Page 18 - 2020 Annual Outcomes Report
P. 18

    INFECTION PREVENTION & PATIENT SAFETY CONTINUED
HOI COVID-19 PATIENT PROTOCOL
Hoag Orthopedic Institute was cautious in commencing patient care activities after the initial six-week statewide COVID-19 shutdown to ensure the safety of patients and staff. In the early days of the COVID-19 crisis, HOI physician and executive leadership teams immediately began developing an orthopedic specific algorithm to serve as a risk-based, phased methodology to safely resume scheduled surgical procedures, when appropriate, and proactively meet the community’s orthopedic surgery needs. HOI physicians and clinical staff met daily and developed a risk-stratified approach based on regional, state and national guidelines for all elective surgical patients. In our plan to reopen safely, HOI shared the details with local health authorities prior to resuming elective surgeries.
The clinical risk criteria were organized into three categories and stratified based on patient age, and comorbidities. A hospital committee comprised of surgeons, anesthesiologists and leadership reviewed each case to assure safe care could be provided. Each surgical case was reviewed for qualification.
All elective surgery patients are preoperatively tested for COVID-19 by the most sensitive assay currently available (PCR) to ensure patient, staff and physician safety. Additionally, all persons entering the facility are screened for temperature abnormalities and clinical symptoms. Everyone involved is required to follow social distancing guidelines when feasible.
Patient requiring elective orthopedic surgery
  Low risk
Age <75
–––––––––––––––––
BMI <39
–––––––––––––––––
ASA 1/2
–––––––––––––––––
Outpatient/LOS <23 hours
Moderate risk
Diabetes, HbA1c <7.5 ––––––––––––––––– Stable cardiac disease ––––––––––––––––– Mild reactive airway disease ––––––––––––––––– Anemia w/ transfusion
High risk
BMI >40
–––––––––––––––––
Active smoker
–––––––––––––––––
Smoking Hx w/ comp. pulmonary ––––––––––––––––– Diabetes, HbA1c >7.5 ––––––––––––––––– Significant pulmonary disease
P
Comorbidities and Criteria
C ––––––––––––––––– tw
Upper respiratory infection ––––––––––––––––– CHF exacerbation in the last 6 months ––––––––––––––––– Chronic kidney disease w/ SCR >2 ––––––––––––––––– Poorly controlled hypertension ––––––––––––––––– Febrile/temp >100.1 ––––––––––––––––– Unstable cardiac disease ––––––––––––––––– Unstable angina ––––––––––––––––– Dementia ––––––––––––––––– Increased likelihood of ECT ––––––––––––––––– CVA in the last
6 months ––––––––––––––––– Immunosuppression
COVID-19 Phase 3 (high risk)
Flu
Pati cleare surg
   16 | HOAG ORTHOPEDIC INSTITUTE
COVID-19 Phase 1 (low risk)
COVID-19 Phase 2 (moderate risk)
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