On 17 April, the American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, and the American Hospital Association released a joint statement outlining guiding principles and considerations that should be adhered to as healthcare providers seek to resume performing elective healthcare procedures. The three major guiding principles note when to begin reintroducing elective procedures, necessary Covid-19 testing capabilities, and ensuring the use of required personal protective equipment (PPE) for frontline workers.

The joint statement suggests that for a facility to begin performing elective procedures, there must be a sustained reduction in local Covid-19 cases over at least 14 days, the state authorities must authorise the reinstatement of elective procedures, other state facilities should be able to safely handle the current Covid-19 caseload, and sufficient beds and intensive care unit (ICU) equipment, such as ventilators, should be stocked in the facility. Additionally, the joint statement suggests that the facility should be prepared to use available Covid-19 testing as a means to protect both patients and staff. Preoperative testing should be used where appropriate, and measures should be put in place to handle the possibility of a staff member or patient testing positive for Covid-19 in order to prevent the spread of the virus within the facility. The elective healthcare procedures statement suggests that facilities looking to reinitiate elective procedures should be fully stocked with the required PPE for the procedures being performed. Additionally, facilities should be fully prepared for the second wave of Covid-19 infections, with staff fully trained on the non-crisis use of all equipment according to evidence-based standards of care. The statement also suggests that facilities should maintain social distancing policies that are in line with local and federal guidelines.

These guidelines have been released in response to healthcare providers furloughing workers after losing huge portions of their revenue due to cancelling elective procedures. The US government included $100B in its Covid-19 stimulus bill to assist hospitals, but providers such as Bon Secours Mercy Health, Boston Medical Center, St. Claire Healthcare, Appalachian Regional Healthcare, and Baptist Health have all begun furloughing workers despite this aid.

Elective procedure volume is expected to increase as healthcare providers begin to reinitiate procedures once local and regional Covid-19 caseload curves have flattened and reduced in a sustained manner. The US appears to have flattened its curve, but new daily cases are still near peak levels, with over 40,000 deaths occurring due to the pandemic. Patients’ uncertainty about both the virus outbreak and a facility’s capacity to protect them are expected to slow the growth of elective procedures until vastly reduced daily caseloads are observed.

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