Access Now: Transmission Precautions for Monkeypox Infection

4 Solutions to Manage Elective Surgeries Through the Pandemic

Publish Date: December 16, 2020

OR Group ImageSafely managing surgical volume through the COVID-19 pandemic has been an important goal for hospitals to serve patients and maintain financial health.

At CentraCare--St. Cloud Hospital in St. Cloud, Minn., like other hospitals across the country, COVID-19 response has led to a shortage of inpatient beds and fluctuations in staffing due to quarantines, according to Larry Asplin, RN, MSN, CSSM, CNOR, surgery director overseeing both inpatient and outpatient surgical care.

However, lessons learned from the start of the pandemic are helping Asplin and his team to continue serving elective surgery patients during this resurgence. Here are four ways they are sustaining elective cases:

  1. Divert Elective Surgeries to Freestanding ASCs
    Moving elective surgeries and surgical staff and physicians to outlying freestanding surgery centers within the health system has been an important way to have beds available for elective surgery patients that require a 23-hour or longer hospital stay for postoperative observation, Asplin explains.

    Their hospital system also received approval from the Minnesota Department of Health to convert 10 beds in their Surgery preoperative center for 23-hour postoperative observation for patients who would normally be admitted for the 23-hour stay. Additionally, they have opened their Birth Center to care for OB/GYN post-surgical patients for recovery.

    “We are reviewing elective surgeries on a case-by-case basis when revaluating the next day’s schedule to look at factors such as patient comorbidities and the need for a 23-hour stay to determine which elective surgeries can be diverted—this takes careful coordination with leaders, physicians and staff to operationalize—our team members are really on board to help.”

  2. Ensure Adequate PPE Supply Across All Settings
    A lack of PPE was one major reason elective surgeries had to be shut down in the Spring during the initial Covid surge at his hospital, Asplin shares. “Now that we are getting most PPE supplies, rather than shut down completely, our hospital is able to ensure protection for our team members, including for care of Covid-positive and Covid-suspected patients.”

    He highlighted the importance of widespread collaboration among professional associations, including AORN, the American College of Surgeons, and the American Society of Anesthesiologists, to appeal to state and federal leaders for coordinated efforts to maintain a steady supply of PPE.

  3. Reassure Patients That Surgery is Safe
    Some patients did cancel elective surgeries in the Spring due to fear of Covid exposure in the healthcare setting. To alleviate patient fears, Asplin’s system continues with significant patient and public education about coordinated safety measures, such as masking, frequent cleaning, hand sanitizing, and social distancing. “This education has worked well to reduce surgery cancellations,” Asplin says.

    He also stresses the value of word-of-mouth from patients who were impressed with the Covid safety measures they witnessed during their surgical stay, including masking and staff use of PPE. “Patients are very aware of the PPE required to reduce Covid-transmission,” he says. Witnessing these safety measures first-hand has proved important for helping his hospital maintain surgical volume.

  4. Be Present in Supporting Your Team
    “Communication is key in any situation, pandemic or not,” Asplin stresses. From the start of the pandemic he empathized with his staff members feeling the frustration with ever-changing guidelines.

    He says helping his staff understand a pandemic is inherent for change, and being transparent with updates through email, postings on a bulletin board, and sending relevant updates from incident command helped tap into preferred communication channels to keep everyone current with the latest practice updates. “We are careful about sharing too much information. For example, our organization has algorithms to explain different steps for Covid-positive patients, and we share this information when it’s relevant to our surgical setting.”

    Asplin and his leadership colleagues coordinate to cover in-person rounding, including on weekends and holidays, to thank team members and solicit feedback for continuous improvement.

    He also works to stay connected with team members who have been deployed outside of the surgical setting. “Many of our team members have been able to work on the frontline and experience firsthand how Covid is impacting patients and families, it’s really eye-opening. I am so inspired by the way our staff and even nursing students preparing to enter the profession are ready and eager to help through this pandemic, whether they are saving lives or just holding the hands of those passing.”

Get top resources and tools to advance your leadership skills with AORN Leader Membership. Learn more.

FREE Resources for Members

Guideline Essentials
Implement evidence-based practices for Team Communication and more with customizable tools, such as Guideline Quick Views, Policy & Procedure Templates, Competency Verification Tools, Key Takeaways, and Audit Tools.

Clinical FAQs

AORN Journal Articles
COVID-19 Resources

Maintaining Perioperative Safety in Uncertain Times: COVID‐19 Pandemic Response Strategies

Learn more on 6 Steps to Better OR and SPD Collaboration in The Periop Life blog.