Elective Surgeries and Procedures During COVID-19

Elective Surgeries and Procedures During COVID-19

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September 8, 2020

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Working together and sharing information is essential to address the COVID-19 crisis. That’s why COPIC developed this document and is providing it as a resource to members of the health care community. As medical providers continue to perform elective surgeries and procedures, there are several key guidelines that have been released and offer a roadmap. COPIC’s physicians and attorneys have compiled the following information in a concise summary that can be customized for your needs. We hope you find value in this document and are proud to contribute as we move forward in the fight against COVID-19.
—Gerald Zarlengo, MD, CEO of COPIC  

Important note: Orders, regulations, and guidelines from local public health agencies may have been issued on procedures to be used in resuming elective surgeries and procedures. All providers should pay close attention to what local agencies may issue and comply accordingly.

There are three areas of preparation a health care system, hospital, facility, or provider group should consider in scheduling elective surgeries or procedures during the COVID-19 pandemic: 
1) Review the considerations contained in the resource links in this document to establish the background data and information they need to ensure that it is safe to proceed with elective surgeries or procedures during the pandemic;
2) Create a “What You Should Know About an Elective Surgery or Procedure During the COVID-19 Pandemic” patient education document that contains important information for the patient to know. This will be provided to the patient and can be readily amended as circumstances necessitate; and,
3) Utilize a “Special Consent Form for An Elective Surgery or Procedure During the COVID-19 Pandemic” (link to suggested COPIC-developed template is in the last section of this document), which would be in addition to the usual permit for the surgery or procedure, and would cross-reference the “What You Should Know…” document.  

Establish the Background and Data Necessary to Establish It Is Safe to Proceed with Elective Surgeries and Procedures: The resources listed in this section list several factors and data points that providers should analyze, consider, and retain for future use before proceeding with elective surgeries or procedures.  
Joint Statement: Roadmap for Resuming Elective Surgery After COVID-19 Pandemic: This is a collaborative statement issued by the American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, and the American Hospital Association. The general categories to consider, with detailed information contained in the statement, are: geographic location, sustained reduction in rate of new COVID-19 cases during the last 14 days, sufficient staff equipped to treat all elective patients, testing capacity for staff and patients, PPE, case prioritization, ability to manage non-COVID-19 patients through the 5 stages of surgical care, collection and management of data with ongoing assessments to re-evaluate policies and procedures, and consideration of a second wave of COVID-19 patients.
CMS Recommendations on Re-Opening Facilities to Provide Non-Emergent Non-COVID-19 Health Care: Phase 2: This is a statement issued on June 8, 2020, by the Centers for Medicare and Medicaid to provide recommendations (a previous Phase 1 version was released in April). The statement says "Non-emergent, Non-COVID care (NCC) should be offered to patients, as clinically appropriate, in localities or facilities that have the resources to provide such care, as well as the ability to quickly respond to a surge in COVID-19 cases, if necessary. Decisions should be consistent with Federal, State, and local orders, and CDC guidance and made in collaboration with State and local public health authorities." Providers should consider if there are adequate facilities, adequate viral testing, and an adequate workforce to provide all phases of care. The use of telehealth services, when available and appropriate, continues to be recommended to minimize the need for in-person services. In addition, all individuals at higher risk for severe COVID-19 illness should continue to shelter in place unless their conditions warrant in-person health care.

Create a Patient Education Communication On: “What You Should Know About an Elective Surgery or Procedure During the COVID-19 Pandemic” (or similar title): This is an informational piece developed by the health care system, hospital, facility, or practice group that contains information the patient should or would want to know. A common document will ensure that providers are giving the same information to patients as generally applied to elective surgeries and procedures, and this allows for amendments to the document as changing circumstances may dictate. This document should emphasize that an elective surgery or procedure does not need to be performed at this time and that there is a risk that the patient could be infected with COVID-19. Other information could include, but not be limited to: determination of surgery or procedure priorities, COVID-19 testing policies for patients and staff, COVID-19 counseling information, patient safety considerations, PPE use, patient family and visitor policies, post-discharge follow-up, advanced directives, and the potential for necessary resources being unavailable should the patient become infected. The document should be referenced in the Special Consent Form referenced in the next section. A helpful reference for the messaging of the communication is: “Local Resumption of Elective Surgery Guidance” published by the American College of Surgeons.  

Ensure That You Are Aware of and in Compliance with Any State Regulations/Guidance
Throughout the COVID-19 situation, states have issued various guidelines and information that may relate to procedures and surgeries. We recommend that you are up-to-date on any state regulations and executive orders, and understand how these may impact your medical practice. COPIC have developed a COVID-19 State and Federal Resources page that includes downloadable PDF summaries of state regulations and executive orders for the following states: Arizona, Colorado, Iowa, Kansas, Minnesota, Montana, Nebraska, North Dakota, Oklahoma, South Dakota, Utah, Wisconsin, and Wyoming.

Utilize a “Special Consent Form for an Elective Surgery or Procedure During the COVID-19 Pandemic” (or similarly titled document): This special consent form would be used in addition to the standard consent form associated with the type of surgery or procedure. Using a special consent form emphasizes the important shared decision of agreeing to, and performing, an elective surgery or procedure. This form can concisely set forth the information and risks and is to be used in tandem with the patient education communication referenced previously. The form should reference the patient education communication and that the communication was, in fact, provided to the patient. Below is a link for a sample template for such a form. Please understand that COPIC provides this sample template only as a suggestion and it should not be considered as providing legal advice under any circumstances. Each provider should consider what information needs to be contained in their own Special Consent Form and patient education communication, then consult with a private attorney to review.   

Download a copy of the suggested sample consent template