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Moving to Third Phase of Resumption of Services: Inpatient Surgeries

June 8, 2020
Published in: COVID-19

Main entrance of Augusta Health

On Monday, June 8, Augusta Health moved to Phase III, the final phase of its plan to safely re-open and resume elective services. Phase III adds elective surgeries that require a post-surgical inpatient stay. All these surgeries require COVID-19 testing 72 hours before the procedure and quarantine following the test until the procedure.

"We've continued to monitor our dashboard daily, and are confident in our ability to move into Phase III," says Shawn Craddock, DNP, RN, CNOR, NE-BC, Administrative Director of Surgical Services, who is leading the Task Force on the resuming of outpatient services. "On the surface, Phase III would seem to be the most straight-forward because we are only adding back one service: Inpatient Surgery. That service, though, is our most complicated because even though we are talking about elective procedures, they require admission to the hospital. A good example is knee replacement surgery. The hospital admission means that balancing bed availability with the need for surgical beds becomes crucial."

"As with our Phase II services, patients in Phase III will be tested for COVID-19 approximately 72 hours before the procedure," adds Craddock. "This testing is for the safety of the patient, other patients and the staff. A positive test affects many things surrounding the procedure: the PPE used, the movement of the patient through the hospital and where the patient is admitted. It also means that we need to consider if the surgery should be rescheduled for the safety of all patients and a better outcome for the surgical patient."

Surgical patients are scheduled for a COVID-19 test at the Waynesboro Assessment Center. The test is given by a 'Drive Thru' method to eliminate any time in the waiting room of the Assessment Center. Craddock reports that, on average, test results are known in about 36 hours. A case manager calls the patient if the result is negative; a physician calls if the result is positive. If the result is negative and the procedure proceeds as schedule, the patient needs to quarantine until the procedure.

"It's very important that the patient quarantine until the procedure," explains Craddock. "Once we know the test is negative and we began planning accordingly, it's crucial that the patient does not risk exposure to the virus before the procedure."

An interesting benefit of the pre-procedure COVID-19 testing has been the opportunity to test members of the community. Of more than 650 pre-procedure tests conducted through June 7, only one has been a positive result. The results have been informative and helped to create appropriate Phase III plans and preparations, although concern for community-spread of COVID-19 remains as the community itself begins to "re-open".

"The phased approach we used has been key to our success," says Craddock. "The first two phases have been the building blocks that literally led to Phase III. First we opened diagnostic imaging, then our Skilled Nursing and Rehab units, and then our therapy services. So as we've reached the time for the Phase III inpatient surgeries, these patients have all the support services they need to be successful in place and operating well."

As with Phase II, physicians and surgeons are contacting patients whose procedures were postponed during the pandemic response to reschedule. Most are scheduling the most urgent cases first, so not all patients may have received a rescheduling call. Patients with concerns or a change in their condition should contact their provider's office.

Craddock continues to emphasize these points to all patients and the community:

  • "We follow the CDC guidelines and do everything we can to keep you safe while in our care," he says.
  • The pre-procedure COVID-19 test is important to protect everyone: patient, staff and other patients. The post-test quarantine is equally important to prevent an unknown exposure and perhaps infection.
  • "Keep masking! Keep washing your hands!" adds Craddock. "These things work at preventing the spread of infections. With the community services opening up, some are assuming it means the danger is past and it's safe to stop these preventions, but the opposite is true. As more services open, it's important to be even more vigilant about masking, social distancing and washing your hands."