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3 Actions to Rebuild Surgical Volume

Publish Date: June 10, 2020

After completely halting elective surgeries from mid-March into early May, two major hospitals in Los Angeles, Calif., and Atlanta, Ga., are slowly getting back to historical surgical volume.

On May 11, elective surgeries at WellStar Atlanta Medical Center resumed for orthopedic, urology and general surgery, and surgical volume is tracking at 50% of historic volume. Since resuming elective procedures on May 4, surgical volume among four acute care hospitals within Memorial Care Health System is averaging approximately 80–90% of historical numbers.

Both systems are building back their surgical volume through focused efforts to protect patients and staff and allay fears about exposure to COVID-19 in health care facilities.

Recognizing the Fear Factor

“Patients are anxious about possibly being exposed to Covid as surgeries resume, you have to make sure everyone feels safe and trusts in your collaborative actions to create a safe environment,” says Vangie Dennis, MSN, RN, executive director of perioperative services at WellStar Atlanta Medical Center.

This ‘fear factor’ about coming to the hospital for surgery is also evident in the Greater Los Angeles area. Feedback from surgeons suggests some patients are opting not to reschedule elective surgery due to concern of exposure to coronavirus in health care facilities, as well as for financial reasons owing to impacted employment and loss of insurance coverage, according to Debbie Ebert, MSN, RN, NEA-BC, CNOR, CCRN, CPAN, CAPA, vice president of perioperative services at Memorial Care Health System in the Greater Los Angeles Area.

Advancing Safety: In Words and Actions

While there is some variability in processes and approaches between the two health systems, Dennis and Ebert share three common strategies to ensure elective surgery is safe and reassure patients that safety measures are in place.

  1. Establish standardized COVID-19 response actions
    In Atlanta, Dennis describes her teams’ structured approach based on system-wide decision-making to ensure safety as orthopedic, urology and some general surgeries resumed on May 11. These actions include:
  • segregating inpatient and outpatient surgeries in different buildings,
  • conducting drive-through testing for every patient 96 hours prior to surgery,
  • requiring masks, and
  • limiting visitors.

Tailored planning is also being established at the service line level to develop standardized practices for treating COVID-19 patients, such as using smoke evacuation during intubation and extubation to reduce coronavirus from circulating in the room and installing 0.3 micron HEPA air filtration in designated COVID-19 ORs, and creating negative pressure ante rooms outside the Covid designated ORs.

Executive team members and the perioperative director at each system facility worked collaboratively with the chiefs of surgery to define criteria for case prioritization based on patient acuity, including:

  • diagnosis,
  • risk of delay, and
  • ability to provide quality within the full continuum of care such as post-acute discharge needs.

“Our goal was to be prepared to resume our services in a safe, strategic and controlled manner,” Ebert shares.

  1. Educate patients in multiple formats
    With coordinated COVID-19 safety precautions in place, the next hurdle was to share these changes to help patients feel comfortable returning to the hospital for elective surgery.

To achieve this, Ebert’s organization created a multi-media marketing campaign entitled “We’re Here, We’re Safe” to assure their facilities and processes are safe. The campaign includes specific steps for surgical procedure safety, such as :

  • preoperative screening of surgical patients for COVID-19 related symptoms,
  • drive-thru COVID-19 testing for patients who require testing prior to surgery,
  • social-distancing markers in waiting areas,
  • enhanced cleaning protocols, and
  • a mask provided upon entry.

This information is shared with patients through the organization’s website, through social media and with surgeon’s offices to share with patients.

In Atlanta, Dennis describes extensive education with patients and staff to make sure COVID-19 safety actions are well understood. “Repetition and education in multiple formats are proving successful,” she says, noting that summaries of safety actions have been shared with patients and physician offices via email, print and online posting on the hospital’s website to reach a broad audience.

  1. Prepare team members
    Dennis worked intentionally with her staff before elective surgeries resumed to make sure they were comfortable, mentally prepared and proficient in new COVID-19 specific safety practices. “You have to be very methodical before you do a big bang because you already harm your staff just starting cases back in this unprecedented situation.”

Ensuring adequate PPE for every team member and showing them how enhanced air ventilation was working were two priorities for Dennis, as well as addressing staff emotional well-being and stress reduction.

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