Covid19 & The “New Normal” for Day Surgery Pathway
Professor Doug McWhinnie
President, IAAS, General & Vascular Surgeon, University of Buckingham
• Covid 19 time-line and impact on surgery
• Changes in patient & procedure selection
• Importance of shared decision making
• Changes to the pathway
Prof McWhinnie discussed the impact on Covid19 on Day Surgery following the journey from the initial cases and the government’s response: freeing up inpatient and critical care capacity to prepare for large numbers of inpatients requiring respiratory support; introducing lockdowns; social distancing and wearing facemasks. Covid19 has caused patients to be reluctant about having surgery through fear, risk, the need to go back to work (after lockdown), no carers at home, but now the R rate is going down again and changes are in place to facilitate Day Surgery including; Covid protection, reduced face to face consultations, consideration of Covid risk factors. Prof McWhinnie said shared decision making is really important to discuss with patients the benefits of surgery against the risk including local prevalence of Covid, we have to remember that most ambulatory procedures are life enhancing rather than life-saving. He said there is no definitive list of procedures for day surgery but there is the BADS directory.
Waiting lists were already out of control in Feb 2020 before Covid hit and NHS England announced a new private sector contract however there has been a 30% increase in empty beds, probably due to time required for cleaning and disinfection and capacity has dropped due to social distancing. Also it is no longer possible to replace late cancellations due to isolation periods. Prof McWhinne said however we are getting back to some normality; "some things have been accelerated with new technology and we have seen opportunities."