Purpose: Protocol for scheduling and testing surgical patients.

Scope: Perioperative Services

Approval: Perioperative Leadership Team and DOS

Date: 8/17/2020

Algorithm for COVID-19 Patient Testing Prior to Surgery:

- Scheduled patients require a Covid-19 test preferably within 4 days of their scheduled surgery. However, tests within 5 days of surgery will be accepted as needed.

- Inpatients are surveillance tested for Covid-19 upon admission and do not need to be retested prior to their procedure.

o If a patient has been inpatient, discharged, and returns for a post-discharge procedure, they do not need to be retested unless their Covid-19 result was more than four days old.

- If the patient presents to PreOp without a Covid-19 surveillance test, the patient will receive a rapid test upon arrival.

- If the patient has previously tested positive for Covid-19, they will not be retested unless their procedure is scheduled for 90 days after the positive Covid-19 test.

Advanced Scheduling Process for Patients who Require a COVID-19 Test Prior to Surgery:

- If the patient screens positive for the major symptoms of Covid-19 (new fever, new cough, or new shortness of breath) on the scheduling call, the surgery will be rescheduled, surgeon will be notified and patient will be referred to the PCP.

- If the patient tests positive for Covid-19, the surgery scheduler will notify the surgeon to see how the surgeon would like to proceed.

o Whenever possible, non-urgent surgical procedures should be postponed or rescheduled until:

- If symptomatic ≥10 days after symptom-onset AND ≥24 hours after afebrile without fever-reducing medication and respiratory symptoms improving –or-

- If asymptomatic, 10 days after first positive test

Patients Who Cannot Obtain a Curb-Side COVID-19 Test:

Per the testing algorithm, if a case requires a Covid-19 test prior to surgery and a curb-side test cannot be arranged, the case will require a Rapid Covid-19 test on the day of surgery. In these instances the case will be moved to the end of the surgeon’s day in the assigned OR. The Main OR scheduler will communicate this to the surgeon and to PreOp / PACU via the 14:30 Covid Testing distribution email. On the one-day-out call, the PreOp/PACU team will tell the patient to arrive early to PreOp to allow time for a rapid test to be administered and resulted prior to surgery. This process applies to adult and pediatric patients.

Patients Who Have a Pending COVID-19 Test:

If a patient’s Covid-19 test result is still pending at the close of the Admin Schedule, the case will be moved to the end of the surgeon’s day in the assigned OR.

For patients who require a Covid-19 test and are advance scheduled (added to the schedule before the close of the Admin Schedule at 1430 the day prior), the patients will use the DH curb-side testing facilities at (Montbello, Webb, and Peña) whenever possible. The OR schedulers will schedule the appointment for the Covid-19 test.

PreOp Rapid Testing Standard Work:

When the patient arrives to PreOp, the PreOp Charge Nurse will review the schedule to identify if the patient does not have a test result. Per the testing algorithm, if the patient needs a test and does not have one, the PreOp Charge Nurse will contact the surgeon to obtain a verbal order for a Covid-19 test. Once the order is in place, the PreOp Charge will contact the lab to request a Rapid COVID test kit. The staff member obtaining the test will don the indicated PPE per the Universal COVID-19 Patient Testing for Hospital Admissions algorithm. Nursing staff may escalate to special precautions if deemed necessary.

Block Release: We have reinstated our pre-Covid-19 block release policies, which are:

- The ortho and surgery add-on rooms (highlighted in yellow on the block allocation schedule) never release. To use these rooms, please contact the ortho trauma or TACs attending.

- Non-release blocks (highlighted in orange on the block allocation schedule) will release to the bridge at 0630 on the date of service. After 0630, the bridge can add cases to these rooms to ensure optimal OR flow and access.

- All other blocks are considered “released blocks” and will release to all services 4 business days prior to the date of service.

- Voluntary release – we encourage surgical teams to voluntarily release blocks that will otherwise go unused 60 days in advance of the date of service. When you voluntarily release your block 60 days in advance, this unused time will not be included in the utilization calculation.

Scheduling: Please adhere to the following scheduling limitations for elective cases:

- In accordance with the governor’s executive order, please consider the risks and benefits for patients who are Vulnerable Individuals before scheduling (please review the CDC guidelines regarding patients who are at a higher rick for sever illness).

- Do not schedule a patient who is positive for Covid-19 in Pav M until:

o If symptomatic ≥10 days after symptom-onset AND ≥24 hours after afebrile without fever-reducing medication and respiratory symptoms improving –or-

o If asymptomatic, 10 days after first positive test.

Did this answer your question?