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ASCs Implement COVID-19 Safety Measures

Reports from the front line

BY SAHELY MUKERJI | MARCH 2020

As the country battles the COVID-19 pandemic, ASCs across the nation have changed their policies and established new protocols to keep their patients and facilities safe.

“We have updated our policies to reflect COVID-19, per the CDC [Centers for Disease Control and Prevention] guidelines,” says Barbara J. Holder, RN, QI/IC/safety/regulatory officer at Andrews Institute Ambulatory Surgery Center in Gulf Breeze, Florida. “We are requesting that only one healthy family member accompany the patient. In the event that a visitor, rep, employee or physician appears ill, our infection prevention RN verbally screens them for signs and symptoms of COVID-19 versus flu or seasonal allergies.” Any person that has signs and symptoms of COVID-19 would be referred to the local ER or health department, she adds.

The ASC is using an online portal that allows patients to log their medical and surgical history. “They are asked about recent travel and illnesses,” Holder says. “In the event that they answer positively to any of those questions, one of our RNs speaks to them on the phone and digs deeper. Their medical history and screening is then forwarded to our medical director/anesthesiologist for review.”

The employees at the ASC have been educated about the signs and symptoms of COVID-19, personal protective equipment, proper cleaning that affects each department and screening protocols, she says.

Education, screening and handwashing are key, Holder says. “Only conduct face-to-face business when absolutely necessary. We are utilizing WebEx and telephone conference. Conserve supplies, be mindful of shortages and act accordingly.”

Kadlec Clinic in Richland, Washington, has put protocols in place for pre-visit phone screening questions for COVID-19 symptoms 24 hours before the procedures, travel-related questions and environmental questions to assess exposure risks, says Gary Richberg, director of ambulatory surgery centers at Kadlec.

“Our ASC is calling our patients a day prior to their respective procedures and inquiring whether they are experiencing any symptoms that resemble COVID-19,” he says. “If this is the case, the case is canceled, and the patient’s treating surgeon is notified. Patient visitors are limited to one adult in the facility to reduce the amount of foot traffic in the facility and potential exposure risks to others. Vendors are asked not to come to the ORs unless asked by the surgeons.”

Richberg encourages all ASCs to make pre-visit screening calls for symptoms, have patients or escorts who have symptoms follow-up with their PCPs, cancel patients who are symptomatic or have risk factors—travel to China or another area—until cleared by their physician. “Keep educated on COVID-19 and be aware that protocols change frequently,” he says.

“The governor has placed a mandate that elective surgeries need to be cancelled for a three- to six-month period at this time,” Richberg adds. “ASCs perform a high majority of elective cases and, thus, this places a significant challenge for them to remain viable, keep staff and function in a normal manner. ASCs are very adaptable and will need to reinvent themselves for the challenges presented to them by COVID-19.”

Menomonee Falls Ambulatory Surgery Center in Menomonee Falls, Wisconsin, has cancelled all elective procedures until further notice and has deferred all urgent procedures to its owner healthcare system hospital for the time being, says Dianne Appleby, RN, director of the ASC.

“Prior to making the decision to close, we were ready to implement the following,” she reports. “Any patient or accompanying adult was to be screened for ‘fever or symptoms of an upper respiratory infection’ upon arrival. If any symptoms were present, both the patient and their driver were to be asked to return home and reschedule at a later date.

“Any patient or accompanying adult who lives with a family member who currently had a fever or symptoms of an upper respiratory infection was also to be asked to return home and reschedule at a later date.

“Any patient or accompanying adult who recently returned from travel overseas or any other area which the federal government restricted travel was to be asked to return home and reschedule at a later date.”

The ASC was ready to implement the following protocols: the preop calling nurse would screen patients for the above when making the preop call; on admission, the front desk staff were to re-ask the same questions; if the admitting nurse determined a patient was febrile, the patient would be isolated immediately, along with any employee who came into contact with the patient. The ASC would follow CDC and infection control guidelines regarding how to treat the environment from that point on; since the ASC is owned by a hospital system, its staff would be referred to the healthcare system occupational health department for testing and follow up; and the patient would be referred to their primary care physician for testing and follow-up.

Recommendations about best practices for managing response to the coronavirus are evolving rapidly. To keep abreast of the changes, visit ASCA’s online COVID-19 Resource Center and other resources available online.