able to stay home and receive their pay, whether they had sick time or not. We held a lot of meetings in the early months to explain the protocols we were putting in place and why.

I've also bought lunch for my team every day during the pandemic to avoid having to manage food deliveries and staff leaving the facility throughout the day. We distanced the breakroom and staggered the breaks, so everyone wasn't eating at the same time.

The support I've shown my staff is a two-way street; I asked them for a commitment to follow safe practices in their personal lives. I told them, "We're doing everything in this facility to ensure we're safe and have a safe place to work, so if you don't need to be out at stores or restaurants or gathering, please don't. Please practice social distancing, wear your masks and don't be foolish."

If your staff projects the image that they're being taking care of, patients will instantly feel safe in their care.
— Robert S. Bray, Jr., MD

The honesty and transparency paid off. In fact, I've had staff come in and say, "I'm worried because of where I was last weekend." In cases like this, I'd tell the staff member to stay home for a couple days (with pay) and get an extra test as soon as one is available. I can't stress this enough: If you're honest with your staff, if you tell them exactly what you're going to do to make the workplace safe, they'll give back that commitment a hundredfold.

3. Tell your story

With proper protocols and a comfortable, supported staff dedicated to providing safe care, the final piece of the puzzle is getting the word out there that your facility is fully operational in the midst of the pandemic. I've made it a point to accept any media requests that come my way. We also post constant updates on the facility's website about our continuous commitment to safety and the documented results we've achieved through our protocols. For instance, thanks to our precautionary measures, we've had zero cases of COVID-19 internally. This type of messaging is what patients need to hear.

Outpatient facilities can be a safe haven where patients still feel safe getting the care they need. We have to remind them that abandoning or delaying care because of the pandemic isn't the answer to the problems we're facing.

Even if your COVID-19 protocols aren't where they should be now, you still have time. We're likely only a third of the way through the pandemic. If you plan on providing safe patient care during the pandemic, commit to doing it right. Don't take any shortcuts.

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