Understanding what is happening in the zip codes your program serves is critical to creating a safe strategies to resume outpatient invasive procedures.
Beyond testing for staff and patients, these are high level considerations in creating Non-COVID care (NCC) zones. Note that the type and level of personal protective equipment (PPE) should be guided by Centers for Disease Control and Prevention recommendations, with policies established by the Steering Committee.
Many cardiovascular programs serve large geographical areas. As services are resumed for non-urgent/non-emergent cases the Steering Committee will need to establish a surveillance process to monitor fluctuations in the cumulative incidence of COVID-19 within and across the communities served by the invasive program.
On June 8, the Centers for Medicare & Medicaid Services (CMS) released a guide for patients and beneficiaries as they consider their in-person care options. During the height of the pandemic, many healthcare systems and patients postponed non-emergency, in-person care in order to keep patients and providers safe and to ensure capacity to care for COVID-19 patients. As states and regions across the United States see a decline in cases of COVID-19, CMS is providing these recommendations to ensure that non-emergency healthcare resumes safely and that patients are receiving needed in-person treatment that may have been postponed due to the public health emergency.
Our progress toward educating patients to seek rapid care for heart attack and stroke has been set back decades by patients’ fear of exposure to COVID-19 in healthcare facilities. As we resume essential but non-emergent invasive procedures our messaging to patients will need to offer assurance that we are taking extraordinary precautions, using CDC guidelines, to mitigate the risk of COVID-19 exposure. Ultimately the informed consent process should include a shared decision-making discussion about the risk of exposure vs. a continued deferral of the procedure. Discuss the plan to avoid overnight stay.
The Steering Committee should develop and monitor policies for COVID-19 patient testing prior to scheduled procedures. If patients will be tested, consider a testing site designed for pre-procedural patients clinically assessed and deemed at low risk of COVID-19 infection.
Although procedural care is "high touch" we can minimize in-person contact before and after the procedural encounter. Leverage the progress made in virtual and telehealth services during the pandemic – use them to support physical distancing to the extent possible by transitioning pre-arrival/pre-procedure and post-procedure/post-discharge tasks to virtual encounters.
Patient messaging is very important – be sure to communicate the role of telehealth to help keep patients and employees safe.
Patient safety policies should be developed and implemented by the Steering Committee. Ideally policies will be shared with patients and families as a part of the pre-registration process.
Although visitors are important to support patients, the number of visitors physically entering the building or patient care unit should be limited and closely monitored.
Masks should be required for all patients and visitors to enter the building or patient care unit. Local levels of PPE will play a role in determining whether patients will need to use their own cloth face mask, or if a surgical mask will be issued to the patient on arrival.
Physical distancing with a minimum of six feet between patients must be engineered into the patient waiting and patient care areas – see Facility Considerations subchapter for additional details.