The New York State Department of Health (NYSDOH) has issued new guidance for ambulatory surgery centers (ASCs), office-based surgery practices (OBSs) and diagnostic and treatment centers (DTCs) resuming elective outpatient surgeries and non-urgent procedures. According to a NYSDOH publication issued on May 19, ASCs, OBSs and DTCs located in eligible counties, or those without high risk of a COVID-19 surge, must adhere to provisions required of hospitals, as well as new testing, preparedness, protective patient equipment (PPE) and infection control protocol specific to these facilities. NYSDOH’s requirements include the following:
- All patients scheduled to undergo surgery must be tested using a molecular assay for detection of SARS-CoV-2 RNA and return negative results three days prior to the procedure. Physicians are directed to send COVID-19 positive patients to the emergency room or counsel them to stay at home, depending on the severity of symptoms. Physicians are encouraged to postpone surgery for 21 days following a positive test.
- When determining whether to perform a procedure, surgeons should consider the following:
- risk based on the type and length of the procedure;
- potential for post-acute care;
- necessity; and
- risk of alternative adverse outcomes.
Patients scheduled for a procedure must be screened for COVID-19 symptoms at the time of scheduling, during the preoperative period and upon arrival to the healthcare facility.
ASCs, OBSs and DTCs are advised to: schedule patients at intervals that allow for social distancing; obtain continued confirmation that local hospitals meet COVID-19 census eligibility; screen staff daily upon entering the facility; and ask personnel to self-monitor for any COVID-19-related symptoms.
- Facilities must have appropriate medical surgical supplies necessary for all procedures and stages of care, pre-operative through post-discharge.
- To optimize infection prevention and control, ASCs, OBSs and DTCs must be extremely thorough in their execution of environmental cleaning and disinfecting and ensure measures are appropriate for SARSCoV-2 in all settings, including all patient-care areas, check in and waiting areas. Protocols should limit traffic to patients, essential support people and necessary employees and allow for proper social distancing. Furthermore, telehealth services should be used whenever possible.
The NYSDOH directive also reminds physicians to reference the Centers for Disease Control and Prevention’s rules for urgent and emergency surgeries when deciding whether to perform a procedure, particularly in cases where the facility is located in an ineligible county.