Issued June 17th, 2020
COVID-19 pandemic has changed how we practice medicine, let alone go about our daily lives. Given this is a new disease, literature is evolving rapidly. Patient, staff, and personnel safety is paramount, as well as providing high-quality healthcare.
Cessation and cancellation of elective adult surgical procedures worldwide due to the pandemic has been estimated to be over 28 million cases over the 12-weeks peak of COVID-191 and the best estimation of cancelled cases in the Gulf countries were over 262,000 and in Kuwait over 31,000 cases2. This resulted in backlog of surgeries that may require up to 45 weeks or more to be cleared.
Moreover, elective surgery has been ceased since end of March 2020 in Kuwait until today and continuing to do so could place many patients at risk of disease progression or complications. The risk of contracting SARS-COV2 within 30 days perioperatively has been associated with high mortality and morbidity3, therefore, while the healthcare system recovers and adjusts to after the peak of COVID-19 new era, careful planning and assessment of local resources is imperative prior to the return of safe surgical practice of elective surgery. With that goal in mind, Kuwait Association of Surgeons, Women Surgeons Committee, and the American College of Surgeons Kuwait Chapter have issued this joint recommendations and statements to provide surgeons and healthcare providers practical tips and guidelines on transitioning back to surgery based on the most recent available scientific evidence.
Resume Elective Surgery Recommendation
The recommendations cover the following issues:
We suggest that the Ministry of Health allocates specific hospitals, or if not feasible, buildings or areas to ensure segregation of both proven and suspected COVID patients from elective surgical cases.
SARS-COV2 negative buildings, or areas should include out-patient clinics, operating suite(s) or room(s), radiology suite(s), elevator(s), designated service(s), intensive care unit(s) and medical and surgical team(s) dedicated for SARS-COV2 negative patients if feasible.
Health care facilities should have an adequate number of ICU beds, ventilators, medications, and the necessary medical and surgical supplies, and personal protective equipment (PPE) needed for the resumption of elective procedures.
We recommend that each hospital forms a committee or a team consisting of surgery, anesthesia and nursing leadership to oversee the initial transition period of resuming elective surgery, and to provide, when required insightful and timely decisions, to make the necessary adjustments during the initial phase.
We recommend that preventative medicine and infection control protocols are set in place as per MOH guidelines in all SARS-COV2 negative health care facilities to promptly provide support and guidance for any rising situation in timely fashion.
The healthcare facility is advised to:
We emphasize on the importance of setting explicit strategies and facilitation of logistics for re-scheduling patients for elective surgeries.
We recommend minimizing hospital visits and utilizing virtual care appropriately for rescheduling outpatient appointments, tracking laboratory and radiological investigation results, medication orders and renewals, admission, discharge and follow up bookings.
We encourage utilization of virtual care and telemedicine in pre-operative counseling, obtaining a history, assessing the need for repeated investigations as well as a pre-surgical SARS-COV2 screening and consent discussion.
Hospitals are encouraged to provide electronic and online relevant educational material for patients undergoing elective surgery.
Hospital administrators are encouraged to regularly collect and evaluate data of their institution’s capacity and resources for elective surgery and to adjust plans accordingly.
We suggest that healthcare facilities dedicate specific number of surgical, anesthesia, nursing, and other ancillary staff for the care of SARS-COV2 negative patients.
We suggest that availability of the staff should meet the complexity of the procedure(s) appropriately to assure safely.
Institutions are encouraged to carefully assess current stocks of test kits of SARS-COV2 and to estimate test kits required for testing of elective surgery patients.
Healthcare facilities are expected to maintain adequate stock for patients testing.
We recommend
We suggest
Symptomatic or patient’s tested positive for COVID-19 should have their elective surgery postponed till asymptomatic and negative for SARS-COV2.
Institutions are expected to carefully assess current stocks of PPE and estimate needed PPE required for resuming elective surgery patients taking in consideration the following:
We recommend that patient selection for surgery should be a coordinated effort between surgical, anesthesia, nursing, and other relevant specialties.
