Elective surgery restrictions eased
As part of the gradual release of societal controls instituted to help contain the spread of COVID-19 the Federal Government has agreed that non-urgent, but clinically relevant surgery can recommence at a reduced level.
Of particular relevance to Bariatric and Metabolic Surgery is that the principles governing patient selection includes, amongst others:
- Procedures representing low risk, high value care as determined by specialist societies
- Selection of patients who are at low risk of post-operative deterioration
(recommended by the Australian Health Protection Principal Committee (AHPPC) and endorsed by National Cabinet)
The aim is to guard against sudden surges in Hospital activity potentially overwhelming the ability to maintain social distancing and “Universal Protections” against in-hospital COVID transmission. While there is mention of Specialist Society guidance in the matter of case selection in the enclosed Joint Statement, we feel that there has been sufficient discussion about this point to date.
All clinicians will have their workload “capped” while our Hospitals adapt the equipment and patient flow requirements needed to maintain safety for our patients, our teams and ourselves. This will give us all the opportunity to select those patients presenting to our services who have the greatest need for prioritisation in order to ensure they achieve a timely service. Ultimately it will be a hospital decision as to which cases proceed and the hospitals in turn are directed by State-based authorities rather than federally. For the time being we would recommend delaying older patients, stable patients requiring revision surgery, uninsured patients and patients with a high risk of requiring ICU, however clinical factors will make surgery difficult to delay for some patients in this group in which case your clinical judgement should be exercised for the patients benefit.
While the Federal Government has suggested a 25% cap on previous activity, we would suggest that if your Hospital service has sufficient capacity, that you discuss with them about Category 1 and Urgent Category 2 patients being excluded from this “cap”. This will allow on-call Surgeons and those with high acuity patients to be able to book elective surgery without potentially arbitrary cancellations occurring.
We will all have to take care, as Clinician leaders in our services to ensure that the safety of our team members is not compromised by inadvertent funnelling of patients and staff into clinical areas not originally designed to meet “social distancing” requirements. The risk of patients presenting for surgery who are asymptomatic for COVID, or COVID carriers is low but not zero. It is vital that we structure our healthcare delivery in such a way that such patients cannot cause a cascade of cross infection in our Hospitals.
Re-introduction of elective surgery creates a risk of introduction of COVID to ourselves and the Community after successful “flattening of the curve”.
I think we are all well placed to take on this opportunity however, and we all have the ability to contribute positively to the health of our communities through the work that we do.
With best regards
Michael Talbot and the ANZMOSS Board.