Provider Groups Update Guidance on Maintaining Surgery Amid COVID-19

Four of the healthcare industry’s leading associations have revamped guidance on maintaining essential surgery as the number of COVID-19 hospitalizations surges across the country again.

The American Hospital Association (AHA), American College of Surgeons (ACS), American Society of Anesthesiologists (ASA), and Association of periOperative Registered Nurses (AORN) recently updated the “Joint Statement: Roadmap for Maintaining Essential Surgery during COVID-19 Pandemic” as providers enter the ninth month of the pandemic.

The joint statement was first released in August when certain areas of the country were experiencing their first spike in COVID-19 cases, which led to widespread shelter-in-place orders and the cancellation of key surgical services lines to stop the spread of the virus.

“Hospitals in many regions across the United States are now reporting near or at bed and ICU capacity due to the resurgence of the Coronavirus Disease 2019 (COVID-19), which is presenting new challenges in meeting the needs of patients who require essential surgical procedures,” the AHA, ACS, ASA, and AORN said in a statement following the update.

The updated statement contains principles and considerations to guide physicians, nurses, and local facilities on addressing the most recent surge of COVID-19 cases in their communities and other care in operating and procedure rooms during the pandemic.

Among its principles and considerations are supply chain, COVID-19 testing, personal protective equipment, and case prioritization and scheduling. For example, the groups urge hospitals to establish a prioritization policy committee to address previously canceled surgeries, specialty prioritization, availability of hospital beds, and staffing issues.

Additionally, the groups advise hospitals to cancel essential surgeries if they do not have adequate personal protective equipment and other supplies during the pandemic.

The roadmap also provides guidance on bolstering regional cooperation, collecting and managing data, mitigating pandemic-related safety issues and risk, and specific COVID-19 issues for the five phases of surgical care (preoperative, immediate preoperative, intraoperative, postoperative, and post-discharge care planning).

The groups also called out in the roadmap the “need for centralized coordinated governmental action to deploy necessary supplies and alleviate the financial burden on physician practices, health care providers and facilities is critical so the health care community can continue to meet the increasing demands for care of COVID-19 patients both in the operating rooms and throughout the facility.”

Initial shutdowns in the US left hospitals without key revenue sources, resulting in massive financial losses through the first half of 2020.

The federal government provided financial aid to struggling healthcare organizations through Coronavirus Aid, Relief, and Economic Security (CARES) Act and subsequent COVID-19 legislation. The bills included a $175 billion Provider Relief Fund to help cover pandemic-related costs and revenue losses.

But hospitals are still facing significant losses because of persistently low volumes and higher-than-normal expenses, and some industry groups have cited the ongoing financial distress as a reason for additional support from the government.

Legislators have failed to agree on another COVID-19 stimulus package, but as a new administration gears up to take office, providers are renewing their calls for help.

“Despite some progress in treating COVID-19 patients and a modest increase in supplies and personal protective equipment (PPE), hospitals and providers remain under resourced and over worked, a state many presumed was temporary while the nation responded to the virus’s initial assault. Now, nine months into the pandemic, the alarming and unrelenting surge in infection rates is a stark reminder to all that many months remain in this journey,” ACS, ASA, and AORN said in a letter accompanying the roadmap.

The groups called on government leadership to specifically address healthcare worker well-being and staffing issues and its plan to launch a federally coordinated deployment of supplies, medications, and vital equipment.

Increased communication with providers and transparency around a vaccine distribution plan should also be addressed, the groups stated.

“Our organizations, health care facilities, and health care providers need prompt, transparent and comprehensive communication from the federal agencies leading the COVID-19 response efforts, including the FDA related to drug and equipment needs, the CDC related to testing, infection control, and NIH related to treatment developments including vaccine approvals and deployment. This need for communication is particularly acute as the administration transitions over the next few months,” the letter stated.

The FDA is currently reviewing two COVID-19 vaccine candidates, which are expected to be distributed to providers by mid-December, according to some reports.

Providers are still waiting on more guidance from government agencies on a distribution and vaccination plan considering the limited supply of vaccines available.