Prioritization of patients should be multi-channeled and further characterized based on prior postponed cases during the COVID-19 pandemic, oncologic and emergent cases, and objective priority scoring4-6. Patients already on waiting lists should be re-triaged and given priority.
We recommend starting elective surgery on younger and healthier patients (below 60 years of age) and with An ASA I (normal healthy patient) or ASA II (patient with a mild systemic disease) in the initial phase of return to elective surgery. As both age and specific comorbidities (hypertension, cardiovascular disease, diabetes, lung disease, liver and kidney disease and BMI > 30 kg.m2) are now recognized to be negatively associated with outcomes of COVID-19.5
We recommend that hospitals should implement prioritization policy for elective surgery cases taking in consideration the following:
We emphasize that confirmed or suspected COVID-19 patients are omitted from elective surgery till they are asymptomatic for 10-14 days and test negative for SARS-COV2.
We recommend that once patients have been selected to proceed with elective surgery, utilization of telemedicine and virtual care in pre-operative planning should be done within local and institutional regulations.
We advise to educate patients about the following:
We advise to consider telemedicine and virtual care in
We advise discussing COVID-19 related concerns in addition to the standard consent of the procedure intended as suggested below
Table1. Important COVID-19 related items to discuss in consent |
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We encourage patients and their relatives to donate blood 3-4 weeks prior to the date of scheduled surgery, and we encourage hospitals to facilitate blood donation process on its premises.
Returning to elective surgery should be timed properly within the pandemic. In Kuwait, private and government healthcare systems co-exist, each with its unique characteristics.
Elective surgeries should definitely be started after approval from the Ministry of Health when COVID-19 cases start to decline in the country for at least 14 consecutive days.
We suggest that institutions (private or governmental) keep proper statistics for the number of COVID-19 cases being admitted daily and consider restarting elective surgery when there is a steady decline of COVID-19 cases for at least 14 consecutive days in that institution.
Resumption of elective surgery for SARS-COV2 negative patients, should proceed with caution with a decline in number of cases and after fulfilment of pre-requisites in these guidelines.
For institutions that do not provide care for COVID-19 patients, resumption of elective surgery should be considered as soon as the MOH approves the start of surgery and after fulfilment of the pre-requisites and considerations in these guidelines.
We recommend assessing these factors prior to safe resumption of elective surgery:
We suggest utilizing the following checklist for healthcare facilities to assess readiness to resume elective surgeries
Checklist A. Resuming Elective Surgery Pre-Requisites | |
Sustained decline of COVID-19 positive cases in the institution for 14 days | |
Healthcare Facilities preparedness and work organization met requirement for | |
Facilities Resources Policies Prevention and Infection Control |
|
Administration met requirement | |
Strategies and logistics for re-scheduling Patient access |
|
Teams and Services | |
Surgical Anesthesia Ancillary Teams Adjunct Services |
|
Testing Availability | |
Patients Healthcare Workers |
|
PPE Availability | |
Number of staff needing to use PPE Number of procedures requiring specific PPE (e.g.: contact vs air-born) Rate of consumption Back up planning for PPE shortage |
|
Protocols for selection, case prioritization and scheduling in place | |
Protocols for pre-operative care is in place | |
Protocols for postoperative, discharge and follow up care available | |
Disposition Protocols for patients who become COVID-19 positive while in hospital in place | |
Data collection system in place | |
Plan in place for increasing OR capacity | |
Backup plan in case of manpower shortage due to COVID-19 second wave | |
Regular evaluation for resources, and outcomes |
We emphasize that assessing the capacity of a healthcare institution is a dynamic process. Starting surgical capacity should be at a capacity goal less than pre-COVID-19 rates and best started at 20% with slow upward increments.
We suggest that healthcare facilities plan the return to Elective Surgery Phases as follows
We recommend starting with healthy and very low risk patients, ASA I, Age 18-50, no comorbidities and BMI ≤ 35, LOS < 12 hours, under local or regional anesthesia, estimated time for procedure should be less than 60 minutes with minimal estimated blood loss of less than 50 ml. The surgical team consists of 1 surgeon only, risk of intubation and ICU admission is very unlikely.
