Massachusetts Society of Plastic Surgeons

NORTHEAST REGION COVID-19 COALITION

GUIDELINES FOR RESTARTING ELECTIVE SURGERY POST-COVID-19
These principles apply to all practitioners performing these types of procedures regardless of scope of practice or setting.

(Applicable to hospital, ambulatory surgery center and office-based settings)


PRACTICE RE-OPENING CONSIDERATIONS

The Northeast region is fairly diverse in how it has been impacted by COVID-19. With that said:

Non-COVID-19 care should be offered to patients as clinically appropriate and within a state, locality, or facility that has the resources to provide such care and the ability to quickly respond to a subsequent surge in COVID-19 cases, if necessary. The recommendations outlined here are a working document and are subject to change and will be updated as the COVID-19 situation continues to evolve.

Maximum effective utilization of facilities to meet elective surgery patient needs requires that each practice setting (hospital, ASC or office-based) independently develop prioritization plans within the scope of its individual capabilities and conforming to all state and local regulatory safety standards as outlined in this document.


To begin this process, certain principles must be considered:

Gating criteria (Local / Regional hospital epidemiologic data):

Must know COVID-19 testing capacity and capabilities (all levels).

Your facility/office must have a transfer policy with receiving acceptance hospital in place.


COVID-19 TESTING/SCREENING CONSIDERATIONS

DRIVING PRINCIPLE: WITHOUT NEGATIVE PREOP COVID-19 TEST (RNA/PCR), NO SURGERY SHOULD BE PERFORMED

Screening


Screening should be done immediately upon entering facility for patients and staff (temperature and a focused history).

Testing for COVID-19

LOCAL PREVALENCE OF COVID-19 X FALSE NEGATIVE RATE OF COVID-19 TEST

Given these numbers, it is impossible to recognize all asymptomatic COVID-19 patients preoperatively, so all surgical patient should be treated as if they are COVID-19 positive patients.

At this point in time, antibody serology testing is not considered reliable and does not address the needs of these guidelines. Further, a link between a positive antibody serology test and immunity has not been established


Patients / Staff Screening / ing Positive for COVID-19

Preoperative Clearance


PERSONAL PROTECTIVE EQUIPMENT (PPE) CONSIDERATIONS

DRIVING PRINCPLE: WITHOUT APPROPRIATE PPE REOPENING AT ANY LEVEL CANNOT AND SHOULD NOT OCCUR

PPE Supply Level


Each facility/practice should ensure that it has enough and appropriate PPE supplies. These supplies should include, but are not limited to:

How often do you change PPE/Ability to Reuse or resterilize PPE


OFFICE/FACILITY CONSIDERATIONS

DRIVING PRINCIPLE: EXPEDITED TESTING FOR POSTOPERATIVE SYMPTOMATIC PATIENTS

Screening

Social Distancing

Cleaning


OR/PERIOPERATIVE/POSTOPERATIVE/CLINICAL CONSIDERATIONS

DRIVING PRINCIPLE: ANY SYMPTOMATIC PATIENT FOR OFFICE VISIT, PROCEDURE, OR SURGERY SHOULD NOT ENTER THE FACILITY AT ANY TIME. THIS INCLUDES COUGH, FEVER, RUNNY NOSE, SORE THROAT, ETC.) THOSE THAT NEED EMERGENT OR IMMEDIATE CARE SHOULD BE REFERRED TO THE EMERGENCY ROOM OR OTHER URGENT CARE VENUE WHERE POSSIBLE (COVID-19 READY FACILITY)

Scheduling Considerations / Prioritization of Cases and Procedures:


In the event that scheduling of operations needs to be phased in, the following scoring factors can be considered (MeNTS Instrument), with the recognition that prioritization will be made at a hospital and surgeon level dependent on state/local factors:

Surgical Capacity Considerations

PPE for Surgery Considerations:

What PPE is needed for each type of surgery?

Anesthesia Considerations

Operating Room Considerations

Recovery Room Considerations


MINIMALLY INVASIVE PROCEDURES (e.g. Botox/Fillers/Cool Sculpting/Lasers)


ADDITIONAL RESOURCES


NORTHEAST REGION COVID-19 COALITION SOCIETY MEMBERS


NORTHEAST REGION COVID-19 COALITION ENDORSEMENT


NORTHEAST REGION COVID-19 COALITION MEMBERS

Updated May 27, 2020

By using this site, you agree to our updated Privacy Policy.  Got it