Stein David E, Chia Stanley H, Breakey Thomas H, Song David H, Woo Edward Y, Fairbanks Rollin J, Jordan David, Curl Leigh Ann, Boucher Henry R, Boyle Lisa, Edwards Karol, Friedrich Hanna, Gilbert Robert J, Matton Jeffrey, Mucci Kathy, Chambers Bradley, Sachtleben Michael, Watson Thomas J
From the Department of Surgery, MedStar Franklin Square Medical Center.
Department of Otolaryngology, MedStar Washington Hospital Center.
Ann Surg Open. 2020 Aug 11;1(1):e002. doi: 10.1097/AS9.0000000000000002. eCollection 2020 Sep.
Coronavirus disease 2019 (COVID-19) infections have strained hospital resources worldwide. As a result, many facilities have suspended elective operations and ambulatory procedures. As the incidence of new cases of COVID-19 decreases, hospitals will need policies and algorithms to facilitate safe and orderly return of normal activities. We describe the recommendations of a task force established in a multi-institutional healthcare system for resumption of elective operative and ambulatory procedures applicable to all hospitals and service lines.
MedStar Health created a multidisciplinary task force to develop guidelines for resumption of elective surgeries/procedures. The primary focus areas included the establishment of a governance structure at each healthcare facility, prioritization of elective cases, preoperative severe acute respiratory syndrome coronavirus 2 testing, and an assessment of the needs and availability of staff, personal protective equipment, and other essential resources.
Each hospital president was tasked with establishing a local perioperative leadership team answering directly to them and granted the authority to prioritize elective surgery and ambulatory procedures. An elective surgery algorithm was established using a simplified Medically Necessary Time Sensitive score, with multiple steps requiring a "go/no-go" assessment based on local resources. In addition, mandatory preoperative COVID testing policies were developed and operationalized.
Even when the COVID pandemic has passed, hospitals and surgical centers will require COVID screening and testing, case prioritization, and supply chain management to provide care essential to the surgical patient while protecting their safety and that of staff. Our guidelines consider these factors and are applicable to both tertiary academic medical centers and smaller community facilities.
2019年冠状病毒病（COVID-19）感染使全球医院资源紧张。因此，许多医疗机构已暂停择期手术和门诊手术。随着COVID-19新病例发病率的下降，医院将需要政策和算法来促进正常活动的安全有序恢复。我们描述了一个在多机构医疗系统中成立的特别工作组的建议，该建议适用于所有医院和服务部门，用于恢复择期手术和门诊手术。
MedStar Health创建了一个多学科特别工作组，以制定恢复择期手术/程序的指南。主要重点领域包括在每个医疗机构建立治理结构、对择期病例进行优先级排序、术前进行严重急性呼吸综合征冠状病毒2检测，以及评估工作人员、个人防护设备和其他基本资源的需求和可用性。
每家医院院长负责建立一个直接向他们汇报的当地围手术期领导团队，并授予其对择期手术和门诊手术进行优先级排序的权力。使用简化的“医疗必需时间敏感”评分建立了择期手术算法，多个步骤需要根据当地资源进行“通过/不通过”评估。此外，还制定并实施了强制性术前COVID检测政策。
即使COVID大流行过去，医院和手术中心仍将需要进行COVID筛查和检测、病例优先级排序以及供应链管理，以在保护手术患者及其工作人员安全的同时，为手术患者提供必要的护理。我们的指南考虑了这些因素，适用于三级学术医疗中心和较小的社区医疗机构。