Out-Patient Phase 1 Procedures | |||||
Patients factors | Procedure factors | Institution factors | |||
Age | 18- 50 | Surgery time | < 60 minutes | Intubation risk | <0.5% |
ASA Score | I | Blood loss | <50 ml | LOS | ≤12h |
Comorbidity | 0 | No. surgical team | 1 | ICU risk | <0.5% |
BMI | ≤ 35 |
Out-Patients Elective General Surgery Procedures | |||
Phase 1 | Phase 2 | Phase 3 | Phase 4 |
OR 20% Capacity | OR 30% Capacity | OR 50% Capacity | OR 100% Capacity |
Out-Patients Benign skin minor-OT and office-based procedures such as sebaceous cyst, in-grow nail, biopsy, small lipomas etc. |
Phase 1 cases and Benign anorectal office-based procedures Hernia and lipoma under regional |
Phase 1 + 2 cases and Circumcision Pediatrics and Adolescence minor out-patient cases |
Phase 1 + 2 + 3 cases |
We propose the following timeline as a model to resume elective surgery with the notion that each institution will weigh the previously discussed considerations and pre-requisites and exercise the best clinical judgement into the application of this suggested timeline to its facility’s capacity and resources and then with slow upward increments.
The model estimates the time projected to start and reach 100% capacity for elective surgery over four phases, and then the fifth phase indicates readiness to begin “Over Capacity phase” by increasing the capacity to 140% eventfully to clear the backlog of cases from the peak of the COVID9 pandemic as illustrated below.
The model incorporates patients, procedures, institutional factors and resources as well as the presumption that the COVID19 pandemic is in the decline over the next few months which would liberate more resources that can be utilized to support more complex patients who may need more healthcare support. Phase one is highlights the beginning of the timeline and phase one marks the start of increase capacity to clear the log back of cases.
We suggest that surgeons exercise their best clinical judgment to fit their patients into this phase appropriately. List of surgical procedures are discussed under the procedure section.
In this phase, the OR capacity starts at 20%. Patients should be 18 to 60 years of age, with ASA score if I-II, with 0-2 controlled comorbidities and BMI ≤ 40. The estimated time for surgery should be less than 120 minutes with minimal estimated blood loss of less than 100 ml. The surgical team consists of 1-2 surgeons maximum due allow for the gradual manpower redistribution and reduce the risk of infection in cases the exposure to false negative patients. The length of stay should be less than 24 hours and the risk of intubation and ICU admission is very unlikely.
In-Patient Procedures and Surgeries Phase 1 | |||||
Estimated OR Capacity 20% | |||||
Patients factors | Procedure factors | Institution factors | |||
Age | 18- 60 | Surgery time | < 120 minutes | Intubation risk | <1% |
ASA Score | I-II | Blood loss | <100 ml | LOS | ≤24h |
Comorbidity | 0-2 | No. surgical team | 1-2 | ICU risk | <1% |
BMI | ≤ 40 |
The estimated OR capacity of 30% in this phase. Patients should be 18 to 75 years of age, with ASA score if I-II, with 0-3 controlled comorbidities and BMI ≤ 50. The estimated time for surgery should be less than 180 minutes with minimal estimated blood loss of less than 250 ml. The surgical team consists of 1-3 surgeons maximum to reduce the risk of infection in cases the exposure to false negative patients. The length of stay should not exceed than 48 hours, the risk of intubation and ICU admission is below 5%.
In-Patient Procedures and Surgeries Phase 2 | |||||
Estimated OR Capacity 30% | |||||
Patients factors | Procedure factors | Institution factors | |||
Age | ≤ 75 | Surgery time | 120-180 minutes | Intubation risk | 1-5% |
ASA Score | I-II | Blood loss | 100-250 | LOS | >24-48 hour |
Comorbid | 0-3 | No. surgical team | 1-3 | ICU risk | <5% |
BMI | ≤ 50 |
Estimated OR capacity is 50%. The patients should be younger than 100 years of age. ASA score I-IV, with 0-5 controlled comorbidities and BMI ≤ 65. The estimated time for surgery should be less than 240 minutes with minimal estimated blood loss of less than 750 ml. The surgical team consists of 1-4 surgeons maximum. The length of stay can be up to 3 days and the risk of intubation up to 10% and ICU admission between 5-15%.
