How ASCs are approaching COVID-19 testing

ASCs across the U.S. are figuring out how to approach COVID-19 testing of patients and staff at their centers.

While some centers are testing all patients ahead of procedures, others without access to testing are proceeding with protocol assuming all patients could have the virus. Below are the policies six centers have adopted in recent months.

Note: This information was gathered in the past four weeks. Given the rapid pace of change during the pandemic, some protocols may have changed. However, this is an example of the policies ASCs have implemented in the past month.

Joshua Alpert, MD, orthopedic surgeon at Midwest Bone & Joint Institute (Elgin, Ill.): 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.): 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.): 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.

Michelle Eilander, RN. Administrator of Ankeny (Iowa) Park Surgery Center: We have implemented several new procedures and protocols, including employee screening, visitor restrictions, requirement of COVID-19 testing on all patients within 48 hours of their scheduled surgery and confirmation of a negative result. All patients are required to self-quarantine following their test.

John Lewis. CEO of Semmes Murphey (Memphis, Tenn.): During the recent shutdown, our staff used that opportunity to expand and improve procedures and policies that are in line with CDC guidelines related to COVID-19, and we have invested in new technologies that will provide added levels of safety in the clinic, ASC and back-office areas. Some of the things we have done include: required COVID-19 testing for all surgical patients 72 hours prior to any scheduled surgery procedure [and] implemented routine COVID-19 testing for all ASC physicians and staff.

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