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CommonSpirit HealthRestriction of Elective SurgeriesMarch 23, 2020The COVID-19 pandemic continues to accelerate globally and nationally. A significant surge in patients needing evaluation and/or hospitalization is imminently expected. In the context of inpatient and intensive care unit capacity constraints, limited equipment and national shortages of personal protective equipment (PPE), all healthcare facilities and systems in the country must reprioritize the allocation and use of their resources.The postponement and rescheduling of elective surgeries is an important way to create and preserve surge capacity. The Centers for Medicare and Medicaid Services (CMS) and numerous professional societies, such as the American College of Surgeons (ACS), agree and have recommended healthcare facilities defer elective surgeries. In addition, several states and municipalities have mandated restrictions on elective monSpirit Health supports these recommendations and will place immediate restrictions on elective surgeries, and defer some non-emergent cases. The urgency of a surgery or procedure cannot be determined solely by reviewing operating or procedural room schedules. Each case must be evaluated individually, and the specific circumstances regarding the patient and facility must be considered. All emergent surgical procedures should proceed without delay, but non-emergent surgical procedures should be evaluated.To assist in the evaluation, CommonSpirit Health will follow the ACS COVID-19: Guidance for the Triage of Non-Emergent Surgical Procedures and adhere to the following algorithm:Tier 1a and 1b (low acuity surgery, not involving a life-threatening illness)Surgical procedures should be postponed until further noticeTier 2a and 2b (intermediate acuity surgery, not life threatening but potential for future morbidity and mortality)Surgical procedures should be postponed until further notice, if the patient is at risk for COVID-19 or the procedure might place the patient at greater risk for COVID-19; is likely to require time in intensive care or an extended length of stay (i.e., greater than 4 days); or will necessitate transfer to a post-acute care facilityRisk factors for COVID-19 include age over 65 years, immunocompromise, lung disease, cardiovascular disease and diabetesSurgical procedure may otherwise proceed if a delay could deteriorate the patient’s health outcomeTier 3a and 3b (high acuity surgery, involving a life-threatening illness)Surgical procedure should proceed as plannedEach CommonSpirit Health facility should ensure that all surgical and procedural departments establish a team or identify a clinical leader who will be responsible for reviewing all scheduled cases. Generally, reviewers should be a member of the Medical Staff. All scheduled cases should be reviewed in advance and classified into one of the three Tiers.Two additional considerations with respect to establishing a review team. First, you should regularly apprise the local Chief Medical Officer (CMO) of the team’s recommendations, to assist with any questions or concerns from scheduling surgeons. Second, you should coordinate with your local CommonSpirit Legal Team attorney to the extent that new, or adjustments to existing, Medical Director Services Agreements or Administrative Services Agreements may be needed to cover the services provided by the review team members. If the facility resides in a State that has issued more restrictive requirements, then those requirements should be followed.Any changes to a surgical or procedural schedule are disruptive to all involved—patient, physician and staff. Nonetheless, this interim change is necessary to maintain capacity and preserve every piece of PPE needed to keep our healthcare workers safe.The need to continue to postpone elective surgeries will be regularly reviewed and guidance will be updated as circumstances dictate.Thank you for your understanding.Robert L. Wiebe, MD, MPHChief Medical Officer, CommonSpirit HealthDistributed March 23, 2020 ................
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