SCA's Dr. Dan Murrey: How ASCs should approach COVID-19 testing, prepare for another surge

As the chief medical officer of Surgical Care Affiliates, Dan Murrey, MD, played an integral role in the company's response to the pandemic and subsequent resumption of elective surgery.

Here, Dr. Murrey discusses how the company's 230 surgical facilities are ramping up case volume.

Question: How has the pandemic affected operations at SCA's surgery centers?

Dr. Dan Murrey: Like everyone else, we had to halt elective surgery and limit cases at surgery centers during the pandemic. That was a tremendous blow to our operations and surgery volume. The good news is that we have bounced back rapidly; we are at 90 percent of our normal capacity. We are pleased that we have been able to navigate the return to elective surgery for the past several weeks in a thoughtful way that manages patient and teammate safety but also resumes close to normal volume.

The patients we are seeing now were largely scheduled for surgery when the pandemic hit and were delayed, so now they are anxious to have surgery done. We are happy to have a place that did not treat COVID-19 patients where surgeons can perform surgery. That is a safety advantage over the hospitals.

We are now screening patients preoperatively so we can operate with a high degree of confidence that we are creating a safe environment for them.

Q: What policy changes have you instituted during the pandemic, especially around COVID-19 testing?

DM: When the pandemic began, our medical executive board (MEB) met to advise on policy issues. We convened and crafted guidance on defining urgent and emergent surgery and then continued to convene as we worked our way back to elective procedures. Everyone entering the facility has to be screened and temperature tested. They have to wear a mask and we limit visitors at our facilities. SCA also secured a contract with Quest Diagnostics for testing, so all our centers have tests available.

For aerosol generating procedures in particular, and for patients who are at high risk, we test them ahead of surgery. As a result, we have been able to keep anyone who tests positive for COVID-19 out of our facilities. We make sure to have sufficient PPE and manage case flow so that we don't have to disrupt any care due to lack of COVID-19 testing or PPE.

We also changed the air flow in the ORs and extended the exchanges to have full air exchange for patients before they enter a new room. Our team has put a lot of work around changing our terminal cleaning procedures as well, and now we're back up to near normal volumes. We are figuring out how to manage through all of these new processes and still take care of patients.

Q: How do you handle patients who test positive for COVID-19? Are their procedures canceled and rescheduled?

DM: Anyone with a positive screen or test has their case postponed. We ask them to self-isolate per CDC guidance and connect with their primary care physicians for follow-up testing. Once the patients are cleared, they can consider returning for surgical treatment. So far, 0.3 percent of our patients have tested positive preoperatively. We are in the process of getting that data out more broadly, but we have found extremely low incidence of COVID-19 tests in our asymptomatic patients.

Q: How are you measuring and anticipating additional surges of COVID-19 around the U.S.?

DM: We created a dashboard that monitors our testing data. It examines how many positive cases there are in different regions of the nation and we correlate that with publicly available data on the effective transmission rate that determines whether you are getting more or less COVID in each community. We monitor how rapidly that spreads as well as hospital occupancy rates, which is another marker of where cases are increasing.

We also created guidance recently that when case rates and hospital occupancy rates go up we recommend more testing and have additional guidelines for clinical teams and medical directors to use as guideposts for when they should be monitoring for a potential resurgence. We are also monitoring PPE levels. So far, we have been fortunate to have access to the PPE we need, but want to make sure there will be enough to continue operations.

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