Best Practices to Resume Elective Surgeries in the COVID-19 Era

May 27, 2020
OR Surgical Light
Elective scheduled surgeries (ESS) were put on hiatus in March 2020 to help slow the spread of  COVID-19. As stay-at-home orders and government-mandated shutdowns are starting to lift, elective surgeries have the green light to resume. For organizations such as ambulatory surgery centers that provide these surgeries, restarting ESS is not simply a matter of opening the doors and conducting business as usual. Instead, they must implement best practices in the era of COVID-19.

Mandates that halted ESS created hardships for both patients and facilities. Each state’s requirements and easing of mandates will vary. Ideally, ESS will resume when infection rates are very low. When surgeries do start, facilities need to take appropriate safety measures and address patient concerns. 


ESS impacts surgical and nursing leaders, infectious disease specialists, epidemiologists, supply chain professionals, medical ethicists and others. To restart surgeries, facilities must work closely with their infectious disease experts, epidemiologists and public health departments to establish a mechanism for monitoring community infection rates, hospitalizations, ICU bed occupancy and ventilator usage in their communities.
As ESS facilities know, COVID-19 presents new and unique healthcare challenges. Meeting these challenges requires facility managers to continually evolve their best practices to reflect new learnings and insights. In addition, COVID-19 ESS strategies must address effective surgical governance, which entails ongoing, frequent evaluation and response to newly relevant clinical information.

Strategies should include planning for COVID-19 to continue into next year. Most healthcare professionals are expecting a secondary surge of the latest coronavirus, which must be accounted for in planning. It’s possible that facilities will need to reduce or even suspend ESS in the future, depending on the magnitude of the secondary surge. To assure both the public and the providers of ongoing safety, a robust program of virus surveillance should be established with infectious diseases experts.


With the supply limitations created by COVID-19, facilities are now challenged with ensuring they have the products they need to perform ESS. The hiatus in ESS has also created significant backlogs for non-emergency surgeries and procedures. Facilities will be challenged to determine which patients to schedule first.
Healthcare providers are looking to clinically prioritize patients based on those who have the most critical or time-sensitive needs. Clinical leadership is essential for creating a prioritizing strategy.

To lessen in-person meetings prior to a procedure, surgical preoperative consultations could occur virtually, depending on the patient’s needs and the facility’s capabilities. This could include a phone call, app, Facetime, Skype, video conference or other remote but secure options. If a virtual visit isn’t possible, an in-person visit with appropriate precautions should be facilitated. Likewise, facilities should ensure arrangements have been made for post-procedural services, including how and where the appointments will take place.


The Coronavirus Aid, Relief and Economic Security (CARES) Act can help support healthcare facilities, including physician group practices and solo practitioners, through the Public Health and Social Services Emergency Fund for expenses or lost revenue due to COVID-19. As of April 16, 2020, $30 billion in funding had been distributed to providers based on their 2019 Medicare fee-for-service claims. 

Additional funds are expected for rural providers, providers in hotspots and providers with a higher proportion of Medicaid patients. The Department of Health & Human Services (HHS) has provided information regarding how CARES Act funds will be allocated.

In April,  HHS updated its terms and conditions for accepting payment and use of the funds. If a provider ceased operations as a result of COVID-19, it’s eligible to receive funds as long as the provider offered diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. The care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19. 

The CARES Act also provides $376 billion in relief for small businesses and workers. Several relief options are through the Small Business Administration. Other programs that offer financial relief include the Payback Protection Program, which is designed to incentivize small businesses to retain employees during the pandemic, and the Economic Injury Disaster Loan Emergency Advance for emergency grants for small businesses with less than 500 employees. 

HHS also launched a COVID-19 Uninsured Program Portal. The portal allows providers who conducted COVID-19 testing or provided treatment of uninsured COVID-19 individuals, on or after Feb. 4, 2020, to submit claims for reimbursement, generally at Medicare rates.

Facilities should realize that many patients may have experienced a change in employment status due to being furloughed or laid off. This means they may have lost or have different insurance. Prior to a procedure, the facility should discuss any changes in insurance or payment plans. Providers should also consider that if they provided treatment for uninsured people with a COVID-19 diagnosis, they can file claims for reimbursement as part of the CARES Act. 

For facilities interested in implementing or expanding their telehealth program, the Federal Communications Commission is providing $200 million in funding to support eligible providers’ connectivity to patients in their homes or other locations. Funding is available for telecommunications and information services and devices to connect with patients until the pandemic ends.


“Between February and March of this year, facilities saw a 55% increase in appointment cancellations due to COVID-19 concerns.”


Between February and March of this year, ambulatory surgery centers experienced a 55% increase in appointment cancellations, according to Provista data. A top reason for the cancellations was patient fear over COVID-19. That’s why it’s paramount for the healthcare industry to understand the importance of patient trust in any strategy toward resuming elective surgeries and procedures during a pandemic. 

A recent webinar with Vizient, Provista’s contacting partner, sheds light on patients' current feelings.  When asked the question “How safe would you feel if you/family member needed a procedure today?” respondents said:

  • 56% somewhat safe.
  • 4% very safe.
  • 13% very unsafe.

When the question changed to a procedure in three months, the results changed:

  • Very safe increased to 13%.
  • Very unsafe decreased to 4%.
  • Somewhat safe moved to 46%.

Healthcare providers who effectively communicate information about COVID-19, including testing and treatment options, help reduce patient uncertainty. Effective communications also promote equity in disadvantaged populations that may feel marginalized during the pandemic.

Because much uncertainty exists about the current coronavirus, one of the most beneficial “treatments” that ESS facilities and other providers can offer is to ensure that patients understand what is being communicated. There’s now a need to explain every detail, ensuring all steps are safe and being reviewed.

Facilities should have current information about their safety procedures on their websites, but they can’t assume patients will visit the site. That’s why facilities must be proactive with their communications. This can include sending emails or traditional marketing mailers, making phone calls or sending texts. Patient portals are also effective, if the facility has them. 

Communications should be clear, concise and detail what’s changed in the office. For example, the messaging can say, “We removed the lobby to ensure social distancing, added sneeze guards to protect staff and patients, and installed touchless doors so you can open them hands-free.” 

Sending a “what you need to do” checklist to patients or their caregivers prior to a procedure is also effective. The checklist should outline patient expectations and provide a step-by-step overview of what to expect when they arrive at the facility. This way, there are no surprises when the patient walks through the door.

An effective approach to help with in-office communication is “Teach Back.” Using this method, once a concept is introduced, providers should ask patients to repeat back what was said to ensure they correctly heard and understood. This approach fosters the development of shared decision making, which is a critical component of facilitating trust between patients and providers.

Setting healthcare expectations and following established processes take on new importance as ESS resume. In addition to adhering to best practices, facilities must practice universal precautions to maintain and ensure patient and staff safety. During this time, as facilities ramp up to help patients by providing ESS and also by easing their fears, they have the opportunity and obligation to model safe behavior while delivering outstanding care.

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