Uncategorized

Update on Elective Surgeries/Procedures

As coronavirus (COVID-19) continues to evolve, we have made it our goal to keep you informed as we have updates to share. We are in the midst of a significant shortage of personal protective equipment (PPE) in both Ohio and the nation as we continue to see an increase in demand with the spread of the virus.

This shortage has called into question the status of elective procedures. The U.S. surgeon general, American College of Surgeons, and numerous other public health experts in recent days have recommended the cancellation of all elective surgeries and procedures which use PPE. Orders released by the Governor of Ohio define and limit the performance of these procedures during this virus outbreak.

To comply with these guidelines, elective surgeries and other elective procedures which use PPE within Kettering Health Network facilities will be postponed until further notice, effective at the close of business of Wednesday, March 18. Please keep in mind that this applies to procedures outside of surgery, including endoscopies as well as cardiology and interventional radiology.

This decision has been made in coordination with public health experts and government leaders and was not taken lightly. We understand this decision will have significant impact, and we would like to reiterate that it was made with the intent to be consistent with other Ohio Hospitals. In addition to preserving necessary PPE and inpatient beds for critically ill patients, this step will provide protections for patients and providers.

This policy applies to surgeries and procedures defined as cases that do not meet at least one of the following criteria:

  • Threat to the patient’s life or limb if surgery is not performed;
  • Threat of permanent dysfunction of an extremity or organ system;
  • Risk of metastasis or progression of staging;
  • Risk of rapidly worsening to severe symptoms, meaning the surgery/procedure is time sensitive

In general, a process has been developed to manage the functionality and specifics on a day-to-day basis. The overall approach is to keep as many of our current processes in place as possible. While significant changes are planned, this approach will be as least disruptive as possible.

An algorithm has been developed for emergent cases and essential cases. The definition of “emergency procedure” has been defined by the Governor as life or limb threatening. The definition of “essential procedure” has also been defined by the Governor as preventing permanent dysfunction to extremity or organ, worsening cancer, or rapidly worsening/severe symptoms. Our new process requires case-by-case approval to determine appropriateness, resource consumption, timeliness, and network uniformity.

Our strategy to treat patients and protect others includes limiting non-essential personal in surgeries and procedures to minimize use of PPE and creating a governance structure to assist physicians and administrative personnel in determining if cases fall within anticipated state guidelines if questions arise.

We ask our physician offices to please contact patients who have elective surgeries or procedures scheduled AFTER Wednesday, March 18 to let them know their appointment has been postponed AND that they will be contacted later to reschedule.

Perioperative Services including scheduling, PAT, pre- and post-op are all available and ready to schedule and perform procedures. Processes are being put in place to review cases (see attached). In addition, physicians will be asked to attest to the rationale for the procedure.

As of March 19, all providers performing procedures in a designated procedural area that requires personal protective equipment are required to include the SmartPhrase titled “COVID19SURGEONS” prior to performing the procedure.

You may contact any of our CMOs or the Vice President of Clinical Performance for questions.

Dr. Robert Smith, KMC / SMC / Troy
Robert.Smith@ketteringhealth.org

Dr. Michael Caccamo, GV/SV
Michael.Caccamo@ketteringhealth.org

Dr. Steven Crawford, IRSMC/GMH
Steven.Crawford@ketteringhealth.org

Dr. David Doucette, KPN
David.Doucette@ketteringhealth.org

Dr. Marcus Romanello, Fort Hamilton Hospital
Marcus.Romanello@ketteringhealth.org

Dr. Patrick Lytle, KHN
Patrick.Lytle@ketteringhealth.org

March 19, 2020