Thread by @DrMStiegler

Time to resume elective surgery cases? A thread summarizing new guidance out today from the @AmCollSurgeons #COVID19

This document intro states that peak COVID rates have already been reached, or will be within a few weeks, depending on region...

[link at end of thread]

They offer four categories, each with specific issues that must be addressed locally before elective surgery may be safely resumed.

Categories:
1. COVID-19 Awareness
2. Preparedness
3. Patient Issues
4. Delivery of Safe High-Quality Care

For the 'awareness' category, the specific issues are:
✅Knowing your local COVID-19 numbers, including prevalence and incidence
✅Knowing local isolation mandates
✅Knowing your diagnostic testing availability
✅Knowing testing policies for pts and HCWs

On that note, I'd say we have very little understanding of our 'numbers' as we've had and continue to have insufficient testing. Plus, some expect that #CovidTesting availability will actually decrease as we do more widespread testing to 're-open'

Also, ACS notes that false negative rates may be as high as 30%
AND
we currently don't know the 🗓️duration for transmissibility for 1) asymptomatic #COVID19 positive patients, or 2) those who have recovered from a COVID-19 illness

For 'preparedness', the issues @AmCollSurgeons identifies are:
✅#PPE policies for health care workers
✅Facility capacity (beds, ICUs, #ventilators)
✅OR supply chain
✅Workforce staffing issues
✅Need for a governance committee

They highlight that an adequate supply AND a reliable supply chain are both needed for #PPE. This is paramount, and not an easy solve, as many places are still experiencing a #PPEshortage

Facility capacity needs to consider sites, equipment, staff, and scheduling. Facility cleaning policies may need to change.

Also important to consider whether support is sufficient - what about clinical laboratory, diagnostic imaging, and sterile processing?

Also, consider
👉potential for second surge
👉anticipated capacity related to trauma/emergencies
👉coordination among multidisciplinary teams, including surgery, anesthesia, nursing, engineering, housekeeping,etc to
#ReopenAmerica safely

About those staff. Consider your numbers, and how many are sick or recovering from #COVID19. What's their level of fatigue, stress, even #PTSD?

Finally, in 'preparedness' category, establish a real-time decision-making body that is multidisciplinary and data-driven, meeting at a daily cadence or more frequently. Focused on safety, quality, and all other items in this thread.

Re: 'patient issues' - @AmCollSurgeons highlights importance of communication on:
👉#COVID19 Testing policies for patients
👉Safety for patients
👉PPE use
👉Patient family/visitor guidelines
👉Postdischarge care/follow-up
👉Advance directives
👉Insurance issues

Also, need for transparency of the prioritization process to everyone:
✅Provide assurance, consistency, and standardization. ✅Reduce ethical dilemmas and potential for #moralinjury for surgeons, anesthesiologists, nursing, others.

Finally, for 'Delivery of Safe and High-Quality Care' :
the @AmCollSurgeons offers 5 phases for consideration
1-Preoperative period
2-Immediate Preoperative Period
3-Intraoperative Period
4-Postoperative Period
5-Post Discharge Period

For pre-op needs, how can we implement telemedicine, #socialdistancing in clinics or testing centers, and plans for rehab or other care than must be in place prior to surgery?

Are there safety checklists that should be developed or modified for the immediate pre-op period?

Intra-operative considerations focus largely on need for PPE, consideration of intubation and airway procedures and how #COVID19 risks can be minimized with new protocols and engineering. Also, consider workflow for specimen pickup, intraop imaging, etc.

Finally, consideration for post-operative recovery at home or in a skilled facility - what's available, what's the capacity, what's the safety? This loops back to everything under 'awareness' in my view. #COVID19Pandemic

So there you have it - my summary (with some of my own thoughts sprinkled throughout) of the @AmCollSurgeons guidance on resuming elective surgery. Here's the full link: facs.org/covid-19/clini…

End of thread :)