It's normal to have some anxious thoughts when facing surgery. Add worries about coronavirus to the equation, and you may just hit the panic button. At Penn Medicine, health care providers have been hard at work implementing new ways to protect patients during the coronavirus pandemic. The result? A safer surgical experience for everyone.
“In the beginning of the pandemic, we halted elective surgeries, which meant we were doing about 18 cases each day. Typically, we’d handle nearly a hundred,” says Ann Marie Morris, MSN, RN, CNOR, associate clinical director of Perioperative Quality and Safety. “Now, we're almost back to 100 percent. And our safety measures have made a big difference for patients and Penn Medicine surgical staff.”
Evolving Surgery Protocols at the Start of the Pandemic
For months, the Perioperative Quality and Safety team has been honing procedures and policies to maximize patient safety. Some of their most impactful changes came at the start of the shutdown.
“At first, we limited visitors to one per patient. But that meant we also had to adjust how we contacted patients before surgery,” explains Morris. “We have a busy operating room and endoscopy center. Pre-COVID, we could have 80 to 90 endoscopies and 80 to 100 surgeries each day. Because of the volume, we used an automated phone system to call patients. But we needed to personalize those calls because patients were going to be scared and anxious about coming in here.”
As a result, hospital staff personally called patients to help them better understand what to expect. When visitation stopped completely, Morris’ team made even more changes.
“Not allowing anyone to come in with the patient was an extreme measure. So we set up a curbside greeter service instead,” relates Morris.
Masked hospital staff would line up on the main driveway in front of the Hospital of the University of Pennsylvania and greet patients when they arrived. They would give patients masks and take the families’ contact information to update them throughout the process.
“We also created a mobility questionnaire to help us identify mobility issues and prevent falls,” says Morris. “And we delayed surgery start times from 7:15 am to 8 am. That gave us extra time to talk more as a team and do things more carefully to address patient and staff concerns.”
Five New Surgery Safety Measures
While some safety measures remain from the pandemic’s beginning, Penn has added and tweaked a few:
1. Mandatory COVID-19 screenings
Penn now requires that every patient receive COVID-19 testing within three days before surgery. The patient’s surgeon’s office explains when and how the patient can get tested. If the patient tests positive, the surgical team may postpone the procedure until the patient fully recovers.
Penn screens all hospital visitors for COVID-19 symptoms as well. This process involves temperature checks and screening questions.
“These protocols protect employees and other patients. We want to avoid exposing them to COVID-positive patients with no visible symptoms, especially in our reception areas,” says Morris. “That’s why it’s so important that patients go for their COVID tests ahead of time. We need to minimize the number of people waiting for results so we can maintain social distancing.”
2. Paperless health care management
Patients can now update their personal and health information in the myPennMedicine patient portal. This helps them avoid physical contact with people and touching paper forms.
Paperless communication was an early staple at the beginning of the pandemic. For example, when telehealth visits were the only option, surgeons obtained verbal consent for procedures. Before the pandemic, surgeons had obtained consent in person by having patients fill out paperwork. Verbal consent allowed surgeons to discuss the risks and benefits with patients while avoiding sharing a pen and paper.
3. Social distancing in reception areas
Because patients can again bring a visitor, curbside greetings have stopped. But more plus-ones could have meant more congestion inside.
“We rearranged our reception areas so people can practice social distancing,” says Morris. “We turned chairs around and put signs on them to maintain six feet between visitors. We’re also making sure patients arrive at their assigned time — not earlier — so we don’t have too many waiting at once.”
4. Virtual post-op visits
A new visitation policy helps family and friends safely see loved ones having procedures. Here’s how it works:
- Each patient can have one visitor with them in the holding area before surgery.
- The visitor then waits in the reception area until the surgery is over.
- The visitor can then see the patient in the recovery room.
- An unlimited number of visitors can then check in with the patient virtually via Penn Medicine’s BlueJeans (video conferencing) app.
“The challenge with PACU (post-anesthesia care unit) visitation is that the patient's still groggy. They usually don’t remember it,” says Morris. “With the virtual visit, the patient’s guest sees them face to face, with as many people as they want.”
5. Rigorous cleaning protocols
In addition to Penn Medicine’s already rigorous cleaning processes, they’ve added other safety measures:
- Staff clean and disinfect care environments several times each day.
- All operating room staff wear N95 respirators, full face shields, surgical masks and other PPE during procedures performed on COVID-positive patients.
- After procedures on COVID-positive patients, operating rooms stay empty for an hour before staff cleans them to use for another patient.
- Between procedures, staff always wear PPE to clean operating rooms.
- Support staff frequently wipe and disinfect high-touch areas, such as door handles and elevator buttons.