In-Patient Procedures and Surgeries Phase 3 | |||||
Estimated OR Capacity 50% | |||||
Patients factors | Procedure factors | Institution factors | |||
Age | <100 | Surgery time | >180-240 minutes | Intubation risk | 6-10% |
ASA Score | I-IV | Blood loss | 250-750 ml | LOS | >3 days |
Comorbid | 0-5 | No. surgical team | 1-5 | ICU risk | 5-15% |
BMI | ≤65 |
In this phase, the OR is expected to return to 100% and therefore, more complex patients and surgical cases is expected to be manageable as more resources are expected to be available.
Less limitation to patient’s factors and surgical procedures, however, considerations to intensive care unit resources should be monitored and spared, as second wave of COVID19 may occur. Patients should be 18 to 60 years of age, with ASA score if I-II, with 0-2 controlled comorbidities and BMI ≤ 40. The estimated time for surgery should be less than 120 minutes with minimal estimated blood loss of less than 100 ml. The surgical team consists of 1-2 surgeons maximum due allow for the gradual manpower redistribution and reduce the risk of infection in cases the exposure to false negative patients. Length of hospital stay can be up to 7 days and the risk of intubation <25% and ICU admission should not exceed 20%.
In-Patient Procedures and Surgeries Phase 4 | |||||
Estimated OR Capacity 100% | |||||
Patients factors | Procedure factors | Institution factors | |||
Age | No limit | Surgery time | >240 minutes | Intubation risk | >11-25% |
ASA Score | I-V | Blood loss | >750 ml | LOS | 3-7 days |
Comorbid | No limit | No. surgical team | ICU risk | 15-20% | |
BMI | No limit |
Hospitals and surgical departments are encouraged to collaborate to accurately assess their local manpower and resource and calculate the number of surgical and procedural cases that was canceled over the period of February 2020 to date to properly estimate and plan re-scheduling of these cases.
Once the numbers are accounted for, prioritization of re-scheduling cases should be based on the as mentioned in sections above.
The following triaging scheme takes in account time-sensitive surgical procedures measured to patient’s general condition, local available resources and expected outcome and integrates it into the timeline model to start the return to elective surgery in multiple surgical specialties such as General Surgery, Surgical Oncology, Hepatobiliary, Bariatric and Metabolic Surgery, Otolaryngology, Orthopedics Neurosurgery, Urology and Plastic Surgery.
Emergency and urgent surgeries that are expected to be done within 24-72 hours are excluded from the following triaging list.
We suggest the following list for triaging Elective General Surgery:
Inpatient Elective General Surgery Procedures | |||
Phase 1 | Phase 2 | Phase 3 | Phase 4 |
OR 20% Capacity | OR 30% Capacity | OR 50% Capacity | OR 100% Capacity |
Oncological diseases causing obstruction:
Oncological diseases not causing obstruction
Cholecystectomy for biliary colic |
Phase 1 cases and Hernia presenting with risks of complications Goiter with mild/moderate strider |
Phase 1 + 2 cases and Cholecystectomy- post acute pancreatitis Hartmann’s reversal and closure of stomas Benign thyroid and parathyroid conditions Benign breast surgery |
Phase 1 + 2 + 3 cases and Abdominal wall reconstruction Benign Hepatobiliary with reconstruction (Choledochal cyst Biliary) Achalasia Heller's myotomy Gastroesophageal reflux surgeries |
We suggest the following list for triaging Elective Bariatric and Metabolic Surgery cases:
Inpatient Elective General Surgery Procedures | |||
Phase 1 | Phase 2 | Phase 3 | Phase 4 |
OR 20% Capacity | OR 30% Capacity | OR 50% Capacity | OR 100% Capacity |
