CMS, ASCA, Accrediting Organizations Release Guidance

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CMS, ASCA, Accrediting Organizations Release Guidance

Key elements to consider before resuming in-person care of non-COVID-19 patients

The Centers for Medicare & Medicaid Services (CMS) released guidance April 19 on restarting non-emergent non-COVID-19 healthcare. If states or regions have passed the Gating Criteria (symptoms, cases and hospitals) the White House announced on April 16, 2020, then they may proceed to Phase I. These recommendations can guide healthcare systems and facilities as they consider resuming in-person care of non-COVID-19 patients in regions with a low incidence of COVID-19 disease.

Decisions must be consistent with public health information and in collaboration with state public health authorities. All facilities should continually evaluate whether their region remains at a low risk of incidence and should be prepared to cease non-essential procedures if a surge occurs. Adhering to the following recommendations can allow for safely extending in-person, non-emergent care in select communities and facilities.

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General Considerations

  • In coordination with state and local public health officials, evaluate the incidence and trends for COVID-19 in the area where re-starting in-person care is being considered.
  • Evaluate the necessity of the care based on clinical needs.
  • Consider establishing Non-COVID Care (NCC) zones that would screen all patients for symptoms of COVID-19, including temperature checks. Staff would be screened routinely as would others who would work in the facility (physicians, nurses, housekeeping, delivery and all people who would enter the area).
  • Sufficient resources should be available to the facility across phases of care, including personal protective equipment (PPE), healthy workforce, facilities, supplies, testing capacity and post-acute care, without jeopardizing surge capacity.

In addition to the general considerations, CMS outlines the following recommendations:

  • PPE for staff and patients;
  • workforce availability and staff screening;
  • facility considerations, including social distancing in waiting areas and maintaining low patient volumes;
  • sanitation protocols, including an established plan for thorough cleaning and disinfection prior to using spaces;
  • adequate equipment, medication and supplies must be ensured and must not detract from the community’s ability to respond to a potential surge;
  • all patients must be screened for potential symptoms of COVID-19 prior to entering the NCC facility, and staff must be routinely screened for potential symptoms; and
  • when adequate testing capability is established, patients should be screened by laboratory testing before care, and staff working in these facilities should be regularly screened by laboratory test as well.

In addition to CMS, ASCA and other healthcare organizations have each identified potential pathways for healthcare providers, including ASCs, to provide care to more patients as the COVID-19 pandemic recedes.

ASCA has released a checklist to help ASCs identify the key elements they need to consider as they prepare to resume in-person care of non-COVID-19 patients in regions with a low incidence of COVID-19 disease.

The checklist does not cover every circumstance that might warrant consideration and does not represent official ASCA policy or constitute legal advice. ASCs should consult with legal counsel, their financial advisers and clinical experts before proceeding.

The Accreditation Association for Ambulatory Health Care (AAAHC) has published a new tool to aid healthcare facilities with identification, isolation and information sharing measures, according to an April 22 release. Based on the CDC guidelines, the ASCA recommendations and their alignment with AAAHC standards reinforce pre-screening measures, social distancing, appropriate personal protective equipment use and treatment and post-operative screening to assess any COVID-19-related symptoms.

“The joint guidance aids our accredited surgery centers by providing clear, actionable methods to limit the spread of infection,” said Noel Adachi, president and chief executive officer of AAAHC, in the release. “By aligning AAAHC standards with the recommendations from ASCA, we are helping our clients perform necessary gap analyses and keep quality of care top of mind.”

The newly released information complements previous educational presentations by AAAHC, including recent webinars and other online resources related to the COVID-19 health crisis, according to the release.

“Our collective efforts are focused on limiting the spread of COVID-19 while helping surgery centers maintain safe operations when performing necessary procedures,” says Bill Prentice, chief executive officer of ASCA. “AAAHC has taken an important step in stressing alignment of industry guidance with established and comprehensive standards related to delivery of care and patient and provider safety.”

The Joint Commission also provides resources on COVID-19.

The ASCA Statement on Resuming Elective Surgery as the Pandemic Recedes, the Society for Ambulatory Anesthesia (SAMBA) Statement on Resuming Ambulatory Anesthesia Care as Our Nation Recovers from COVID-19, supported by the American Society of Anesthesiologists (ASA) and ASCA, and the Roadmap for Resuming Elective Surgery after COVID-19 Pandemic, prepared by the American College of Surgeons, ASA, the Association of periOperative Registered Nurses and the American Hospital Association, can all be found in ASCA’s COVID-19 Resource Center.