Spine surgeon Nitin Khanna, MD, advocated for orthopedic surgeon leaders to develop a pathway back to elective surgeries in an article published in the International Society for the Advancement of Spine Surgery.
Dr. Khanna, who practices in Munster, Ind., outlined nine key areas where strategies can be implemented to help practices return safely to elective surgery.
1. ASCs: As freestanding ASCs have no emergency rooms, sick patients or ICU beds, there is a decrease in the overall COVID-19 infection risk. It is important to install a system that minimizes the risk of COVID-19 transmission based on current understanding of the disease.
2. Patient check-in and visitor management: Patients must check in alone and have companions wait outside the facility. Once surgeries resume, companions can be virtually updated when the patient enters the OR and when the procedure is completed.
3. Temperature: Patients and staff must have their temperatures checked on the day of surgery. Patients with temperatures over 100°F should not be permitted in the facility.
4. Masking: Universal mask-wearing should be enforced in all healthcare facilities.
5. Intraoperative care: Only an anesthesiologist and a nurse should be allowed in the OR during intubation.
6. OR turnover: To ensure a sterile environment, turnover will require 30 minutes in negative pressure ORs with antiviral disinfectant. This may slow the two-room strategy that many surgeons adapt.
7. PPE: Longer surgical cases will present a challenge. There is a need for surgical masks with newer sterilization technology, advanced filtration head gear and updated eye protection.
8. Insurance contracting: Improved competitive contracts need to be offered for ASCs, in line with hospital reimbursements for similar procedures. This would provide access for patients seeking elective surgery, but have concerns about out-of-network charges.
9. Hospital or freestanding ASCs: Cordoning off hospital ASCs from their main ORs will address challenges presented by shared staff and equipment, as well as population overflow between the two facilities.
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