Restarting elective surgery in the COVID-19 era

The Covid-19 pandemic has not only stress-tested the United States health care system but how also we go about our daily lives to such a degree that in the future we may end up referring to time as BC (before Covid) and AC (after Covid).  Google Trends highlights the surge in Covid-related searches for symptoms, testing, characteristics of the virus itself and, of course, the economic chaos and uncertainty it has created. Covid-19 has taken over our daily lives to such a degree that it’s left many of us wondering what our daily lives will look AC.

As the number of overall Covid-19 cases peaks in some parts of the country, discussions and plans to reduce some of the restrictions that have been adopted to minimize the spread of the virus have begun. One of the biggest topics of conversation surround health care operations and when elective surgeries should resume. These conversations are exploring what precautions should be put in place to prevent asymptomatic patients from unknowingly spreading coronavirus to others, how to ensure health care workers don’t inadvertently transmit coronavirus to patients and how to provide reassurance to  patients and their families that it is safe to undergo elective surgery.

As health care facilities prepare to resume elective surgery, one of the key stakeholders they should engage is patients and their families. Organizations that have Patient Family Advisory Councils are optimally positioned to understand what patients and their families want to know about the risks of contracting Covid while undergoing an elective surgery.

Patient Family Advisory Councils

The goal of these groups is to bring the perspectives of patients and families in the planning, delivery and evaluation of care. Despite the overwhelming demands of Covid-19, some health care organizations have had the opportunity to speak with patient family advisors and ascertain what information is important to discuss so that patients and their families feel safe and are informed so that trust remains sacrosanct.  

Kellie Goodson, MS, CPXP, Director, Performance Improvement Programs for Vizient says, “(Patients) want details and they want data.” This level of detail includes how many staff have had the virus and how many have recovered from it and how and where facilities are treating Covid-19 patients. She also says, “Whatever you tell (patients) must happen.”  For example, there are certain highly visible aspects of infection prevention, like the use of Personal Protective Equipment and policies and procedures for cleaning rooms and equipment. Ensuring these aspects of care are communicated and are visibly occurring can reduce anxiety in patients and their families.

Because the number and severity of Covid-19 infections varies across the country, engaging patient and family advisors can allow organizational leaders to “create strategies and communications plans that are tailored to the patients they serve,” according to Tomas Villanueva, DO, Associate Vice President Clinical Resources at Vizient.

Specific Strategies

·       Teach-Back Method. The use of the teach-back method is employed by an individual who is communicating an important point. In this case, it might be information related to the accuracy of antibody testing for Covid-19. After delivering the information, the individual asks the patient to “teach back” what he/she has just said. This ensures salient information has been accurately heard.

·       Plain language. The National Assessment of Adult Literacy has reported that only 12% of the U.S. adult population has proficient health literacy which can negatively impact patients’ ability to understand and perform sometimes complex instructions and activities to self-manage their health. Hand outs should be written at a 5^th grade level that minimize large amounts of text and use easy to understand graphics.

·       Change of Shift huddles. Because information surrounding Covid-19 is coming from multiple sources and can change quickly along with stress of working under incredibly demanding situations, it may be beneficial to have multiple team huddles where important information is conveyed in order to minimize variation in information that might come from various staff that come in contact with the patient. Although health care workers can understand nuances of information that allow them to believe a consistent message is being communicated, patients without a background in healthcare may get frustrated that “everyone says something different when I ask them a question,” because there is variability in how information is being communicated.

What are the potential drawbacks of not seeking patient engagement?

Although many health care systems are suffering significant revenue declines from canceling elective surgeries, resuming surgeries without a comprehensive plan that not only addresses location of surgery, testing, and infection prevention, but one that also fails to account for patients and families’ perspectives, can lead to an erosion of trust and patients receiving their care elsewhere.  

When Goodson and Villanueva were asked, “What do you think is an incorrect assumption that health care providers and systems may have in the era of Covid-19 and the resumption of ambulatory surgery?” they both agreed that “the old concept of, ‘you build it and they will come’ does not correlate during these times.” Some patients may seek to put off elective surgery until next year, especially if there is a belief that a vaccine may be available soon.

The foundational aspects of shared-decision making that incorporates introducing choice, describing options and exploring preferences before making a decision with patients should always be practiced despite the disruptions of Covid-19. When patients and families are scared and uncertain, the ability of health care providers to communicate in a clear, empathetic way that is honest, but hopeful, might be one of the strongest treatment options to be deployed against the virus.

Joseph M. Geskey, works at Vizient as a Principal, Data Sciences & Member Insights. He is currently working on a book about the healthcare experiences of patients with limited health literacy and challenging social determinants of health in the digital and technological era medicine is embracing.