How a 2nd round of elective surgical delays will affect ASCs — 6 administrators share insights

As increasing COVID-19 case counts shut down elective surgical programs across the U.S., six administrators shared their thoughts with Becker's ASC Review on what the shutdowns could mean for their centers.

Note: Responses were edited for style and content and are presented alphabetically.

Suzi Cunningham, administrator of Advanced Ambulatory Surgery Center in Redlands, Calif.: The current surge we are seeing here in California and across many states right now is very concerning. Our center has implemented strict protocols so we can safely continue to provide much needed orthopedic care to patients in our community while also providing a safe environment for our staff, patients and providers to work. Since a shutdown did happen earlier this year, we know this is a real possibility. The impact of this [will be] far-reaching as people who are in extreme pain are forced to wait for surgery and in some cases with long-lasting health implications.

If we are able to remain open, we can take the pressure off of the local hospitals by caring for their trauma cases, not to mention being able to provide a means for our staff to continue to work and provide for their families.

Robert Lerma, administrator at Blue Springs Surgery Center in Orange City, Fla.: What I have seen in the media and at our center is that an elective procedure a patient would normally have chosen to correct a medical condition prior to the COVID-19 pandemic, is now deferred. In certain cases, it is only those procedures that are emergent in nature that are being chosen by the patient.

The older patient may have medical issues that may be further complicated with the induction of anesthesia or procedures that are more invasive, which may result in a longer procedure time in the operating room. Those procedures unless emergent, are sometimes being delayed.

Our surgeons are spending more time educating our patients that an ASC is just as safe now as in pre-COVID times. Furthermore, there are extra precautionary steps that ASCs have implemented to minimize the risk of spreading the virus:

  • The wearing of masks by our staff
  • Social distancing within the ASC space
  • Preoperative COVID-19 testing 
  • Continuance of hand-washing and all other aseptic techniques that were used prior to the COVID-19 pandemic

I anticipate COVID-19 spikes reducing surgical procedure volume within our ASC, and our challenge is to educate our patients on the extra precautionary steps we have taken to maximize their safety.

Alex Andrade. Vice President of Ancillary Operations at DuPage Medical Group (Downers Grove, Ill.): As COVID-19 surges, we know our patients will still have non-COVID-19 related healthcare needs and we will continue to be there to care for them. As hospitals in our communities may need to eliminate elective procedures to decompress the healthcare system and reallocate resources towards inpatient care, our outpatient model allows us to help fill the gaps.

Now more than ever, patients are seeking an outpatient environment for their surgical procedures that is safe, comfortable and away from people who are sick. To ensure the safety of our patients, physicians and associates, we continue to evaluate each case and use clinical discernment to determine the right time and the right environment for each surgical procedure. We’ve also implemented enhanced cleaning protocols and a thorough testing and screening process. Each patient that is having a surgical procedure at our ASC is tested for COVID-19 according to standards set by the Illinois Department of Public Health, and anyone who enters our ASC is properly screened.

Bonnie Brady Lavoie, RN, vice president of operations at West Morris Surgery Center in Succasunna, N.J.: If elective procedures are closed down again for spikes, then we expect to see decreased volumes. However, if they close electives for hospitals only, then ASCs can benefit from providing care to those patients for emergency care. In New Jersey, we were allowed to care for those emergent elective procedures during the last spike. Some centers did not follow the governor's executive order and continued to do those procedures that may not have been emergencies and reported volumes stayed the same or increased. That should not be the case if you were compliant. For centers following the orders, we would probably see a decrease in volume but will stay compliant for the safety of patients and staff.

Joleen Harrison, BSN, RN, administrative director at Mankato (Minn.) Surgery Center: With the spike in COVID-19, we anticipate patient volumes to decrease some. We are uncertain of how many. Minnesota is in a four-week shutdown. ... We have [a] 50 percent orthopedics [case mix] which this [shutdown] could impact with fewer sports injuries. The other deciding factor is those that may be without jobs and lose healthcare coverage. [For patients losing] either, it may become cost prohibitive to have a surgical procedure. We have started to see more patients cancel or delay with a COVID-19 exposure who are either quarantining or are out with COVID-19. Our surgery center hopes COVID-19 numbers decrease with the new executive order in place. We wish for all to stay safe in the next weeks to come.

Raghu Reddy, administrator at SurgCenter of Western Maryland in Cumberland: Our community is experiencing a higher infection rate than the rest of the state at the moment. The hospital has opened a tent-based triage unit and additional COVID-19 units to accommodate the steep increases in community infections. We have canceled several days in the past week due to staff shortages and anticipate that the cancellations could continue intermittently until the infection rate is low again. We are also experiencing a shortage of N95 masks and a few other types of personal protective equipment, which has become a significant challenge. Fortunately, our hospital partner is assisting us with this situation, and we are doing our best to protect everyone while performing the cases. Overall, during this pandemic, except for the mandated shutdown, our ASC volume has fared better than we expected. However, the recent surge is imposing our case volume due to closures. We are in constant communication with the health department and the hospital regarding the community spread and patient and staff testing, and plan the center's operations accordingly.

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