COVID-19 has compelled surgical care programs around the world to quickly adapt to a new normal wherein the provision of this essential healthcare service must be maintained, yet a flexibility in organizational response is required in light of new information and changing conditions – often on a daily or even hourly basis. In anticipation of the arrival of COVID-19, the Nova Scotia Health Authority (NSHA) began updating its system-wide pandemic plan.  As co-lead of NSHA’s Perioperative/Surgical Services program, our goal was to implement a COVID-19 plan that aligned with the larger provincial plan and ensure the continuation of essential surgical care, while protecting patients and staff, and managing valuable resources (both human and material).  I present here a high-level synopsis of the key elements of our COVID-19 surgical care plan to continue the dialogue on how healthcare systems have prepared for, and responded to, this unprecedented healthcare crisis.

The NSHA is the result of the 2015 amalgamation of nine district health authorities into one health authority with four geographic health zones (The Canadian Press 2015).  The Perioperative/Surgical Services program comprises 17 surgical suites and includes the management and operation of these surgical suites, post-anesthesia care units (PACU), inpatient surgical units, day surgery suites, pre-admission clinics, endoscopy and medical device reprocessing units. Having an already established provincial surgical care program was a distinct benefit in planning for COVID-19 as many essential systems, processes and reporting channels were already in place.

Each of the four zones was tasked by their executive director leadership to develop a zone-specific plan that would reflect the unique attributes of each zone and contribute to the province-wide surgical plan.  The journey began with meetings of program leadership, development of new working groups, updating and sharing documents outlining processes reflective of the best available evidence as it became available, ongoing dialogues with clinicians, and consolidating information on a shared website supported by our senior communications advisor.  Aspects of the plan included:

• Collaborating with Infectious Diseases, Infection Prevention and Control, Laboratory Services, Diagnostic Imaging, Interventional Radiology and Cancer Care
• The immediate postponement of elective surgeries to conserve hospital beds and personal protective equipment (PPE), and to safeguard the health of patients and surgical staff
• Temporarily transforming surgical inpatient units to COVID-19 units
• Redeployment of surgical staff
• Reviewing guidelines and best practices from the American College of Surgeons, Queens University, Vancouver Coastal Health, and Alberta Health Services
• Updating guidelines and staff education for PPE and N95 usage
• Engaging in collaborative initiatives such as processes for electroconvulsive therapy with Mental Health and Addictions, prioritization of cancer care, access to dialysis, prioritization of PPE for endoscopy cases and prioritization of gynecology, oncology, transplant, cardiac and neuro-surgery cases
• Implementing a surgical screening tool for emergent/urgent wait-listed surgeries, prioritizing emergent cases versus elective cases and a systematic review of all patients
• Recommendations for the triaging of urgent and benign cancer surgeries
• Role clarification for anesthesiologists, operating room nurses, charge RNs, PPE coordinators, surgeons, support staff and environmental services staff
• Reviewing and updating policies for protocols related to the wait time before intubation and extubation procedures
• Recovery of patients to begin in the surgical suite
• Updating transfer processes to the PACU and intensive care units (ICUs)
• Updating pre-operative, intra-operative and post-operative patient preparation protocols
• Weekly team calls with the anesthesiologists, surgeons, and the Perioperative/Surgical Services leadership
• Continuing daily pandemic planning with different teams

The impact of our collective planning for this pandemic locally, nationally, and globally, and the contribution of all citizens (in terms of practising physical distancing) will determine the magnitude and severity of this wave and the potential for subsequent waves of COVID-19. As senior director of NSHA’s Perioperative/Surgical Services, I am so proud of our team’s collaboration, hard work and compassion. These are difficult times, and much is asked of healthcare workers and their families.  Open dialogue, sharing best practices, evidence-informed decision making, and having each other’s back will ensure we get through COVID-19 together and emerge stronger than ever.

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