Resources for Elective Procedures During COVID-19

Kim Hathaway, MSN, CPHRM, Patient Safety Healthcare Quality and Risk Management Consultant, and Julie Ritzman, MBA, CPHRM, Vice President, Department of Patient Safety and Risk Management

Updated February 26, 2021: As COVID-19 infection rates continue to wax and wane across the country while the vaccine rollout is far from complete, patients may be apprehensive about the safety of surgery during the ongoing pandemic and the potential for contracting COVID-19 post-procedure. Healthcare providers continue to focus on keeping staff safe and informing patients about new risks the pandemic has created, and the latest concerns around mutations and variants of the virus may cause additional infection surges and further surgical delays. Potential liability risks related to cancelled or delayed surgery remain a concern for surgeons who strive to provide safe, timely, and effective care to their patients.

To provide guidance during this crisis, we offer the following resources and strategies for maintaining safe practices and reducing liability risks. Although the following considerations apply to medical office procedures as well, they should be applied with special focus when approaching surgical care:

1. Check with your state medical board and local authorities to understand the conditions that must exist to safely perform elective surgeries, and determine if you are meeting those directives. This should include all clinical settings in which you practice (i.e., hospital, ambulatory surgery center, clinic, or office).
2. Recognize that pandemic response is fluid, and based on data related to the virus, the situation can change. The changes may be frequent as variants are detected in the community, testing becomes more available, and vaccination rates increase. Stay connected with local authorities, and be flexible to meet the directives.
3. Consult with the organizations where you practice, and review the policies and protocols in place. Determine whether the facility has sufficient capacity, supplies, and personal protective equipment (PPE) for you to safety perform your patients’ elective procedures. 
4. Contact your specialty organization for recommendations and guidance. The American College of Surgeons (ACS) has general surgical information and links to the major subspecialties available at COVID-19: Elective Case Triage Guidelines for Surgical Care.
5. Recognize that anesthesia in patients recently recovered from COVID-19 may place them at greater risk for complications and adverse events. It is important to test for COVID-19 prior to elective procedures and review guidelines related to COVID-19 and Patient Testing from the American Society of Anesthesiologists (ASA), including guidance on vaccinated patients.
6. Check the Roadmap for Maintaining Essential Surgery during COVID-19 Pandemic, jointly provided by the ACS, ASA, Association of periOperative Registered Nurses (AORN), and American Hospital Association (AHA).
7. Review the ACS guidance on surgical case prioritization, utilizing the Medically Necessary Time-Sensitive (MeNTS) worksheet.
8. Document a delay or cancellation of an office procedure or surgery due to the pandemic. Your documentation will be critical in case of any future adverse events, and should show what your thought process was at the time. Describe the situation and how you and/or the patient determined whether to proceed or delay. Include any limitations such as closures of surgery centers or PPE/equipment shortages that were imposed on the decision because of COVID-19. Document patient notification of abnormal studies or lab results that required follow-up interventions, and your attempts to reach the patient and reschedule. This documentation is always important, but especially so during the uncertainty of the pandemic.

We offer these strategies as part of our mission to advance the practice of good medicine. During these unprecedented times, practicing medicine requires fortitude, resilience, and judgment. Continue to be diligent and proceed with caution. Stay abreast of community incidence of disease, and restructure your approach when needed.