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Resumption of Elective Orthopaedic Surgery in the US Epicenter of COVID-19
Eugene S Krauss1,2,3,4, Ayal Segal1,4, Debra Schulman1,4
1Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, NY, USA.
Insights
New York hospitals adapted to resume elective surgeries post-COVID-19 by implementing rigorous cleaning, patient prioritization, and revised protocols. This ensured patient safety and operational readiness in a challenging healthcare environment.
Area of Science:
- Healthcare Management
- Infectious Disease Control
- Surgical Operations
Background:
- New York State experienced a significant COVID-19 outbreak in early 2020, leading to the suspension of all elective surgeries.
- Syosset Hospital, a facility primarily for elective procedures, was repurposed for COVID-19 patient care during the surge.
- The need to resume elective surgeries necessitated a strategic plan for safe and efficient patient care.
Purpose of the Study:
- To outline the process and challenges of resuming elective surgeries in a hospital setting after a COVID-19 surge.
- To detail the safety protocols and operational adjustments implemented to facilitate the restart of non-essential surgical procedures.
- To describe the prioritization system for rescheduled surgeries and the logistical considerations for a "non-COVID" hospital environment.
Main Methods:
- Designating Syosset Hospital as a "non-COVID" site and performing thorough cleaning and disinfection.
- Implementing a surgeon-led patient prioritization system for cancelled elective cases (scale 1-4).
- Expediting disaster credentialing for surgeons and revising presurgical, surgical, and postoperative protocols based on CDC and local guidelines.
Main Results:
- The hospital successfully transitioned back to providing elective surgical care.
- A structured approach to patient and staff management was established to navigate the complexities of post-surge operations.
- Revised protocols and safety measures were put in place to mitigate risks associated with resuming surgeries.
Conclusions:
- Resuming elective surgery post-COVID-19 required significant adaptation and adherence to new safety standards.
- The "non-COVID" designation and meticulous preparation allowed for the safe recommencement of essential surgical services.
- Hospitals faced unprecedented challenges in managing patient care and operational logistics during the transition period.
Abstract:
On March 1, 2020, New York State confirmed its first case of COVID-19. This state has had the largest initial mortality in the United States with more than 479,000 confirmed cases and over 25,000 deaths as of October 10, 2020. All elective surgeries in New York State were suspended on March 23, 2020, due to the national state of emergency. Syosset Hospital is a 75-bed community hospital dedicated primarily to elective surgery. During the COVID-19 surge, the hospital was converted to provide needed beds for the treatment of COVID-19 illness. In anticipation of the resumption of urgent elective procedures, this hospital became one of the two designated sites within the Northwell Health system to be "non-COVID." Once the hospital was emptied of all inpatients, a complete and thorough cleaning and disinfection was performed on the entire building. All equipment was thoroughly decontaminated following Centers for Disease Control and Prevention (CDC) guidelines. In anticipation of the resumption of elective surgery, each surgeon evaluated their cancelled case list to determine patient priority, based on a scale of 1 (elective, non-urgent), 2 (semi-urgent), 3 (urgent), to 4 (highly urgent). Site-specific disaster credentialing was expedited so that emergent surgeries could be performed by surgeons located at other Northwell sites. To ensure a structured and informative onboarding process, each visiting surgeon received a "welcome" email which requested pertinent information to facilitate the surgical process. Presurgical, surgical, and postoperative protocols were revised based on federal and local guidance and regulations. Resumption of elective surgery post COVID-19 placed the hospital into uncharted territory.
