​​Scripts and guidance for NSW Health booking office staff to use with their patients during the COVID-19 pandemic.

Last updated: 14 January 2022
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Aim

  • For patients to receive their elective surgery in a safe and timely manner
  • To ensure continuity of care for the patient
  • To provide a resource for booking clerks to advise patients correctly
  • To ensure booking clerks direct clinical questions to appropriate clinician or resource

Information to support booking clerks to talk to patients about surgery whilst COVID-19 continues in community

A suggested script for booking officers to use with their patients:

1. Set patient expectations from the start

It is important to reassure patients that NSW Health aims to keep our patients, visitors, and staff safe and explain why surgery has recommenced.

Suggested sentence to include when offering a patient, a date for their surgery:  "Surgery like your <enter surgery> has now been able to safely start again in NSW due to the very high vaccination rates in NSW and the declining community cases of COVID-19."

2. Ensure patients are aware of the safeguards that are in place for them in hospital

Consider including the following information in your conversation and/or letter of offer to the patient. Alternatively you can refer patients to your District/Network COVID-19 webpage which can provide reassurance to a patient.

"Staff must be vaccinated against COVID-19"

It is a mandatory requirement that all Health Care Workers are vaccinated under Public Health (COVID-19 Vaccination of Health Care workers) Order by 20 January 2022.

COVID-19 vaccnation: Information for Clinicians in NSW

"All patients are screened for COVID-19”

All patients that require non-urgent elective surgery are screened for symptoms prior to their entry to the hospital.

"Additional infection control processes are in place to address COVID-19”

These are publicly available in the COVID-19 Infection Prevention Control Manual (version 1.7) from the Clinical Excellence Commission.

“Local COVID-19 cases numbers are publicly available”

Up to date COVID-19 numbers in the local area are available on the NSW Health website.

“All visitors must be fully vaccinated (two doses of a TGA approved COVID-19 vaccine) and must provide evidence when they enter a hospital”

Screening for all visitors will continue with the following expectation. They must also wear a surgical mask for their duration of their visit and scan QR codes and complete appropriate entry forms.

Any visitor arriving from overseas within the previous 7 days (fully vaccinated or not) must apply for a visitor exemption.

3. If the patient is still hesitant, offer the patient time to consider the option

Suggested response to patient: “I understand that I have given you a lot of information which you may want to discuss with your family and GP before accepting your surgery date. Is it ok if I call you back on <day/time?> To confirm?”

4. If the patient still declines surgery it is important to ascertain how long they will want to decline

4a. If the patient says “not until 2023/12 months” or “when COVID-19 has gone away”

A discussion needs to be had with the patient and the treating doctor as to if surgery is the best way forward for the patient or if they should be removed from the list.

Suggested response to patient:

“Thank you for letting me know you are choosing to decline your surgery at this time. Under NSW Health policy I need to include on your record how long you think you will want to wait to have your surgery. You have said that you won’t be willing to have your surgery until <include patient reasoning i.e. 2023 or when COVID-19 has gone away>.

Unfortunately, due to the nature of COVID-19 there may still be cases in the community or in hospital for some time and you are asking me to put your surgery on hold for a long time.”

4b. At this point you could suggest a timeframe to the patient to again give them some time to reflect, follow case numbers and seek expert advice to assist them in their decision if they want surgery at this time.

Suggested response to patient:

“Given the number of COVID-19 cases continue to go down, would you feel comfortable with me putting your surgery on hold for <timeframe dependent on category i.e. for a category 2: 2 weeks category 3:1 month> so you can think if your surgery is something that you feel you need at this time or if you would prefer to seek other options with your treating doctor or GP.”

4c. If the patient is determined that they do not want surgery until COVID-19 has been eradicated or for longer than 12 months:

Suggested response to patient:

“I will need to discuss with your doctor if surgery is still the best option for you as we cannot put you on hold for such a long time. I will speak to your doctor and get back to you. You may also want to speak to your doctor about alternative treatment that you may be more comfortable with.”

5. In the event the patient does defer surgery currently

The patient’s decision should be documented in the medical record and Recommendation for Admission Form (RFA). If the patient is a category 1 (surgery within 30 days) the treating doctor should also be consulted before the patient can defer.

Although a review of patients individual circumstances should be taken into account, in the event that hospitalisation and community COVID-19 numbers continue to decrease, patients should be advised that there are time limits to how long a patient can postpone surgery due to non-clinical reasons and they can be removed from the waitlist if these timeframes are exceeded.

Any decisions made to remove a patient from the waitlist must be made in line with section 6.12 of the PD2022_001 Elective Surgery Access policy and include consultation with the treating doctor. Authorisation from the Local Health District or Speciality Health Network Program Director of Surgery or equivalent is required as well as notification to the patient and GP.

Resources for further information on managing patients on the Elective Surgery List

COVID-19 specific resources

Please ensure any clinical questions are referred to a clinical nursing or medical staff.

Key questions and concerns that may be raised by patients

​Here are some suggested responses to give to your patients when they ask these questions or raise these concerns:

I have been told I am a close contact to someone who is positive for COVID-19. What should I do?

If the patient is a Category 1:

“Your doctor has said that your surgery is urgent. I will need to check with him before I can postpone your surgery. I will get back to you as soon as possible with his decision”

If the patient is a Category 2 or 3:

“I understand that you will need to follow the guidelines from NSW Health. We will delay the current booking and place you on hold.  Has NSW Health advised how long you need to self-isolate for? "

NOTE: As of December 2021 - 7 days

I have not yet had my second vaccination. What should I do?

“Thank you for letting me know your vaccination status. You are not required to be fully vaccinated to have your surgery as all patients are screened for symptoms before they come to hospital”

If the patient wishes to defer and the patient is a Category 1: “As your surgery has been classified by the doctor as urgent you need to talk to the doctor before I can defer your surgery”.

If the patient wishes to defer and the patient is a Category 2 or 3, ask the patient:

“Do you have an appointment for the second vaccination?”

<if yes> “We can place you on hold for this < XX > time and allocate a new date 7 days after the vaccination date”

<if no>

  1. Enquire if there is some concern about getting the second vaccination and if they can discuss this concern with their GP.
  2. If no concern but patient does not know how to book or have missed their 2nd appointment – direct them to their GP.

My driver/support person is not fully vaccinated and cannot get accommodation

If the patient is a Category 1:  “I understand the restrictions make it difficult, Your doctor has said that your surgery is urgent so I will need to check with him if it is ok to delay your surgery”.

If patient is a Category 2 or 3 and after above if Category 1: “Do you know when the second vaccination is due?"

<if yes > "We can allocate a date after this time if that is suitable and we will place you on hold until this time."

<if no > "Would you like to discuss with your support person and call us back​.”

I am not vaccinated. Will my surgery be cancelled?

"Thank you for contacting us, you will be able to have your surgery. We will need to do some screening prior to your admission and the clinical staff will contact you to discuss."

Will I be removed from the waitlist if I say no to this offer?

“Let’s just have a look at your record, may I ask why you wish to decline? <confirm any previous suspensions>”

Will my surgery be delayed if I decline this offer?

“Thank you for calling, may I ask why you wish to decline whilst I look at your record < if no other offers> follow guidelines as per the policy”.

Do I have to have a negative COVID-19 test before my surgery?

Follow local policy if your site has introduced mandatory testing and advise accordingly.

Current as at: Friday 14 January 2022
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