NHMS Statement on Considerations for the Postponing of Elective and Non-Urgent Procedures for COVID-19 Mitigation

March 18, 2020

Given that New Hampshire and greater New England are beginning to experience pockets of community transmission of COVID-19, it is prudent for New Hampshire hospitals, ambulatory surgery centers and physician offices to review and consider their impact on mitigation strategies.

Following recommendations by the U.S. Surgeon General and the Centers for Disease Control and Prevention (CDC), the New Hampshire Medical Society joins with the New Hampshire Hospital Association in urging the postponing of “elective and non-urgent procedures” as specifically written for the Puget Sound area https://www.cdc.gov/coronavirus/2019-ncov/downloads/Seattle_Community_Mitigation.pdf, for New Hampshire hospitals, ambulatory surgery centers and physician offices. And we thank the many health care facilities and physician offices that have already voluntarily put these considerations into place.

Due to the broad nature of what is meant by “elective” and “non-urgent” procedures, the following  draft statements can be used to help define and direct consistent implementation. New Hampshire hospitals, ambulatory surgery centers and physician practices should engage in a discussion about elective and non-urgent procedures in the event that COVID-19 becomes a widespread community event.

The rationale for considering the postponing of elective and non-urgent procedures is multi-faceted: preservation of scarce resources such as personal protection equipment (PPE), re-deployment of staff to support surge in hospitals, use of limited equipment such as ventilators in other patient care areas and reduction of exposure to staff and patients. This is a fluid and changing situation and these standards may change to meet community care needs.

Considerations for the Postponing of Elective and Non-Urgent Procedures:

Hospitals, ambulatory surgery centers and physician offices should consider the postponing of procedures that, if delayed, will not cause harm to the patient. Examples include: some joint replacements, some cataract surgeries, some cardiac procedures, and some interventional radiology services.

Hospitals, ambulatory surgery centers and physician offices should consider providing needed procedures as it is safe to do so, prioritizing care that if delayed could negatively affect the patient’s health outcome, harm the patient, or lead to disability or death.

Elective and non-urgent procedures, both those in an operating room and in other procedural areas of hospitals, ambulatory surgical centers and physician offices may be performed based on evaluation of the following factors:

  • Current and projected COVID-19 cases in the facility and in the surrounding area.
  • Supply of personal protective equipment, staffing availability and bed availability.
  • Urgency of the procedure, with maintenance of procedures most urgent. The least urgent procedures or those with the least long-term impact to be postponed first.
  • Effectiveness of steps to reduce local inpatient hospital load, such as moving pediatric patients in general hospitals to pediatric hospitals to vacate beds for critically ill adult patients, and moving hospitalized patients not in need of acute care to a lesser level of care.
  • Length of stay of the patient post-procedure and the ability to discharge the patient efficiently, with the goal of not tying up hospital beds for lengthy stays. In particular, consider delaying procedures for patients who need to be discharged to post-acute care given the current inability to discharge patients.
  • Whether the patient is well enough for a procedure, including age and underlying health factors, particularly given the risks of COVID-19.
  • Clinical judgement of patient needs and the situation at hand.

For further information, please contact:

James Potter, Executive Vice President

603.224.1909

james.potter@nhms.org