BMI ≤45 Age 18-50 years ASA I & II Surgery time ≤ 120 mins LOS 24 hours Need of post-op ICU <2% Anticipated blood loss < 100ml Number of surgical team 1-2 Intubation possibility <1% |
BMI ≤50 Age 18-55 years ASA I & II Surgery time ≤180 mins LOS <48 hour Need of post-op ICU < 5% Anticipated Blood loss 100-250 Number of surgical team 1-3 Intubation possibility 1-5% |
BMI ≤65 Age 18-65 ASA I-III Surgery time 180-240 mins LOS up to 3 day Need of ICU post op 5-15% Anticipated Blood loss 250-500 ml Number of surgical team 1-4 Intubation possibility 6-10% |
BMI ≤ 80 Age 18-65 ASA I-IV Surgery time ≥240 mins or LOS up 3-7 days Need of ICU post op <20% Anticipated Blood loss >750 Number of surgical team 1- >4 Intubation possibility <25% |
Primary gastric band Primary sleeve |
Phase 1 cases and Primary gastric bypass Primary one anastomosis gastric bypass |
Phase 1 + 2 cases and Primary duodenal switch |
Phase 1 + 2 + 3 cases and Revisions for weight gain |
Emergency and urgent surgeries that are expected to be done within 24-72 hours are excluded from the following triaging list. We suggest the following list for triaging Elective Otolaryngology Surgery cases:
Inpatient Elective General Surgery Procedures | |||
Phase 1 | Phase 2 | Phase 3 | Phase 4 |
OR 20% Capacity | OR 30% Capacity | OR 50% Capacity | OR 100% Capacity |
Excisional LN biopsy (for suspected lymphoma) Panendoscopy, micolaryngoscopy + biopsy for suspected malignancy of the upper aerodigestive tract Thyroid/Parathyroid cancer High grade salivary cancers Oropharyngeal/Nasopharyngeal cancer surgery Sinus cancers |
Phase 1 cases and Thyroid enlargement-with mild to moderate airway compromise Tonsils/Adenoids (mild to moderate airway compromise) Thyrotoxicosis not responding to medical management Pediatric micro laryngoscopy for progressive airway conditions (RRP, Subglottic stenosis) Sinus surgery – complete nasal obstruction associated with severe sleep disordered breathing |
Phase 1 + 2 cases and Cochlear implantation post-meningitis Barotrauma perilymph fistula Diagnostic thyroid lobectomy CSF fistula repair Symptomatic mucocele Cochlear implant in preverbal profound HL where delay may impact long term outcome |
Phase 1 + 2 + 3 cases and ALL other rhinology cases CSOM surgery Ossicular chain implants/middle ear surgery Tympanoplasty Tonsils/Adenoids/Grommet tube Uncomplicated nasal bone fracture Procedures for Benign laryngeal pathology Rhinoplasty Benign salivary gland surgery |
Emergency and urgent surgeries that are expected to be done within 24-72 hours, discussed in the previous guidelines, are excluded from the following triaging list. We suggest the following list for triaging Elective Orthopedics Surgery cases:
Inpatient Elective General Surgery Procedures | |||
Phase 1 | Phase 2 | Phase 3 | Phase 4 |
OR 20% Capacity | OR 30% Capacity | OR 50% Capacity | OR 100% Capacity |
Simple nerve decompression (carpal tunnel, ulnar nerve) Trigger finger release Hallux valgus correction knee arthroscopy (meniscal pathology) Simple shoulder arthroscopy (AC decompression, simple cuff repair) Simple lumbar microdiscectomy Stem cell injection, PRP injection procedures |
Phase 1 cases and Single level lumbar spine surgery Primary ACL reconstruction Foot corrective osteotomies |
Phase 1 + 2 cases and Primary total knee arthroplasty Primary total hip arthroplasty Primary total shoulder arthroplasty |
Phase 1 + 2 + 3 cases and Revision total knee arthroplasty Revision total hip arthroplasty Revision shoulder arthroplasty Multiple level lumbar spine surgery Cervical spine surgery Revision ACL reconstruction Complex shoulder arthroscopy Complex Foot correction |
Emergency and urgent surgeries that are expected to be done within 24-72 hours, discussed in the previous guidelines, are excluded from the following triaging list.
