SAULT STE MARIE, ONTARIO ~~~ June 2, 2020 (LSN) The Ontario government has lifted its directive issued in March, which restricted elective and non-urgent surgical and clinical procedures, programs and clinics. In expectation of the resumption of services, Sault Area Hospital (SAH) has been working regionally to plan for a safe, cautious reopen and reschedule of services.
The easing of the provincial directive calls for a gradual resumption of carefully thought-out scheduled cases.
“We are all looking forward to restoring services that have been paused for several weeks while we worked to protect our community from the risks of COVID-19,” says Dr. Silvana Spadafora, Chief of Staff of Sault Area Hospital. “We ask our community to please be patient while we take the steps necessary to allow a safe, slow and cautious approach to gradually resuming services.” The earliest that some services or procedures will be reintroduced will be June 9, 2020.
We have developed a hospital-based plan that was shared and approved regionally and reviewed by our SAH Clinical Teams, Algoma Public Health and regional health care system partners. “The same detailed, collaborative approach in restoring postponed hospital services is being undertaken across our region,” says Wendy Hansson CEO Sault Area Hospital. “From June 9, 2020, onward, we will monitor the situation daily within our hospital and community and formally compare our findings at least weekly as a region to determine if changes are necessary to our plan,” explains Hansson.
Patients will be notified of their rescheduled surgeries and other appointments. Please do not contact the hospital about a postponed appointment. Patients who are waiting for surgery will be contacted directly by their physician’s/surgeon’s office. Virtual visits will continue to be utilized by physicians as much as possible to support patient appointments.
“In developing a plan for the resumption of services, all hospitals are using an ethical framework designed by the Ontario government to prioritize patient care. Resuming scheduled hospital-based care for patients waiting for treatment has to be very carefully weighed with the overriding need to ensure Ontario hospitals can maintain the capacity to be ready for any surge in COVID-19 patients,” explains Dr. Spadafora.
Resumption of services will roll out in phases over the coming weeks as follows:
Phase 1 of the recovery plan will focus on the resumption of surgical and cardiac procedures and tests. We will be resuming services at about 60% of our normal activity. Our decisions regarding which cases will be rescheduled is based on an established priority.
Phase 2 will see our services resume to approximately 75% of our normal case activity. This increase will be reached by mid to late July.
It’s important to note that the SAH may need to stay in a specific phase for several weeks at a time, or longer, or return to an earlier phase, depending on occupancy, personal protective equipment (PPE) and drug supply status.
SAH will continue to monitor and reassess this plan, in partnership with Algoma Public Health and our regional partners, on an ongoing basis, especially if there is a sudden surge in COVID-19 cases in the community.
In the meantime, current COVID-19 policies and procedures, including visitor restrictions, remain in place.
To find out more about SAH, visit: www.sah.on.ca
Gradual Resumption of Services at SAH Frequently Asked Questions
When will SAH return to normal operations?
Ontario needs to take a measured, equitable, province-wide approach to manage the wait list of patients, using a fair process to safely resume care. Understandably, patients, family members, clinicians and all healthcare workers want to know when and how surgeries and procedures might safely resume.
The risk of surges in either community or congregate settings remains very real. And we are developing our plans keeping in mind the safety of our patients, hospital and community. We will continue to weigh the benefit of treatment against the potential risk of transmitting the coronavirus to patients and healthcare workers.
While June 9, 2020 marks the start of a return to some procedures, services and programs, it’s only a start. The restoration of full service from pre-COVID-19 levels will be gradual and incremental.
How soon can postponed surgical procedures take place?
The gradual and incremental restoration of more elective surgeries will take many weeks, when you consider the need for pre-operative care that has been on hold. A framework designed by the government outlines conditions for resuming scheduled surgeries and procedures such as the adequate supplies of personal protective equipment (PPE), adequate supplies of drugs for surgeries, the ability to take activity down quickly should there be a re-emergence of multiple cases of COVID-19 positive patients, evaluation and use of different approaches to care, and the potential for having patients and their care team travel for care.
Patients waiting for surgery will hear directly from their physician’s/surgeon’s office.
What will be different for patients when they services resume?
Elective surgical patients will be advised to self-isolate for 14 days until their day of surgery. Patients are advised to selfmonitor for symptoms prior to surgery and phone the pre-admission clinic if they develop signs or symptoms consistent with COVID-19 or have contact with any confirmed COVID-19 individuals. o Prescreening of patients before their scheduled appointment will occur, allowing for sufficient time for COVID_19 testing if warranted. o Patients will be called 24 hours prior to planned surgery to repeat screening for relevant exposure and symptoms and review COVID-19 test collection results. o Pre-surgical patients will be screened on arrival the day of their procedure and accompanied by a staff member to the pre-surgical prep area.
Patient who are unable to pass these requirements will need to be rescheduled. Physical distancing is still required; masking in all encounters is required. Patients will see fewer people in the waiting rooms throughout the hospital and their care teams wearing the appropriate personal protective equipment (PPE).
Physicians will also, continue to use virtual visits as much as possible. The reopening of clinical services does not lessen the need for the continuation of virtual visits.
What will happen if a patient’s appointment needs to be cancelled, because they are unable to pass screening?
The patient will be tested and once cleared they will be reacheduled for their appointment.
What is the ‘ethical framework’ hospitals are required to follow in planning the resumption of postponed services and procedures?
All hospitals are using an ethical framework to prioritize patient care. Resuming scheduled hospital-based care for patients waiting for treatment is necessary and has to be very carefully weighed with the overriding need to ensure Ontario hospitals can maintain capacity to be ready for any surge in COVID-19 patients.
What factors must hospitals consider in developing plans to restore services?
Hospitals must conduct a feasibility assessment and the following nine factors must be assessed:
The community has a manageable level of disease burden or has exhibited a sustained decline in the rate of COVID-19 cases over the past 14 days;
The organization has a stable rate of COVID-19 cases;
The organization and region have a stable supply of PPE;
The organization and region have a stable supply of medications;
The organization and region have an adequate capacity in inpatient and ICU beds;
The organization and region have adequate capacity in health human resources;
The organization has a plan for addressing pre-operative COVID-19 diagnostic testing (where appropriate, in consultation with local IPAC);
The organization has confirmed that post-discharge care outside the hospital is available and can be coordinated in a timely manner (e.g., home care, primary care, rehabilitation, clinic care); and
The organization and region have a wait list management mechanism in place to support ethical prioritization. When all of these conditions have been met, and hospitals have sign-off by their Regions, they must take a gradual approach to increasing surgeries and procedures that is agile enough to quickly ramp down, if needed, and include contingency capacity for COVID-19 patients. This assessment must be conducted weekly and reviewed within the hospital by their COVID-19 Surgical and Procedural Oversight Committee and then by the Region to determine whether to continue.
This approach requires both organizational (hospital) and Regional oversight. Throughout this process, hospitals must work hand-in-hand with their Regions:
To monitor regional resource availability (e.g., primary care, home and community care, and rehabilitation, PPE and medical supplies);
To ensure equity across the region and to foresee and mitigate any unintended adverse consequences that may arise across the region;
To mitigate barriers that arise; and
To continually assess the impacts of provincial and regional COVID-19 community mitigation measures (e.g., tightening and loosening of physical distancing).
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