Is Your Hospital Resuming Elective Surgeries? 5 Key Points From Paul Giles

5 Key Points

Follow your state’s guidelines on safety, but ideally, test a prospective surgical patient for COVID twice a day for negative results for seven straight days
Block scheduling needs to be reconsidered as Block recommendations. Communicate this with your surgeons
Assume two months for each month surgeries were down in order to get through the backlog
The two types of surgeries that may not come back due to loss of insurance and deductibles are GI and EGD.
Don’t staff-up fully right away. A return to full volume may be slower than you think. Create a schedule tying staff to case volume

Full Interview with Paul

When did you open up for Elective Surgery?

Restrictions were lifted in the state of Virginia on May 1st. After meeting state guidelines and processes, our first elective surgery cases are scheduled for May 7, 2020.

What is the process for determining if a patient is ready for surgery?

Once the case has been scheduled, it goes to preadmission testing where a testing visit is scheduled. In this visit, the patients’ health history is reviewed, and a COVID-19 test is conducted. The results for this testing ranges from 48 hours to 3 days. Once the testing results come back negative, the patient is given more testing kits that have to be conducted AM and PM for 7 days. If the patient’s test remains negative, then the procedure will continue.

What is the process for determining what cases are approved?

There are 4 case level types. Emergency cases which are a level 3. Urgent cases that fall within level 3. Urgent elective cases that are a level 2, these are cases that cannot wait 30 days. Then we have elective cases which are level 1.

The case process is physician-driven. The physician will come with the case they want to perform. The physician and I then qualify the case based off one of the four levels. If it is qualified as an Emergency or urgent then it is scheduled immediately, but if it falls within a gray area and I deem it not to be done immediately I contact our Chief of Surgery or Chief of Staff and we discuss it together before it gets moved forward.

What are you doing to alleviate worry or concern in advance of May 7^th?

One of the things we do every single morning is a “Go-No-Go meeting” where we talk about what is on the schedule, what is the update on COVID-19 in the area, staffing concerns, and back-up. Back-up has been a big topic, making sure we have available staff for emergency cases since we have been operating with a bare-bones crew due to the volume nature. We also talk about supply – blood and PPE. We talk through how many regular and ICU beds are available and isolation rooms we have. We talk about the COVID-19 testing we have done specifically to the patients whose surgeries have been scheduled. Making sure they have been compliant with the process and have tested negative to move forward with surgery.

How long will it take you to work through the backlog?

For every month we were down, it will probably take two months to fulfill the backlog. Since we were down roughly two months, it will probably take three and a half to four months to get all of the backlog scheduled. When all of this first started, I immediately jumped on taking all the elective cases that came in and started designating them as level 1’s, 2’s, and 3’s. I then divided my team in half so that one part of the team worked one day and the second team worked the next day so I could divide the hours up. Once I had a better understanding of what was happening and the scope of impact this would have, half of the team was furloughed out. Now that things are opening back up again, there are steps I have to take in order to ensure we are showing consistent volume. The consistent volume will be when we have enough cases to run 8-10 hours every day. That is when I will be able to start bringing teams back onboard.

It sounds like that could be a scheduling challenge. Do you have experience with this, or have you received guidance from hospital administration?

It is a mixture of the corporate office and administration lending advice and guidance. I also lean on my own experience too. This is not my first pandemic. I remember working at USMD Fort Worth when the Ebola outbreak happened. When I arrived there, more than half of the hospital staff had left. So, I learned quickly how to reassemble a team, taking it from bare-bones and growing it back accordingly.

What would you share with hospital administration at a facility that hasn’t started elective surgeries yet?

Communication is important. What I always want to know from administration is where do we stand with positive COVID-19 tests. Either a number or percentage. Having those accurate numbers will help me know how to protect my patients and protect my staff. In the healthcare industry, there are a lot of people who are very specialized and knowledgeable about what they do from infection control to quality. If the administrators can pass along the intelligence of what is going on, the nursing leadership will know what to do and how to react, they just need to be provided with the information.

What would you want for a Director of Surgical Services to know?

Relationship with your physicians and providers is paramount. At this particular hospital, I have four physicians that have block time. I had to take away block time and shift to a model that was more flexible. These doctors can request preferred times for operation but know that it may have to change depending on what we are dealing with. I have tried to set up a model that alternates doctors so one can go first one day and the other goes first on another day. Having a relationship with providers and speaking to them, I find they are working together and being more flexible. It’s working the schedule as a team.

What do you think may change for the next 12 months or until we have a vaccine?

Immediately I think facilities may be reacting too quickly to pulling people off furlough. What some assume is that we will capture back all the lost cases and be back to the same case volume that we had before COVID-19. But what is not being thought about is now a lot of the population is out of work and the deductible they were planning to use toward surgery may have been reallocated to something different or no longer is there for use. It may take 4-6 months before we start capturing back that case volume or until there is a vaccine created.

Do you have any predictions as to what our world looks like in the future?

That’s tough to say, but I think the United States is a pretty resilient country. We’ve been faced with all kinds of things; it seems every year we are dealing with a new kind of flu or virus. I do think people will feel better once there is a vaccine for COVID-19. I think for healthcare staff, staying true to who we are as professionals and taking care of every patient in the safest manner has and is going to remain important.

What surprised you about the restart for elective surgery cases?

As soon as it was announced that we were going to open back up beginning May 1, I was a little surprised by the reactions from corporate. They were wanting to do this slowly. There didn’t seem to be a bottom-line focus. The communication we received was to proceed with safety and do this in an orderly fashion. Which in my previous experience it seems the corporate office is mainly focused on the bottom line. They want to ramp things back up to recoup what they lost. That was not the case in this instance which impressed me.

The biggest thing that has surprised me since this all happened has been the support towards the healthcare profession being deemed as heroes. This line of work we are in, this is what we do. There is no social distancing. Whenever we are needed, we are right there in the middle of it. There is no hiding or running from what we do.

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Carisa Brewster

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Is Your Hospital Resuming Elective Surgeries? 5 Key Points From Paul Giles