ATS Releases New Guidelines for Elective Pulmonary and Sleep Procedures

Kevin C. Wilson, MD

A team of clinicians have presented new guidance as to how to resume elective pulmonary and sleep services in the face of the ongoing coronavirus disease 2019 (COVID-19) pandemic.

The investigators, led by Kevin C. Wilson, MD, chief of Guidelines and Documents at the American Thoracic Society and Professor of Medicine at Boston University School of Medicine solicited volunteers from the Association of Pulmonary, Critical Care, and Sleep Division Directors (APCCSDD) and the American Thoracic Society (ATS), developed plans by discussion and consensus for resuming elective services in pulmonary and sleep medicine clinics, pulmonary function testing laboratories, bronchoscopy and procedural suites, polysomnography laboratories, and pulmonary rehabilitation facilities.

In March, the US Centers for Disease Control and Prevention (CDC) recommended the cancelation of all elective medical services for an undefined time period. However, with case rates declining in some areas of the US, there is a need for guidance as to how to resume some elective procedures.

The new recommendations include a suggestion that the community new case rate should be consistently low or have a downward trajectory for at least 14 days prior to resuming elective clinical services, assuming that the volume of testing remains relatively constant or the variation in the daily case rate reflects changes in testing volume rather than the infection rate.

"This document provides important guidance to health care institutions about when it is reasonable to begin resuming elective in-person clinical services in pulmonary and sleep medicine, as well as strategies to mitigate the risk of viral transmission as those services are resumed," Wilson said. "To facilitate implementation of the guidance, we aimed to account for limitations in staff, equipment and space that are essential for the care of COVID-19 patients and provide access to care for patients with acute and chronic conditions."

The group also recommends institutions have an operational strategy that consists of patient prioritization, screening, diagnostic testing, physical distancing, infection control, and follow-up surveillance with an aim to protect patients and staff from viral exposure, while accounting for limitations in staff, equipment, and space.

The study authors also wanted to provide guidance for access to care for patients with acute and chronic conditions.

The group also suggest prioritizing outpatient services on the basis of patient acuity and tailor services to institutional resources, patient and provider preferences, and community disease prevalence.

“Transmission of SARS-CoV-2 is a dynamic process and, therefore, it is likely that the prevalence of COVID-19 in the community will wax and wane,” the authors wrote. “This will impact an institution’s mitigation needs. Operating procedures should be frequently reassessed and modified as needed.”

The study, “Restoring Pulmonary and Sleep Services as the COVID-19 Pandemic Lessens: From an Association of Pulmonary, Critical Care, and Sleep Division Directors and American Thoracic Society-coordinated Task Force,” was published online in the Annals of the American Thoracic Society.