On Sunday, April 19th, the Centers for Medicare & Medicaid Services (CMS) released Phase 1 recommendations to re-start elective and non-emergent procedures in regions where low incidences of COVID-19 are present. The guidance is the first step in the President’s Open Up American Again approach that is designed to gradually increase elective procedures that have been limited or deferred since March 18th. Under the new guidelines, high acuity and high complexity cases continue to be a top priority, but preventive and elective procedures can occur as well when recommended preconditions are met.
CMS has established prerequisite gating criteria to help facilities determine if the timing is appropriate to advance to Phase 1. This criteria includes the presence of symptoms, the pervasiveness of the local incidence of COVID-19, and the coordination between the facility and the state and local health officials.
General considerations for healthcare facilities that meet Phase 1 prerequisites include the recommendation that facilities establish “Non-COVID Care (NCC) Zones” where all patients, healthcare providers, and ancillary workers are screened for COVID-19 prior to entering the area. Additionally, it is recommended that staff working in NCC zones not rotate into COVID-19 care zones. This guidance is of particular concern to anesthesia providers that routinely rotate through many clinical areas of facilities, and may assist with intubations and critical care management. To comply with this recommendation, some anesthesia groups may need to delineate a subset of providers to work in the NCC zones.
Additionally, the guidelines recommend that sufficient resources are available, such as personal protective equipment, healthy workforce, facilities, supplies, testing capacity, and post-acute care. Be sure to review the Phase 1 guidelines within these six domains:
Personal Protective Equipment (PPE)
Workforce Availability
Facility Considerations
Sanitation Protocols
Supplies
Testing Capacity
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