Resuming Elective Surgeries and Procedures – Special Resource

Written April 29, 2020

Important Note: Orders, regulations, and guidelines from state and local public health agencies may be issued within the next few days on procedures to be used in resuming elective surgeries and procedures. Our insureds should pay close attention to what local agencies may issue and comply accordingly.

Working together and sharing information is essential to address the COVID-19 crisis. As part of our commitment to you, KAMMCO has developed and compiled resources for you. While you necessarily make decisions on a case-by-case basis using your clinical judgment, we wanted to provide you with some resources and tools that might be of assistance in a given environment or situation. We hope you find value in this document and are proud to contribute as we move forward in the fight against COVID-19.

- Kurt Scott, President and CEO of KAMMCO

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As some of our insureds prepare to resume elective surgeries or procedures during the COVID-19 pandemic, below are a few ideas and resources that you may find helpful:

• Communication Materials
Consider creating informational material for your patients, e.g., “What You Should Know About an Elective Surgery or Procedure During the COVID-19 Pandemic.” Such patient education could contain helpful information for the patient regarding elective surgeries during the COVID-19 Pandemic. In creating such an informational document, consider how to make the information available to the patient and amend the information as circumstances change.

This document might describe whether an elective surgery or procedure needs to be performed at this time and whether COVID-19 infection risks are heightened for the elective surgery described. Other information could include, but not be limited to: determination of surgery or procedure priorities, COVID-19 testing policies for patients and staff, COVID-19 counseling information, patient safety considerations, PPE use, patient family and visitor policies, post-discharge follow-up, advanced directives, and the potential for necessary resources being unavailable should the patient become infected. The document could be referenced in the Special Consent Form referenced in the next section.

A helpful reference for the messaging of the communication is: “Local Resumption of Elective Surgery Guidance” published by the American College of Surgeons.
• Special Consent Form
Consider creation of a “Special Consent Form for An Elective Surgery or Procedure During the COVID-19 Pandemic”. To help get you started, here is a link that could be adapted by you for use in your practice setting. Such a Special Consent could be used along with your usual and customary consent or you could embed some of the COVID-19 Special Consent language into your customary Consent. If you have questions about adapting the Consent, feel free to reach out to our Risk Management Department or to your other advisors.

Below is a link for a sample template for such a form. KAMMCO’s sample template is only an example. It is not legal advice under any circumstances. Each insured should consider what information needs to be contained in their own Special Consent Form and patient education communication, then consult with their health care attorney for review. Download a copy of the suggested sample consent template.

Special Consent Form Example
• Additional Resources:
The resources contain other factors and data points that you may find helpful as you move forward with elective surgeries or procedures. While we will work to keep these resources updated, you should confirm the resource is the most recent statement by the publishing organization prior to using it.
1. Joint Statement - Roadmap for Resuming Elective Surgery After COVID-19 Pandemic
This is a collaborative statement issued by the American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, and the American Hospital Association. The State addresses several general categories of factors to consider as you move to resume elective surgery: geographic location, rate of reduction in new COVID-19 cases during the last 14 days, sufficiency of staff equipped to treat all elective patients, testing capacity for staff and patients, PPE, case prioritization, ability to manage non-COVID-19 patients through the 5 stages of surgical care, collection and management of data with ongoing assessments to re-evaluate policies and procedures, and consideration of a second wave of COVID-19 patients.
2. Opening Up America Again - CMS Recommendations on Re-Opening Facilities to Provide Non-Emergent Non-COVID-19 Health Care: Phase 1
This is a statement issued on April 19, 2020, by the Centers for Medicare and Medicaid regarding “non-emergent, non-COVID-19 healthcare.” You may find it helpful to review the gating criteria for phases 1 and 2 in the Opening Up America link below.
Considerations include:
  • Activity of state and local public health departments
  • Adequacy of facilities, testing supplies, and workforce to provide care during different phases
  • Evaluation of COVID-19 incidence trends
  • Evaluation of the clinical needs for the elective surgery or procedure
  • Ability to establish “non-COVID care zones”
  • Adequacy of PPE, routine testing of the workforce and patients, visitors controls sanitation, and ongoing data evaluation.
3. “Opening Up America” federal Guidelines:
These federal guidelines itemize various considerations to review before moving forward with an activity in one of the three described phases.

This document should not be interpreted as medical or legal advice. Because the facts pertaining to your situation may fluctuate, or the laws in your jurisdiction might vary, please contact your attorney if you have questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions​