Montpelier, Vt. – Governor Phil Scott today announced limited elective procedures would resume, which had previously been put on hold as Vermont’s health care system focused on preparing for, and responding to, COVID-19.
The Governor’s decision comes as the state’s modeling continues to show spread of COVID-19 has slowed – thanks to Vermonters’ physical distancing efforts – and the state’s ability to track and trace outbreaks of COVID-19 has become more robust. Health care providers who recommence these procedures have been provided guidance and must meet specific mitigation criteria to protect patients and clinicians from possible infection.
“Our testing and tracing program will allow us to work with our health care providers and hospitals to begin providing some procedures that were put on hold,” said Governor Scott.
“While postponing these procedures was necessary to help protect our healthcare system, workers and patients during this pandemic, we know these procedures are important to Vermonters’ overall health. We thank everyone for their patience; they’ve helped us make sure we did not risk our ability to care for COVID-19 patients,” Governor Scott added. “But we’re at a point where we can begin lifting some restrictions.”
Under the Scott Administration’s guidance, health care providers can begin non-essential outpatient clinic visits, diagnostic imaging and outpatient surgeries and procedures if the following steps are taken.
Outpatient clinic visits and diagnostic imaging
Outpatient clinic visits and diagnostic imaging can resume immediately if providers demonstrate they are adhering to physical distancing and relevant CDC guidelines regarding infection control and prevention to maintain a safe environment for patients and staff. Examples of the precautions that should be taken when providing care in both the hospital/facility and clinic settings include, but are not limited to, the following:
- A process to screen patients for COVID-19-related symptoms prior to scheduled procedures.
- A process to screen all staff and essential visitors for COVID-related symptoms prior to entering facility.
- Protective equipment and supplies should be worn and utilized as necessary to ensure staff and patient safety. This may require surgical, N95, KN95, or other equivalent masks and eye-protection goggles.
- All patients and companions must wear mouth and nose coverings (provided by the patient or by the site) when in public areas.
- Patient companions are permitted only if required for direct patient assistance.
- Only individuals who are essential to conducting the surgery or procedure shall be in the surgery or procedure suite or other patient care areas where personal protective equipment (PPE) is required.
- Waiting room chairs must be spaced to require a minimum of six-feet physical distancing.
- Providers must have written procedures for disinfection of all common areas.
- Providers must have signage to emphasize social restrictions (distancing, coughing etiquette, wearing of mouth and nose coverings, hand hygiene) and access to hand sanitizer.
- Providers will comply with guidance issued by relevant professional specialty societies regarding appropriate prioritization of procedures and care issues specific to COVID-19.
- Continue to consider alternative care delivery models, including telemedicine, when appropriate.
- Providers will reevaluate and reassess policies and procedures frequently, based on COVID-19 related data, resources, testing and other clinical information.
Outpatient surgeries and procedures
Providers may also begin to perform outpatient surgeries and procedures that have a minimal impact on inpatient hospital bed capacity and PPE levels, including those performed in the office or ambulatory surgical center. In the case of outpatient surgeries and procedures, providers should adhere to the mitigation requirements for outpatient clinic visits and diagnostic imaging, described above, and put into place the following measures:
- Screening: A process must be in place to screen patients for COVID-19-related symptoms prior to all scheduled procedures (by phone, online, or in-person).
- Testing: COVID-19 testing is required for procedures requiring airway management. Testing should be done as close as possible to the procedure and not to exceed 96 hours prior to the procedure. Patients will be required to self-quarantine between testing and procedure.
- Testing of Health Care Employees: Each provider shall develop and implement a plan for the periodic testing of healthcare workers including nurses, physicians, emergency medical personnel, medical and nursing students, laboratory technicians, pharmacists, hospital volunteers, administrative staff or any other employee who may come in contact with a patient. These plans shall be coordinated with the Vermont Testing Task Force.
- Available Personal Protection Equipment: Each outpatient clinic will be responsible to ensure that it has adequate supplies of PPE, through its own suppliers, for needed examinations or procedures and in the case of a COVID-19 surge. Providers will not rely on state sources or state supply chain for PPE.
- Testing Results: Results of the test should be communicated to the patient prior to arrival at the facility for the outpatient surgery; and facilities and providers should continue to collaborate regionally to determine testing locations and follow Department of Health Advisories regarding location of testing sites and collection of specimens.
Suspension of Operation
If the Vermont Department of Health has determined that a COVID-19 outbreak has occurred and providers cannot safely care for Vermonters in a way that (1) limits the exposure of patients and staff to COVID-19; (2) preserves PPE and ventilators; and (3) preserves inpatient hospital capacity, it will notify and require all providers in the region to return to the standards set out in the executive order issued on March 20, 2020. Depending on the severity of the outbreak, the Vermont Department of Health may require all Vermont providers to return to those standards.
Monday, Governor Scott signed an amendment to Addendum 3 to allow for these procedures, which can be found here https://governor.vermont.gov/content/amendment-addendum-3-executive-ord….
For more information on:
- COVID-19 health information, guidance and case data, visit www.healthvermont.gov/covid19.
- The Governor’s actions, visit governor.vermont.gov/covid19response.
- The state’s modeling, visit https://dfr.vermont.gov/about-us/covid-19/modeling.