As more states allow elective procedures to resume, orthopedic practices and surgery centers are working tirelessly to restart their surgical programs.
Here, four administrators share what they've done to reopen their centers and prevent the spread of COVID-19.
Note: Responses have been edited for style and clarity.
Joshua Alpert, MD, orthopedic surgeon at Midwest Bone & Joint Institute (Elgin, Ill.): The clinicians at Midwest Bone & Joint Institute are available for in-office appointments and are scheduling elective surgeries with the following policies and procedures in place:
- All staff must wear masks in all areas while on the premises
- Our staff is meticulously sterilizing all areas in between patient visits
- Our waiting room has been reconfigured to adhere to social distancing guidelines
- When necessary, patients may be asked to wait in their vehicle if social distancing cannot be maintained in the waiting room due to patient volume
When an appointment is scheduled, the patient is notified that [Illinois] requirements state they must wear a mask to their appointment, and that they will be asked about recent travel, illness, or exposure to any COVID-19-positive patients. Upon check-in, each patient has their temperature read using an infrared thermometer. Patients are requested that they not bring companions to an appointment with them unless they require a translator, guardian or special accommodation. We send periodic reminder emails and texts to our patients about these policies to keep them informed and ensure that they feel safe and confident in our care.
Additionally, all patients are being tested for COVID-19 48 to 72 hours prior to their scheduled surgical procedure and are then required to self-quarantine from the time they are tested until their surgical procedures are performed. Testing is typically ordered by the surgeon but arranged and completed by the hospitals or surgery centers where the procedure will be performed.
Alan Beyer, MD, orthopedic surgeon and executive medical director, Hoag Orthopedic Institute (Irvine, Calif.): HOI has proceeded with limited elective surgical procedures. [We're] monitoring the data daily and willing to adjust as necessary based on current conditions. The move to slowly and carefully resume scheduled surgical procedures was made in the context of recent guidance from federal, state and local government agencies and in alignment with the approach recommended by the American Academy of Orthopedic Surgeons and other clinical professional organizations.
We have developed and implemented additional safety measures to protect our patients, clinicians and staff members in accordance with CDC and other federal, state and local guidelines. In addition, we resumed performing elective orthopedic procedures on carefully selected patients first, primarily on an outpatient basis and on those patients with fewer health-related issues that might increase surgical risk. We have an outstanding clinical care team and we are all excited to resume orthopedic care for our patients, as many are quite limited by their musculoskeletal conditions.
Out of an abundance of caution, all patients undergoing elective surgery procedures are required to obtain COVID-19 testing three days prior to surgery. Following the test, all patients will be required to quarantine at home prior to arrival at the facility for their surgical procedure.
HOI has taken additional safety measures to ensure the safety of all, including:
- Patient screening at admission in accordance with CDC guidelines, including temperature, health and travel history
- Visitor limitations
- Screening and limiting all personnel to facility
- Limiting personnel in the operating room
- Implementing new protocols and procedures for staff and clinicians including but not limited to masking, distancing guidelines and hand-washing
Pamela Bronson, administrator at Access Sports Medicine & Orthopedics (Auburn, N.H.): Recapturing lost surgical volume: Our first goal is prioritizing the backlog of patients who have been waiting for their elective surgery these past several weeks. With more staff working from home during the quarantine, we focused our resources on checking in with patients who canceled or postponed their surgery to ensure their well-being as well as following up to reschedule surgery dates. We also ramped up our communication with patients and our community on both our current status and other relevant and helpful information as a way to stay connected.
Ensuring your supply chain inventory stays uninterrupted: We worked closely with our current suppliers to order the maximum allowable amounts of supplies that were being limited due to nationwide shortages and in order to secure an adequate level of supplies needed to reopen. We are also very fortunate that our state was able to secure the necessary amount of personal protective equipment including gowns and masks that were otherwise not available or limited by our current suppliers.
Best practices around making your patient areas COVID-19-safe: We have adopted and implemented all published state, federal and other guidelines as they are updated, including temperature checks for all patients and staff, no-visitor policies, and use of appropriate PPE at all times. We stay current with any new guidelines as they become available. Our state has been able to provide us with an adequate supply of PPE and COVID test kits to be used as needed in order to reopen safely. We are administering the COVID tests ourselves, and the state is providing test results within 48 hours offering an additional level of assurance in addition to our rigorous and timely screening of all patients and staff. We had a "deep cleaning" of the facility, which tests surfaces for the presence of bacteria and other agents post-cleaning. We are confident we are doing everything possible using all available resources to keep our patients and staff safe.
William Ritchie, MD, orthopedic surgeon at New Mexico Surgery Center Orthopaedics (Albuquerque): New Mexico guidelines for expanding surgical cases include screening patients 72 to 48 hours preoperative for COVID-19, but antibody testing is not recommended.
All patients are surveyed for respiratory complaints, exposure to infected persons and fever. Patients are then asked to self-quarantine after they are tested until two weeks post-procedure.
Masks are mandatory in the surgery center, and patients are only allowed one person to accompany them as they check in and check out. We aren't allowing visitors to remain in the surgery center unless the patient is a minor. The state mandated surgery centers operate at 50 percent volume for the first two weeks until the governor establishes new guidelines. We'll follow guidelines from the Ambulatory Surgery Center Association and American Academy of Orthopaedic Surgeons otherwise.
Initially, the center will perform cases that can be done under local and/or regional anesthesia. When intubating and extubating, personnel in the operating room are limited, and [the anesthesiologist] wears a powered air purifying respirator-type device. Patients who might require admission to acute or other care will still be postponed.
We intend to extend hours slightly to accommodate longer turnover times for cleaning and anesthesia, and we are considering operating on Saturday to accommodate the longer times as well. To figure out our caseload, surgeons are being asked to submit waiting lists of cases to help with scheduling and assigning block time.