Guidance for New Jersey Ambulatory Surgery Centers: Resumption of Elective Surgery and Invasive Procedures

On May 19, 2020, the Commissioner of the New Jersey Department of Health (DOH), Judith Persichilli, issued guidance for New Jersey’s ambulatory surgery centers, permitting them to resume performing elective surgery and invasive procedures. The guidance follows Governor Murphy’s Executive Order No. 145, issued on May 15, permitting the resumption of these activities pending DOH’s guidance.

The detailed guidance is broad in scope and incorporates a range of guidance documents published by the CDC and elsewhere by the DOH.

General Requirements:

• Comply with state and CDC guidelines.
• Institute screening of healthcare staff for symptoms of COVID-19 and have policies in place for removal of symptomatic employees from the workplace.
• Enforce social distancing requirements.
• Require masks for patients, except patients receiving services that would not allow for the use of masks, and for any patient support person.
• Have an established plan for cleaning and disinfecting prior to using facilities to serve non-COVID-19 patients.
• Be prepared to modify reopening in conjunction with surge status and to repurpose and redeploy staff to urgent care roles to the extent feasible.

Targeted Requirements:

• Transfer Agreements: Ambulatory surgery centers must have transfer agreements in place with an acute care facility partner and must confirm and document, before each surgery day, that the facility has an appropriate number of ICU and non-ICU beds to support emergent transfers, adequate PPE, ventilators, medications, and trained staff.
• Hospitals: Hospitals must have available staffed ICU, Critical Care, and Medical Surgery Beds and must have downward trajectories of the following:
  • Influenza-like illness or COVID-19-like syndromic cases
  • COVID-19 infection rates
  • COVID-19 hospitalizations
  • COVID-19 emergency room admissions
  • COVID-19 Intensive Care Unit (ICU), Critical Care, and Medical Surgical bed utilization
  • Ventilator utilization
  • Ventilator availability
• Scheduling and Prioritization: All cases must be reviewed by a site-based governance group. The governance group must develop and review prioritization of surgical and procedural care for essential cases, such as fractures and cancer. Capacity must be modeled based on extended turnover and spacing out procedures and appointments.The governance group may also consider: prioritization of previously cancelled and postponed cases; specialties’ prioritization; strategy for allotting daytime “OR/procedural time”; identification of essential healthcare professionals and medical device representatives when necessary for procedures; strategy for increasing “OR/procedural time” availability (e.g., extended hours or weekends); and issues associated with increased OR/procedural volume.
• Personal Protective Equipment: The DOH establishes requirements for use, planning, and policies pertaining to PPE.
• Staffing: Training requirements are established pertaining to, among other things, protection and testing of staff.
• Disinfection Protocols, Supplies, and Equipment Maintenance: ASCs must confirm that cleaning and disinfecting supplies are COVID-19 compatible; ensure adequate supply of hand sanitizers, tissues, and non-touch trash receptacles; ensure that all equipment is up-to-date on preventative maintenance: check all expiration dates; remove magazines from waiting areas; and confirm that all preventative infection policies are updated.
• COVID-19 Positive Patients: Ambulatory surgical centers cannot perform procedures on COVID-19 positive patients.
• Social Distancing: Scheduling must be coordinated to promote social distancing, i.e., to minimize time in waiting area; stagger appointments, and signage regarding signs or symptoms and precautions.
• COVID-19 Testing: Facilities must test (specimen collected and result received) each patient within a 96-hour maximum before a scheduled procedure with a preoperative COVID-19 RT-PCR test and ensure COVID-19 negative status.
• Patient Counseling: Facilities shall counsel patients about self-quarantine, social distance, and wearing a mask in their place of self-quarantine, and patients must be counseled to immediately inform the facility: if there is any contact with a suspected or confirmed case of COVID-19; if there is any contact with a person with symptoms consistent with COVID-19; and if the patient develops any symptoms consistent with COVID-19 while in self-quarantine.
• Patient Screening: Facilities must have a process to screen patients for COVID-19-related symptoms prior to scheduled procedures and to ensure that the patient has worn a mask, social quarantined and social distanced since testing.
• Visitor Policies: Until further notice, no visitors will be allowed, except as permitted below:
  • Pediatric patients may have one parent or guardian.
  • Same-day surgery or procedure patients may have one support person.
  • Outpatients may be accompanied by one adult.
  • Otherwise as permitted in waivers from DOH available at https://nj.gov/health/legal/covid19.
• Reporting Metrics:
  • Comply with Governor Murphy’s Executive Order No. 111 (2020) concerning reporting of data, including PPE inventory on a daily basis.
  • Report case load on a weekly basis through the same NJHA portal.
• Resources: Web-links and online information portals are provided for access to general and more targeted guidance pertaining to: Planning, Infection Prevention and Control, PPE, Staffing, Pre-Procedure Testing, Visitors and Support Persons, and Discharge.