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I think we can all agree that 2020 has been a year like we’ve never seen, nor could have ever imagined. Most everyone has experienced either a direct or indirect effect of the COVID-19 virus, and our ASC industry is still dealing with the after-effects.

Recently, I addressed this topic at OR Excellence’s virtual conference sponsored by AORN. To prepare for the topic, I asked over 60 of my industry colleagues who work in all areas of our industry what the top 3 effects they felt had the most impact on their ASCs and/or their work. I sorted the answers, and I presented the results based on categories. The responses fell into 12 categories:

1. Human Resources (HR)
2. Communication
3. Financials
4. Education & Training
5. Medical Supplies & PPE
6. Sources of Regulations
7. COVID-19 Testing
8. Departments of Health
9. Documentation
10. Risk Assessment
11. Leadership
12. Available Resources

1. HR was the category that garnered the most responses from these leaders. They recommended that taking care of your people should be the top priority. Suggestions included: not to underestimate opinions and suggestions from your employees; find ways to remain positive (not always easy to do); and to appoint a “go to” leader for employees to contact if needed. Concerns were also raised regarding the downsides of unemployment insurance and the fact that employees don’t feel that their jobs are secure in these uncertain times.

2.The category of communication was a close second, and overwhelmingly, colleagues said that you cannot overcommunicate with the staff. A good rule of thumb is to always tell your staff “why” things are changing; set clear expectations and be totally transparent.

3. When it came to financials, the smaller centers found that they were not prepared for the effects that COVID-19 caused. They had no line of credit, and at that point, they were unable to get one. Money wasn’t coming in and bills still had to be paid.

4. Much to their surprise, centers discovered that they were still responsible for education & training while the centers were closed, and employees were furloughed. When the center was to reopen, all the training had to be current. What a challenge!

5. Who would have thought that PPE would become a part of our daily lexicon? Did they have enough? Could they get it once the pandemic was declared? Were their regular suppliers able to help them? How much PPE was enough, and could they prove it? The time came when they were scrambling for resources, and new suppliers wouldn’t help them. When they could get PPE, they over-ordered so they didn’t run out, and this resulted in large invoices in many cases.

6. At the start of the pandemic, regulatory bodies caused a lot of confusion as so many sources contradicted others. Some industry colleagues suggested ASCs choose one source to build their program around.

7. The topic of COVID-19 testing was a hotly debated one, and there is ongoing concern about who should be tested, how early they should be tested, if the ASCs or MD’s office should be the one to request it, what happens when a patient doesn’t comply, what the policy should be if results are not received by the day of surgery, if staff should be tested, and more. In the end, it should be considered best practice to document everything. Leave a substantial paper trail to prove that you did the best you could.

8. Dealing with the Department of Health (DOH) in your state can be a real challenge, but one administrator said it all: “Develop a good relationship with your DOH, as you’ll more than likely interact with them during the pandemic.” The DOH can help you in many ways: press releases, protocols, etc. Learn to work with them, as they can help you if you have an exposure, and you need them to help with contact tracing, etc.

9. As the nurses who read this will understand, document, document, document. It’s all you’ll have to show a CMS COVID-19 surveyor who shows up unexpectedly at your door. Create binders and keep the information organized and up to date.

10. Some responders stated that when all of this started, they felt lost and they didn’t know what to do first. They agreed that a COVID-19 (pandemic) risk assessment needed to be conducted before anything else. The purpose of this assessment is to chart a plan to manage this or any another pandemic. Make sure the governing body is involved with the decisions, and document this.

11. As far as leadership was concerned, the message was clear: employees follow the guidance of the leader. Be positive, offer support, and engage the staff often.

12. Some responders didn’t know where to go for help at first but found that acknowledging a need for help was the first step. Reach out to other centers in your area, professional organizations, ASCA Members’ Community, etc. One person suggested that a template would have been helpful for centers trying to comply with all the guidelines. Perhaps this is something to consider in the future.

In summary, I presented these suggestions:

  • Take care of your people.
  • You cannot over communicate with staff.
  • Prepare for the worst-case scenario.
  • Keep up with regular education and training, and account for time to complete training when staff returns from being furloughed.
  • Maintain a solid relationship with vendors.
  • Consider using a primary source of information initially.
  • Assign a small team of clinical staff and managers as the “go to” employees.
  • Develop a solid relationship with the DOH.
  • Create COVID-19 binders with documentation.
  • Start the entire process with a thorough risk assessment.
  • Be a leader who sets a good example for the employees.

Remember, you are not alone in dealing with this. Take care of yourself first, because if you’re not doing well, you won’t be at your best for your staff and patients.