Interim Guidance last updated 27 May 2020

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Context

All non-urgent elective surgery was temporarily suspended to ensure adequate hospital capacity to respond to COVID-19.

On 23 April 2020, the Australian Health Protection Principal Committee (AHPPC) recommended elective surgery could incrementally recommence from Monday 27 April, without increasing the risks of the COVID-19 pandemic and ensuring the capacity of the hospital system is maintained to respond when needed.

  • In line with National Cabinet’s approach to easing other restrictions imposed as part of the COVID-19 response, the easing of elective surgery restrictions and restoration of hospital activity involves 3 stages.
  • Within NSW there may be differing stages applied by geographic region dependent on local factors:
    • Stage 1 – up to 50 per cent of normal surgical activity levels (including reportable and non-reportable)
    • Stage 2 – up to 75 per cent of normal surgical activity levels (including reportable and non-reportable)
    • Stage 3 – up to 100 per cent of normal surgical activity levels (including reportable and non-reportable) or as close to normal activity levels as is safely possible.
  • Private Hospitals should mirror their own state’s approach to surgical activity unless agreed otherwise with the relevant state.

Elective surgery

Screening patients prior to surgery​

Management of patients prior to surgery should be according to current public health guidance for testing and home isolation:

  • All patients should be asked if they have ever been diagnosed with COVID-19 infection
    • Time since diagnosis and recovery should be confirmed to support the decision around whether clearance testing is required
  • Anyone with respiratory symptoms or unexplained fever should be tested for COVID-19
    • Public health and clinical judgement should be used in testing patients who do not have the typical respiratory symptoms or fever for COVID-19 prior to elective surgery
    • See COVID-19 testing advice​
  • Close contacts of confirmed cases and individuals who have travelled internationally or on a cruise ship should follow isolation guidelines
    • Health services should follow release from isolation​ guidelines for patients confirmed to have COVID-19 who are required to enter a healthcare setting.

For elective surgery that has recommenced, staff are required to screen patients at the time of booking confirmation as part of routine risk assessment. Ask the patient if they have:

Question​​ Action if confirmed
  1. Ever been diagnosed with COVID-19 disease?
  1. Ask date of diagnosis and time since recovery
  2. Organise COVID-19 clearance testing as part of pre-surgery work-up in accordance with:
  • national guidelines on clearance of recovered cases entering high risk settings
  • advice from Clinical Excellence Commission
    2. Any symptoms suggestive of COVID-19: fever (≥37.5°C) or history of fever (e.g. night sweats, chills) or acute respiratory infection (e.g. cough, shortness of breath, sore throat) or a combination of other non-specific symptoms (headache, tiredness, muscle pain, runny nose, loss of sense of taste or smell, diarrhoea, nausea/vomiting or loss of appetite)

 

Clinical and public health judgement should be used when considering testing individuals with the other non-specific symptoms for COVID-19 and may depend on other risk factors for infection (CDNA National guidelines for public health units).

If the patient has no symptoms, remind them if they develop new respiratory symptoms or fever to call healthdirect on 1800 022 222 or their GP for advice

  1. Ask about other risk factors in the last 14 days prior to illness onset
  2. If no other risk factors, support the patient to get tested if they have not already done so:
  3. Ensure the patient is appropriately isolated (whether at home or in hospital) until COVID-19 test result
  4. Postpone surgery until COVID-19 is excluded after testing negative if it will not significantly impact patient outcomes  – this decision will require discussion with the clinical team

Ensure the surgery is re-scheduled as soon as practicable after COVID-19 is excluded after testing negative.

    3. Symptoms and in the last 14 days prior to illness onset, has the patient had:

      • close contact with a confirmed case
      • travelled internationally
      • travelled on a cruise ship as a passenger or crew.
  1. If symptoms and other risk factors, support the patient to get tested if they have not already done so:
  2. Ensure the patient is appropriately isolated (whether at home or in hospital) as per public health guidance
  3. Postpone surgery until 14 days after the last contact day if it will not significantly impact patient outcomes – this decision will require discussion with the clinical team.

Ensure the surgery is re-scheduled as soon as practicable after the 14-day exclusion period has lapsed or COVID-19 is excluded after testing negative.

Infection control considerations for operating theatres

The Clinical Excellence Commission (CEC) has developed general COVID-19 Infection Prevention and Control Advice for Health Workers​, which should be followed by all NSW Health staff.

In addition, operating theatre staff should abide by the following advice:

More information


Outpatient clinics

Management of patients prior to outpatient appointments should be according to current public health guidance for testing and home isolation.

