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editorial
. 2020 May 19;220(3):561–565. doi: 10.1016/j.amjsurg.2020.05.024

Table 1.

Institutional playbook for Administrative and Surgical Staff for rescheduling elective surgery.

Surgical Staff
Administrative staff
Before Telehealth Visit
  • •
    Inform protocols to prioritize case scheduling that consider:
    • •
      the clinical urgency of the clinical diagnosis
    • •
      resources required to do the case (e.g. PPE, staff, number of hospital days, etc.)
    • •
      length of delay that the patient has already experienced
  • •

    Inform the development of objective scoring system based on case specific historical institutional data to help prioritize cases in a way that is equitable and sensitive to resource allocation.
  • •
    Identify patients via EHR whose original operations were postponed
    • •
      Patients originally scheduled for ambulatory surgery (i.e. outpatient) are scheduled first for a telehealth visit. Within this group, priority is given to those who had their operation postponed the earliest.
  • •

    Schedule individual patient for a video visit with the Provider within the next two weeks.
Date of Telehealth visit
  • •

    Confirm the indications and need for surgery including the impact of symptoms on quality of life. Non-surgical options should be discussed and considered.

  • •

    Discuss the patient’s current health situation and pertinent changes from the previous clinical visit, including the need to reschedule any required ancillary testing and/or evaluation (e.g. laboratory tests, radiographic or endoscopic procedures, referrals, prior to rescheduling the operation.

  • •

    If a patient’s health status has changed since the most recent preoperative assessment clinic evaluation, a follow-up evaluation should be scheduled

  • •

    Assure patient that we feel confident that we can safely move forward with the procedure while minimizing risks.

  • •

    Make a joint decision with the patient about proceeding with surgery using your best clinical judgment. If the patient wishes to proceed with scheduling, inform them they will undergo testing for COVID-19 and will be provided information about this once they are scheduled.

  • •
    Update inform consent to include an explicit discussion about the steps the institution has taken to mitigate the risk of contracting COIVD-19 during the elective surgery, including pre-operative testing, daily screening of staff, and use of appropriate PPE. Patients should also be informed about visitor restrictions.
    • •
      Additionally, discuss that contracting COVID-19 could affect the post-operative recovery process and that rehabilitation services and post-operative care may be provided utilizing virtual visits or telephone visits in order to limit in-person interactions.
  • •

    Complete the COVID-19 Surgical Recovery Worksheet and send to your Administrative Staff/Appointment Scheduler.
  • •

    Ensure provider knows to complete the COVID-19 Surgical Recovery Worksheet for every patient.

  • •

    After the patient has been seen by the Provider, open the COVID-19 Surgical Recovery Worksheet, and ensure the Provider has completed their sections.

  • •
    Complete the remaining section and save form. and input the Elective Procedure Stoplight Flag for case rescheduling as follows (obtained from the COVID-19 Surgical Recovery Worksheet), directly into the Depot:
    • •
      Red Light – the patient does not want to pursue rescheduling the operation and does not want us to initiate further contact about the operation
    • •
      Yellow Light – the patient is unsure about rescheduling the operation at this time and needs repeat contact at a later date
    • •
      Green Light – the patient would like to proceed with rescheduling the operation
  • •

    Confirm with the Provider any ancillary testing (e.g. laboratory tests, radiographic or endoscopic procedures) or other consultations that may need to be performed prior to the new operative date.

  • •

    If a patient’s health status has changed since the most recent preoperative assessment clinic evaluation, a follow-up evaluation should be scheduled.
After Telehealth Visit
  • •

    Provide preoperative teaching as required for the operation.

  • •

    Review medications to be held or modified prior to the procedure (e.g. anticoagulation or antiplatelet therapy) and duration for withholding.

  • •

    Confirm that the patient has information about risks of contracting COVID-19 with elective surgery and potential impact on recovery

  • •
    Make the patient aware of current information about COVID-19 at website and precautions being taken to ensure their well-being:
    • •
      Every surgical patient will be proactively tested at least 72 hours before surgery for COVID-19 and will need to remain quarantined until their procedure takes place.
    • •
      There will be emphasis on social distancing, screening for temperature and symptoms, visitor restrictions, and widespread use of personal protective equipment such as masks.
    • •
      All COVID patients are cared for on dedicated units separate from all others.
  • •

    Initiate communication with other providers as needed for additional information regarding held or modified medications. o There will be emphasis on social distancing, screening for temperature and symptoms, visitor restrictions, and widespread use of personal protective equipment such as masks.
  • •

    Schedule any pre-surgery testing, referrals, or Preoperative Assessment Clinic visits.

  • •
    Schedule preoperative COVID-19 testing at least 72 hours before surgery for COVID-19
    • •
      Remind patient to remain quarantined until their procedure takes place.
    • •
      Provide patient with information and logistics regarding preprocedural COVID-19 testing
  • •

    Inform the patient that we will contact them to schedule their surgery.

  • •
    When confirmation is obtained to proceed with rescheduling, reschedule patient operations designated as Green Light procedures only when confirmation is obtained to proceed with rescheduling.
    • •
      After confirmation has been obtained to proceed with Phase 1 of the Responsible Return to Surgeries and Procedures, only ambulatory surgery procedures should be rescheduled.
    • •
      After confirmation has be obtained to proceed with Phase 2 of the Responsible Return to Surgeries and Procedures, certain non-ambulatory surgery procedures can be rescheduled. Instruction regarding which non-ambulatory surgery procedures that can be scheduled during Phase 2 will be forthcoming.
  • •

    Develop a call plan to contact Yellow Light patients and contact them within 2 months.