We suggest the following list for triaging Elective Neurosurgery cases:
Inpatient Elective General Surgery Procedures | |||
Phase 1 | Phase 2 | Phase 3 | Phase 4 |
OR 20% Capacity | OR 30% Capacity | OR 50% Capacity | OR 100% Capacity |
Oncology: with potential to progress (e.g. symptomatic meningioma, low grade glioma with little or no mass effect) Spinal: Progressive myelopathy in patients with a risk of falling, Severe radiculopathy causing severe pain. This pain is requiring extensive opioid use Epilepsy: VNS battery revision |
Phase 1 cases and Trauma: e.g. cranioplasty |
Phase 1 + 2 cases and Pediatric: Laser ablation procedures Spinal: Nerve root schwannoma, herniated disc with controlled radiating pain |
Phase 1 + 2 + 3 cases and Pediatric: Craniosynostosis , Asymptomatic Occult spina bifida Epilepsy Oncology: e.g. incidental meningioma Vascular: Unruptured intracranial aneurysm or AVM , Epilepsy: Unoperated epilepsy foci, VNS insertion Functional: non-operated cases |
: Expected large blood loss (>50% of circulating blood volume in 30 minutes, +/- blood loss exceeding >150cc/min or blood loss necessitating plasma or platelet transfusion). Surgery expected to last more than 2 hours on average. |
Emergency and urgent surgeries that are expected to be done within 24-72 hours are excluded from the following triaging list.
We suggest the following list for triaging Elective Urology Surgery cases:
Inpatient Elective General Surgery Procedures | |||
Phase 1 | Phase 2 | Phase 3 | Phase 4 |
OR 20% Capacity | OR 30% Capacity | OR 50% Capacity | OR 100% Capacity |
MTD Testicular cancer surgery (non- metastatic) MTD Bladder cancer surgery MTD Renal cancer surgery (non-bleeding) MTD Upper tract transitional cell cancer surgery Acute Urinary Retention |
Phase 1 cases and Stent removal/ exchange Hematuria - investigation for non-visible |
Phase 1 + 2 cases and Prostate cancer surgery Fistula surgery Female urology for benign conditions (e.g. incontinence/ prolapse/Sacral Nerve Stimulator/ fistula/urethral diverticulum) Andrology/GU Surgery (male fertility surgery) Endourology- uncomplicated stones/ percutaneous nephrolithotomy/ pelviureteric obstruction |
Phase 1 + 2 + 3 cases and Urethral stricture Gender reassignment Andrology/GU Surgery (surgery for erectile dysfunction/ urethral stricture/ Bladder outflow surgery |
Emergency and urgent surgeries that are expected to be done within 24-72, are excluded from the following triaging list. We suggest the following list for triaging Elective Plastic Surgery cases:
Inpatient Elective General Surgery Procedures | |||
Phase 1 | Phase 2 | Phase 3 | Phase 4 |
OR 20% Capacity | OR 30% Capacity | OR 50% Capacity | OR 100% Capacity |
Excision and coverage for burns (skin grafts with or without dermal substitutes) Complex infantile hemangiomas with significant ulcerations, bleeding or causing significant impediments such as vision obstruction, that are not responsive to medical therapy |
Simple limb trauma reconstruction, unsuitable for conservative treatment: - Skin graft - Dermal substitutes - Local flaps |
Diabetic foot reconstruction (by skin grafts, dermal substitute, and local flaps) Bedsore reconstruction, unsuitable for conservative treatment, e.g.: - Rotation flap - Gluteus maximus myocutaneous flap - Tensor fascia lata flap - V-Y gluteus maximus flap - Propeller/perforator flaps Some oncologic and trauma-related reconstructive procedures, especially for head and neck or perineal malignancies (e.g. TRAM flap, LD flap, Pectoralis major muscle flap, supraclavicular flap, gracilis flap, internal pudendal artery flap) |
Major limb trauma reconstruction (by free flaps e.g.: latissimus dorsi free flap, ALT free flap, SCIP free flap, free fibula flap, radial forearm free flap) All aesthetic surgeries, e.g.: - Abdominoplasty - Brachioplasty - Belt lipectomy - Thigh lift - Reduction mammoplasty - Mastopexy - Breast augmentation Most other craniofacial and reconstructive plastic surgery procedures (e.g. cleft lip & palate surgeries, orthofacial surgery, tissue |
We advise healthcare service and surgeons to provide the optimal care for patients by strict adherence to standardized care and protocols for elective surgery and accelerated discharge pathways.