Outpatient clinics should review models of care and incorporate risk assessment and mitigation processes that include:

  • Screening of patients for symptoms prior to attendance, at reception and as part of routine clinical assessment. Anyone who is symptomatic or has a temperature should be advised to access testing at an appropriate location.
  • Measures to encourage physical distancing to ensure 1.5 metres of space between people where appropriate and practical. However, household members who are normally in close contact should be permitted to sit together.
  • Measures to encourage good personal hygiene, including access to hand washing facilities and/or hand sanitiser and signage to encourage hand hygiene and cough etiquette
  • Prioritise alternative models of care such as use of telemedicine technology where appropriate, especially for people who are vulnerable to severe illness such as elderly or immunocompromised people.​

Before attendance at outpatients

Screening patients prior to the outpatient appointment​

Develop a system, prior to attendance (e.g. phone call, SMS), to ask patients whether they have:

1. Ever been diagnosed with COVID-19 disease?

  • For people who have had COVID-19, ask date of diagnosis and time since recovery
  • Organise COVID-19 clearance testing as part of pre-treatment work-up in accordance with national guidelines and advice from the Clinical Excellence Commission

2. Any symptoms suggestive of COVID-19: fever (≥37.5°C) or history of fever (e.g. night sweats, chills) or acute respiratory infection (e.g. cough, shortness of breath, sore throat) or a combination of other non-specific symptoms (headache, tiredness, muscle pain, runny nose, loss of sense of taste or smell, diarrhoea, nausea/vomiting or loss of appetite)

  • If the patient has symptoms, support the patient to get tested if they have not already done so:
  • organise testing (if already at the hospital or outpatient clinic)
  • call their GP
  • call 1800 022 222 (healthdirect)
  • visit one of the public COVID-19 clinics​
  • visit one of the Australian Government COVID-19 GP Respiratory Clinics
  • If the patient has no symptoms, remind them if they develop new respiratory symptoms or fever to call healthdirect on 1800 022 222 or their GP for advice

Clinical and public health judgement should be used when considering testing individuals with the other non-specific symptoms for COVID-19 and may depend on other risk factors for infection (CDNA National guidelines for public health units)

3. Had contact with a person with confirmed COVID-19 while infectious, travelled internationally or been on a cruise, in the 14 days before the scheduled outpatient appointment

  • Advise the patient to seek testing if they have any new symptoms
  • Remind them they are to self-isolate at home for 14 days since last contact with the person with confirmed COVID-19 whilst infectious or after they returned from travelling internationally or on a cruise.

Reviewing the appointment

If the patient meets any of the above criteria:

  • consider alternate of methods of conducting the appointment if appropriate (e.g. telephone or tele-medicine) to reduce overall attendance and numbers of people in waiting rooms and hospital areas.
  • if it is not possible to conduct the appointment in an alternate way, reschedule their appointment unless it is clinically necessary to proceed
  • reschedule the appointment for as soon as possible after a negative test or the 14-day exclusion if they have been identified as a close contact or a returned traveller
  • Note, facilities will need to develop a system to implement the above steps, including appointing an appropriate person to assess whether or not it is safe to defer the outpatient appointment.

At the time of outpatient attendance

Screening patients at the outpatient clinic

  • Implement a process to actively identify patients who meet the screening criteria when they attend the outpatient clinic waiting room
  • in addition, use waiting room signage to identify people with symptoms or who have had close contact with a person with confirmed COVID-19 while infectious, in the previous 14 days
  • For patients who meet the screening criteria:
  • ask the patient to wear a surgical mask and where possible, move them to an area that is away from other patients
  • ask the patient if they have any new respiratory symptoms or fever.
  • For patients who meet the screening criteria
  • if it is clinically appropriate to conduct the appointment, consider alternate methods of conducting the appointment, or ask the patient to wear a surgical mask and conduct the appointment while following appropriate infection control procedures. This will include standard precautions, as well as contact and droplet precautions, hand hygiene, environmental cleaning and usual waste management.
  • For additional infection control procedures, see: Keep Patients Safe: COVID-19 Resources.
  • remind the patient that they should self-isolate at home for 14 days after they returned or have had contact with a person with confirmed COVID-19 while infectious.
  • For patients who meet the above criteria and who report symptoms, manage the patient in conjunction with the emergency department as per the clinician guidance.

Other guidance:

  • ensure availability of surgical masks and hand hygiene facilities
  • encourage 1.5 metre distancing in waiting rooms and at reception desks e.g. spacing chairs, floor markings, signage.
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Page Updated: Wednesday 27 May 2020
Contact page owner: Health Protection NSW