ACS Releases Guidance for Resuming Elective Procedures

With some parts of the US at or nearing the peak of the coronavirus disease 2019 (COVID-19) outbreak, the American College of Surgeons (ACS) has released a new surgical resource document to aid health care facilities preparing to resume elective procedures.

After issuing guidance urging a halt to elective procedures in mid-March, the new set of recommendations is broken down into 4 main sections that contain guidance on an array of hurdles facing these facilities, including preparedness and how to ensure delivery of safe, high-quality care in the wake of COVID-19.

“The current document offers a set of principles and issues to help local facilities plan for resumption of elective surgical care,” authors wrote in the 10-page surgical resource. “While the effect of the COVID-19 pandemic on local communities or facilities is a spectrum, we suggest facilities use this checklist as a guide to ensure issues have at least been considered.”

Published on the ACS website, the 4 sections of the document addresses COVID-19 awareness, preparedness, patient issues and delivery of safe and high-quality care. With an emphasis on collaboration throughout the document, authors highlight 10 issues in these 4 sections—2 listed under COVID-19 awareness, 5 under preparedness, 2 under patient issues, and 1 under delivery of safe and high-quality care.

The current document joins more than a dozen other published works on the ACS website offering guidance to clinicians and health care workers. Other guidelines and recommendations released by the ACS pertaining to COVID-19 include maintaining trauma center access and care, management of COVID-19 hospital patients, and the creation of a surgical review committee for COVID-19-related surgical triage decision-making.

When discussing COVID-19 awareness, key takeaways included knowing the prevalence, incidence, and isolation mandates in your community as well as having awareness of testing availability and policies for patients and health care workers. Authors included multiple considerations for facilities in regard to awareness of testing, including having knowledge of false-negative rates and possible development of a risk-versus-benefit model to decide risk to patients and health care system for testing.

The preparedness portion of the document addresses use of PPE, knowledge of facility capacity, and awareness of the supply chain. The largest portion of the document, authors include a plethora of information and recommendations. Specific recommendations included having at least 30 days of PPE or a reliable supply chain. Other highlighted points from the section include the ability to address workforce staffing issues and creation of a governance committee.

The governance committee should be designed to clarify, interpret, and iterate policies, make-real-time decisions, and initiate and communicate clear messaging. Of note, authors direct readers directly to the Centers for Disease Control (CDC) online PPE calculator.

The 2 issues addressed in the patient issues section included patient communication and surgery prioritization. Authors suggested placing an emphasis on clear messaging and communication while also creating a prioritization plan considering institution resources, priorities, and patient needs. Authors also suggest establishing a strategy for the phased opening of operating rooms.

Finally, the delivery of safe and high-quality care portion of the document contains more than a dozen recommendations. Authors wrote the goal of the section is to allow for safe, high-quality care across the ACS’s Five Phases of Care, which address the preoperative, immediate preoperative, intraoperative, postoperative, and post-discharge periods of care.

This guideline, “Local Resumption of Elective Surgery Guidance,” was published online on the ACS website.