Getting Elective Procedures Back on Track
Patients will face new requirements in the wake of COVID-19
When Judy Winkler injured her knee in early March, little did she expect it would take a month to have an MRI to find out just how bad the injury was, and three months before she could have arthroscopic surgery to repair what turned out to be two tears in the meniscus in her right knee.
She wasn’t the only one whose elective procedure was put on hold due to the COVID-19 pandemic that shut down non-essential medical services across the country for two months. In early March, OSF HealthCare performed more than 350 outpatient procedures per day across all of its facilities, including outpatient surgery centers that are part of the 14-hospital Ministry across Illinois and the Upper Peninsula of Michigan. By April 1, that number was fewer than 80 cases a day, a 78-percent drop. Even though they were elective, procedures such as cardiac catheterizations were considered essential and continued during this time.
Elective procedures were allowed to restart as of May 11. Across OSF, just over 100 cases took place that first day as patients navigated pre-surgery testing requirements and their own concerns about any risk associated with the virus. By June 10, a month later, the number of outpatient procedures had rebounded to nearly 280 per day, a 161-percent increase. While the numbers are starting to rebound, it’s still a 10-percent decrease over the year before.
The first thing Judy had to do once her surgery was scheduled was get a COVID-19 test 72-hours before the procedure.
According to Sherri Greenwood, the vice president of surgical and procedural services at OSF HealthCare Saint Francis Medical Center in Peoria, pre-surgery COVID tests are now required to protect both the patient and hospital staff. Through their physician’s office, a patient schedules the time for their drive-up screening at an approved location.
“You'll come to the site, you'll call a number when you get there, the staff will come right out to your car - you don't even have to get out of the car, it's really great - and they’ll do the test. It takes about 30 seconds and then you're on your way.”
“You have to have the Covid test within 72 hours of the surgery and that's a requirement from the state. If that test is negative, you don't have Covid, your surgery proceeds just as normal. If the test is positive then your surgery would be canceled and you would recover from Covid, and then in about two weeks we’d retest you to see if you could move forward with your surgery.”Judy wasn’t looking forward to having the test because she had heard from others how uncomfortable it was. But the guidelines have changed, where before it had to be nasal pharyngeal, which meant the entire way to the back of the nasal cavity, now it is a swab inserted just one to two inches into each nostril.
She says the testing process was smooth. “I received a reminder call, pulled up and called the number on the sign. The staff verified my identity, they gowned and masked up in front of me, performed the test and I was done. I would say the entire process took less than two minutes. It was over very quickly and not painful at all.”
While it is preferred that those undergoing an elective surgery or procedure self-isolate for seven days beforehand, it is required for the three days between a patient having their test and the day of surgery to avoid any potential exposure to COVID-19.
When it comes to the day of surgery, that process has changed, too. Sherri Greenwood says it will also sound a little like a broken record repeating the same questions.“We’ll take you up to our pre-op area and before that you'll actually get some screening questions and those screening questions will be very similar to what you've received in the office all along - do you have a cough, do you have shortness of breath, are you running a fever, any of those sorts of things, and we’ll also check your temperature.”
With Judy’s negative COVID-19 test result coming through her electronic medical record the night before, she was good to go. “The day of surgery was very smooth. When we pulled up, we were greeted by a nurse to confirm my identity. My husband and I were both screened for COVID with questions and a temperature check. The check-in process went smoothly and I was reassured of infection control measures the entire time - they even wiped the pen in front of me before handing it to me to sign documents!”
“We’ve taken lots of precautions, we’re ready for you and your family to be here to have procedures and tests done, so don't be fearful. We’re ready for you and you're very safe while you're here,” reassured Greenwood.
Judy’s husband was not allowed to accompany her to the pre and post-op area, but the staff kept a close watch over her. “Everyone was masked and my personal mask stayed on the entire time - I think they took it off once I was under anesthesia. It was back on when I woke up.”
An additional change for outpatient elective procedures is the number of people who can accompany the patient and remain onsite. OSF HealthCare has restrictions in place across all facilities because of the COVID-19 pandemic, but is allowing a support person to accompany a patient in most cases, something that is discussed by the care team in the days leading up to a patient’s procedure.
“At that time we’ll tell you whether or not you can bring a support person. That’s the person that you might bring to be able to be with you if you have a lot of anxiety, you're fearful, if you're getting anesthetic you need to have some discharge instructions, all of those sorts of things, so it's important to have a support person. We’ll let you know whether or not you're able to do that. The guidelines are always changing with the state and IDPH and we want to always stay in compliance with that, but we also want to bring a support person in if it all possible,” said Greenwood.
A support person is also required to wear a personal mask and undergo a COVID-19 screening upon arrival with the patient.
For Judy, surgery on her knee went smoothly. Four hours after she arrived, she was wheeled out the door to her husband who was waiting in the car. “I am so glad I had this done and did not wait! I felt safe the entire time.”
Learn more about elective surgery procedures across OSF HealthCare here.
COVID Test Video