On June 1, we announced that all patients planning a procedure at Salem Health could be tested for COVID-19. The test that is being offered to pre-procedural patients is a commercial test sent out for results with a five to seven day turnaround time.
What does testing do for us?
Our number one goal is to keep our patients, staff, and providers safe. Identifying patients with active infection before their procedure allows time to delay the case to a time when the patient is healthy. In addition, reducing the number of people with active COVID-19 infections coming into our hospital environment reduces the risk of community transmission. Lastly, once we’ve demonstrated test reliability, we will be able to eliminate the wait times after aerosol generating procedures (AGPs), including extubation. This will increase our efficiency and capacity in the operating room as well as conserving airborne PPE.
When will we be able to eliminate the wait times after AGP?
To validate our region’s data, we need 658 tests on asymptomatic, non-suspected patients from our local patient population. If the results continue to show a low rate of positivity, we can conclude that our negative predictive value is reliable at greater than 99%. This will give us confidence that a negative test is accurate and reduce the need for wait times after AGPs. Wait times will continue to be observed for patients who have not been tested. We hope to reach the necessary number of tests within a few weeks, with help from you and our healthcare partners in the community!
What do we need to do next?
Based on the above, we will be making pre-procedural testing of scheduled patients our standard. Going forward, if you see a patient in your clinic who will be having surgery, please order a COVID-19 test as part of your pre-op lab panel, to be done 7 days prior to the procedure.
If pre-procedure testing is being done at Salem Hospital Laboratory, use the 2019 Novel Coronavirus SARS COV 2 BY PCR, LAB4144 EPIC order. The prompts will ask you to indicate whether this is for a pre-procedural, asymptomatic patient. Please instruct patients to get their test done 7 days before their surgery to ensure results are back timely. Quest Labs is not scheduling or collecting COVID tests, so patients will need to be directed to a Salem Hospital Laboratory location. Lab tests from other clinics (Kaiser, Salem Clinic, etc.) will be accepted by Salem Health as well, as long as the test was done within 7 days of surgery. Data from these tests will also be used toward our data for community prevalence.
Please continue to advise patients to self-isolate and use good hand hygiene in the weeks leading up to their procedure and to notify your clinic if they develop COVID-19 like symptoms.
As we launch this new standard, our goal is for all patients to be tested for scheduled procedures July 1 and onward. We know that there are patients currently scheduled for July. For procedures scheduled as of today that will occur July 1 and forward, our pre-surgical screening team will place an order and call the patient with instructions about getting tested for COVID-19.
Please order COVID-19 testing for any patients you see and schedule procedures for today and beyond. Follow the process you normally use to order preoperative labs, and use Order LAB4144 2019 Novel Coronavirus SARS COV 2 by PCR. Patients added to the schedule urgently (without the 5-7 days to get the test resulted) will not be able to be tested at this time.
When should we expect to see the change in wait time after AGP?
We will announce in Common Ground and in OR huddles when we have reached the negative predictive value we are looking for. At that time, we will be able to eliminate the wait time after AGPs for patients testing negative prior to their procedure. Patients without a negative test (e.g. patients scheduled urgently, or patients who refuse a test) will continue to require the use of airborne PPE and wait time for AGPs for procedures. Once we are able to establish more capacity for in-house rapid testing, we will be able to get more asymptomatic patients tested with a shorter turnaround time, and will keep you updated as our availability increases.
Thank you!
We will continue to check and adjust this process to streamline it and manage any changes in testing supplies.
As we have been saying for 12 weeks now—thank you so much for your support and understanding as workflows continue to change as we respond to this event.