Staff and patient safety standards must be guaranteed before planned surgery can resume

Published: 01/05/2020

The Royal College of Anaesthetists has developed, in partnership with the Faculty of Intensive Care Medicine, Intensive Care Society and Association of Anaesthetists, a strategy document to facilitate the resumption of planned surgery in the wake of COVID-19. Maintaining staff and patient safety standards is central to a return to planned surgery, and national guidance is required to ensure a smooth transition to post-COVID-19 services.   

Suspending planned surgery freed up resources, including staff and critical care bed capacity, to deliver care for COVID-19 patients. Although a necessary step to take, this had the effect of delaying important procedures for non-COVID-19 patients and has had implications for their treatment. Now that hospital admissions for COVID-19 are decreasing and critical care bed capacity is being released, steps can begin to be taken to resume planned surgery. However, no concrete timeframe can be assigned to returning to so-called ‘normal service’, and indeed COVID-19 will continue to impact how healthcare and treatments are delivered for some time to come.

The published strategy outlines four key categories that must be considered before elective surgery can resume: Space, Staff, Stuff (equipment), and Systems.  A red-amber-green rating system for each category designates preparedness for a return to elective surgery. For example, a green rating indicating readiness to resume elective surgery would indicate that:

  • Sufficient numbers of staff are able to return to routine work
  • Sufficient anaesthetic and critical care drug stocks have been secured
  • Sufficient supplies of and access to personal protective equipment (PPE) are available
  • Sufficient intensive care and recovery unit spaces are available for non-COVID-19 surgery patients.

Readiness to resume planned surgery will vary between regions, hospitals, and surgical services, but the philosophy of equity of access to treatment must be considered.

Commenting on the resuming elective surgery strategy document, Professor Ravi Mahajan, President of the Royal College of Anaesthetists said:

 “It is encouraging that, due to the dedicated work to flatten the COVID-19 curve, hospital admissions are decreasing and critical care bed capacity is becoming available. These represent the first steps towards resuming the delivery of non-COVID-19 NHS services, including important planned surgeries. We welcome the recent Letter outlining the second phase of the NHS’s response to COVID-19, and hope that our strategy document can sit alongside future national guidance.

 “However, it is clear that the NHS cannot simply resume planned surgery services before sufficient resources are in place. I appreciate it is hugely frustrating for patients who are waiting to have surgical procedures, but we must make sure we get this right and avoid overwhelming the NHS or putting healthcare staff and patients at risk. As well as adequate PPE and drugs supplies, staff capacity will be key in resuming planned surgery, and I am conscious that anaesthetists and all healthcare staff have been working incredibly hard throughout the pandemic. We must be mindful that the return to planned surgery will only add to their heavy workload, and many staff may already be dealing with fatigue and mental distress. The College will continue to work to ensure patient safety, and support our members as they begin to transition back towards more regular services.”