INCREASED CAPACITY Surgery centers can take on more outpatient procedures to free up hospital ORs for complex cases.

As the coronavirus surges in parts of the nation, several national healthcare organizations have teamed up to ensure health systems continue to perform essential surgeries and remain prepared to treat patients hospitalized with COVID-19. The Association of periOperative Registered Nurses (AORN), American College of Surgeons (ACS), American Society of Anesthesiologists (ASA) and American Hospital Association (AHA) released a roadmap for providing safe surgical care in areas of the country hit hard by the pandemic.

The joint statement builds on the organizations' roadmap for resuming elective surgeries released on April 17. In the new guidance, the organizations stress:

• Regional cooperation among facilities to address capacity and new patient needs to ensure there are enough ICU and non-ICU beds, PPE, testing supplies, ventilators and trained staff to treat all non-elective patients without resorting to a crisis standard of care. The organizations encourage daily forecasting of COVID-19 demand on all resources for determining the ability to add non-COVID-19 cases. In addition, they encourage hospitals, professional societies and government agencies to work together to ensure adequate supplies of vital equipment and medications.
• Use of available COVID-19 testing for patients and staff, and implementation of a policy addressing requirements and frequency for patient and staff testing in accordance with current CDC guidelines.
• Facilities without adequate PPE and surgical supplies appropriate to the number and type of procedures to be performed should not schedule non-emergent surgeries.
• Establishment of case prioritization policy committees consisting of surgery, anesthesia and nursing leadership that develop appropriate strategies to address immediate patient needs.
• Adoption of policies addressing care issues specific to COVID-19 and postponement of surgical scheduling.
• Frequent reevaluation and reassessment of policies and procedures based on COVID-19 related data, resources, testing and other clinical information.
• Implementation of face covering and social distancing policies for staff, patients and patient visitors in non-restricted areas in the facility that meet current local and national recommendations for community isolation practices.

The guidance also suggests hospitals partner with surgery centers to expand surgical capacity. "Many patients see ASCs as the provider of choice for surgery, as they are aware that COVID-19 patients have not been cared for in these facilities," says AORN CEO and Executive Director Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN. "The potential for expanding the capacity in the ASC allows complex procedures to be performed in hospital operating rooms."

"As part of moving cases to ASCs, it is encouraged that waivers be addressed allowing ASCs to increase the average length of stay for postoperative patients," adds Ms. Groah. "This will be dependent on having the appropriate staff to care for patients."