We encourage minimizing risk of infection and exposure to nosocomial infections by
We recommend in the case of a patient becomes symptomatic for COVID-19 postoperatively, clear instructions for testing and patient isolation while awaiting test results should be in place. Once test results are positive, arrangements should be clear on disposition of the patient (COVID-19 hospital vs COVID-19 wards in the same institution).
We advise that patients are instructed to
We recommend implementing out-patient care protocols that ensure adequate post-operative follow-up with unimpeded access to the healthcare service in the event of possible adverse outcome or complication (provide early post-op virtual or phone call, online support or hospital contact for discharged patients).
We encourage surgeons and the healthcare provider to utilize telehealth when possible for the postoperative follow-ups unless face to face consultation is required or further investigations or treatment is needed (e.g. chemotherapy treatment).
We advise Health Care facilities to gather relevant data (electronic or on paper) and set key performance indicators at the institution and departmental level
We encourage hospitals to analyze and review this data regularly to improve current practice, policies and outcome.
We encourage institutions to share with local authorities and MOH and consider forming a national registry to assess and improve outcome.
Data collection is suggested to be in the following areas:
Sample 1. Checklist for Patient’s Eligibility for Re-scheduling for Elective Surgery Phase 1 (Non-Bariatric Surgery)
Sample 2. Checklist for Patient’s Eligibility for Re-scheduling for Elective Surgery Phase 2 (Non-Bariatric Surgery)
Sample 3. Checklist for Patient’s Eligibility for Re-scheduling for Elective Surgery Phase 3 (Non-Bariatric Surgery)
Sample 4. Checklist for Patient’s Eligibility for Re-scheduling for Elective Surgery Phase 4 (Non-Bariatric Surgery)
Sample 5. Checklist for Patient’s Eligibility for Re-scheduling for Bariatric and Metabolic Surgery Phase 1
Sample 6. Checklists for Patient’s Eligibility for Re-scheduling for Bariatric and Metabolic Surgery Phase 2
Sample 7. Checklists for Patient’s Eligibility for Re-scheduling for Bariatric and Metabolic Surgery Phase 3
Appendix 1. Pre-Visit COVID-19 Screening Questionnaire
Question | |||
1 | Are you coming from a. home b. hospital c. long term care | ||
2 | Have you had any of the following symptoms BEGIN in the last 14 days? | YES | NO |
Fever |
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Chills | |||
Cough | |||
Shortness of breath or breathing difficulties | |||
Runny nose or nasal congestion | |||
Joint or muscle pain | |||
New headache | |||
Recent onset of loss of smell or taste | |||
Weakness, exhaustion | |||
New onset diarrhea, nausea, vomiting | |||
Pink eye | |||
Any other symptoms or illness | |||
3 | Have you been in contact with, or close to anyone who has the coronavirus in the last 14 days? | ||
4 | Have you been in contact with, or close to someone who has been sick in the last 14 days (such as a cold, pneumonia, etc.), in absence of negative COVID-19 test. | ||
5 | Have you travelled in the last 2 weeks? If so, where? | ||
6 | Do you work in a high-risk facility and have you been tested positive for COVID-19? If so, when? |
Asmaa Al-Rashed, BSc. MD. FRCSC. FACS., Maha Al-Gilani, MBBS, FRCSC, MSCI., Shamlan Al-Qinai, MB. BCh. BAO., KBS. Athari Al-Wael, MBBS, FRCSC. FACS., Alya Hasan, MD, FRCSC., Omar Al-Hunaidi, BSc. MD. KBU.,Muneera Ben Nakhi, MD. KBS. FACS., Ali Jarragh, MB. BCh, FRCSC., FRCSC, Salman Al-Sabah, MD. MBA. FRCSC. FACS.