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Elective Case Triage Guidelines for Surgical Care

March 24, 2020 10:33 PM | Anonymous

The ACS has collected guidelines from various specialties, facilities, and thought leaders to help inform the decision making occurring at the local level.

The guidelines include

Some overarching principles for all cases include the following:

  1. Be aware that while some of the following triaging guidelines include a “Level 1” (e.g., lowest level of COVID-19 acuity) in the recommendations, one must be aware that the rates of COVID-19 are predicted to skyrocket in the next few weeks, and the overarching recommendation is to prepare for markedly increased rates when triaging elective cases at present.

  2. Patients should receive appropriate and timely surgical care, including operative management, based on sound surgical judgment and availability of resources.

  3. Consider nonoperative management whenever it is clinically appropriate for the patient.

  4. Consider waiting on results of COVID-19 testing in patients who may be infected.

  5. Avoid emergency surgical procedures at night when possible due to limited team staffing.

  6. Aerosol generating procedures (AGPs) increase risk to the health care worker but may not be avoidable. For patients who are or may be infected, AGPs should only be performed while wearing full PPE including an N95 mask or powered, air-purifying respirator (PAPR) that has been designed for the OR. Examples of known and possible AGPs include:
    1. Intubation, extubation, bag masking, bronchoscopy, chest tubes
    2. Electrocautery of blood, gastrointestinal tissue, any body fluids
    3. Laparoscopy/endoscopy
  7. There are insufficient data to recommend for/against an open versus laparoscopy approach; however, the surgical team should choose an approach that minimizes OR time and maximizes safety for both patients and healthcare staff. Refer to to Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines for these patients.

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