As NHS services attempt to return to normal, NICE has produced a new guideline to help healthcare professionals deliver efficient planned care while minimising the risks of COVID-19.
The guideline (NG179) is for adults, young people and children in hospitals and diagnostic settings having planned care, for example, day surgery, inpatient stays or other procedures and seeks to help patients make decisions about their planned care.
Advice and support for shared decision-making for planned care
NG179 suggests that hospitals and services providing planned care in the current COVID-19 pandemic should:
- Make reasonable adjustments to ensure adequate information is available for all patients as outlined in the NICE guideline on decision-making and mental capacity.
- Discuss all possible outcomes of the procedure or investigation with patients and/or family members/carers to enable them to make an informed decision. This discussion should include the benefits of the planned care and the potential health consequences of not having the care, the associated risks due to COVID-19 and alternatives if patients decide against having the planned care or it is postponed.
- Staff should also agree an admission and discharge plan (and any necessary follow-ups) for patients receiving elective surgery)
- Explain the UK government guidance on infection prevention and control measures and how this will minimise the risk of getting COVID-19.
When deliberating the risks of getting COVID-19, NG179 advises staff to discuss any individual factors that may increase a patient’s risk of infection or of becoming severely ill, for example, their age, gender, ethnicity, any possible occupational factors before and after the planned care, as well as the presence of relevant underlying conditions which makes them clinically extremely vulnerable. NG179 also directs patients to the UK government local and national prevalence data on COVID-19 which might impact on a patients’ risk.
Prior to planned care
The guidance recommends that patients receive timely health and wellbeing advice (such as the patient advice from the centre for perioperative care). It is also useful to follow the NICE guidance on lifestyle and wellbeing. Additionally, inform patients that planned care may be brought forward or even postponed especially if they test positive for COVID-19, have symptoms of the virus or need to self-isolate and if they are clinically unwell for any other reason.
Patients (and their family or carers) should be informed of what they can or cannot bring with them for example, type of clothes, mobile phones etc. They will also need to follow social distancing and good hygiene measures before, during and after the planned care, paying attention to the UK government guidance on staying alert to stay safe. In cases where transport services are not available, patients should use private transport to planned care setting and where this is not possible to use public transport, provided they follow government advice on travel.
Minimising the risks of COVID-19
NG179 advises that for children and young people having elective surgery, the guidance from the Royal College of Paediatrics and Child Health should be followed for the recovery after elective surgery. Similarly, maternity and antenatal services should follow the Royal College of Obstetricians and Gynaecologists guidance.
In general terms, all patients (and family/carers) should minimise contact with others to reduce the risk of becoming infected with COVID-19. NG179 strongly recommends that patients are assessed for COVID-19 the day before planned care either by telephone or video call. Patients will apparent symptoms of COVID-19 should self-isolate before a planned procedure.
Patients requiring anaesthesia (both general, regional and local) or sedation
All patients requiring any form of sedation should following social distancing and hand hygiene for 14 days prior to admission. It will also be necessary to have a test for COVID-19 3 days before admission and to self-isolate from the day of the test until admission.
All other planned procedures
NG179 advises patients to follow social distancing and hand hygiene as above (that is, those requiring sedation).
Planning and scheduling
NG179 recommends that departments develop flexible measures to ensure efficient delivery of care. This should involve:
- Process mapping to tackle bottlenecks in the system and organising workflow by high or low volume procedures
- Allowing sufficient time for cleaning between patients and even having two treatment areas so that one is operational while the other is cleaned
- Having a stand-by list if a patient cannot attend or if they test positive for COVID-19.
The amount of time spent in the hospital should be minimised by careful scheduling of appointments, discouraging early attendance and by texting patients to inform them that they are ready to be seen.
During planned care
NG179 advises staff following advice infection prevention and control and guidance on personal protective equipment and make efforts to minimise the potential for transmission of COVID-19. Keep visitors to a minimum during inpatient stays and ensure that visits are in line with the government guidance on infection prevention and control. If a patient’s stay exceeds five days, follow NHS England and improvement guidance on testing.
Ongoing care and support
The guideline also suggests staff test inpatients to ensure that they do not have COVID-19 before being discharged to other settings. In addition, to making arrangements for post-operative care, patients should be inform staff if they develop COVID-19 symptoms within 3 weeks of having their planned care.
NG 179 suggests that staff working in planned care are offered individualised COVID-19 risk assessments. In cases where staff are known/suspected of having COVID-19, or live in a household where another person is known/suspected of having the virus, they should self-isolate and arrange to be tested in line with local policies. Such staff should only return to work in accordance with the government advice on management of staff and exposed patients or residents in health and social care setting.
The final part of NG179 requests that service providers maintain effective communication with NHS England and NHS Improvement Regional teams to monitor the current COVID-19 prevalence in their areas and be in a position to adapt processes to increase or decrease service provision. Service providers are directed to the weekly COVID-19 surveillance reports produced by NHS England.
NG179 is available online and interested readers should check this version for further updates.