Roadmap for resuming elective surgery after COVID-19 pandemic – MTAA

The Medical Technology Association of Australia (MTAA) brought together leaders from across private and public health to discuss the challenges and opportunities that will be presented with the resumption of elective surgery in Australia.

The webinar addressed:

• How far elective surgery has returned to normal rates of effort
• Constraints on returning to full capacity
• Key points from the National Health Agreement
• Risk management, including PPE supply and staff safety
• Industry reps in theatre and how best to partner effectively with hospitals during this time to support their effort
• Lasting impact of COVID-19 for surgery

Alison Verhoeven
CEO – Australian Healthcare & Hospitals Association (AHHA)

In March 2020, the states and territories together with the Commonwealth made a decision to suspend non-urgent elective surgery. In the lead up to that decision, a number of states had brought forward some stage two and stage three procedures in anticipation of a suspension.

More recently, the National Cabinet took a decision that elective surgery may resume to 75% of capacity by the end of June 2020.

The public hospital system provides about 40% of elective surgeries in Australia. Research from the International COVIDSurg project, published in the British Journal of Surgery in mid-May, estimates that around 400,000 elective surgeries were cancelled in Australia due to COVID-19 between February and May 2020, and that included 25,000 cancer surgeries. The researchers estimated that it would take approximately 10 months to clear the backlog if elective surgery was increased to 110% of pre-pandemic capacity, about five months if elective surgery was increased to 120% or about three and a half months to clear the backlog if it was increased to 130% of pre-pandemic capacity. Keeping in mind that most states and territories are aiming for an increase to 75% of capacity by the end of June, there is going to be a substantial backlog in elective surgery.

“During this COVID-19 journey, the partnership between the public and private sectors has been really critical to ensure capacity in the system,” noted Alison Verhoeven.

The resumption of elective surgery depends on the capacity of each individual hospital, but also the availability of personal protective equipment (PPE). The Director General of Queensland Health, Dr John Wakefield PSM, said recently that it will probably take up to 12 months to clear the backlog or longer if there’s a second wave of COVID-19.

NSW public hospitals normally deliver around 100,000 emergency surgeries as well as 235,000 elective surgeries a year. In NSW, there are more than 90,000 people currently on the waiting list in public hospitals for elective surgery.

The NSW Government has just kicked in $388 million to support the resumption of elective surgery in partnership with the private sector.

“What we’re seeing right across the public sector is essentially a risk management approach, anticipating, responding, mitigating, and then eventually moving to a scenario where residual risk will shape policies and procedures,” said Alison Verhoeven.

Longer term it is likely that protective masks, gloves and gowns remain standard practice, and particularly as clinicians and services remain really vigilant about a possible second wave of COVID-19.

Lastly, the National Health Reform Agreement has a very strong focus on patient outcomes. There is provision in the national health reform agreement for 2020 – 2025 to explore innovative funding models addressing variation in the types of care that is provided across Australia. The goal is to reduce low value care, but also give permission to the Independent Hospital Pricing Authority (IHPA) to trial new models of care.

Really importantly for the medical technology sector, the schedule C of the Agreement highlights new ways of undertaking health technology assessments in the public sector. There is going to be a working group that’s aiming to create a federated approach with a national framework for health technology assessments. There are some exemptions from funding caps for new therapies for two years in public hospitals, requirements around timely decision making, improved transparency and information sharing.

Annette Holian
2nd VP – Australian Orthopaedic Association & Councillor – Royal Australasian College of Surgeons

Presently, in orthopaedics surgery, the hospitals are working around 75% of capacity focusing on patient needs and clinical priorities. It’s expected that if all goes well, they will return to 100% capacity by the end of July.

The limitations for elective surgery resumption have been based on the allocation of beds as many were closed and became COVID-19 wards. There were limitations on staff and not wanting to burn people out. Training time was allocated for staff about the use of PPE and how to manage patients who were infected with COVID-19. There were certainly limitations on the supply of PPE which seem not to have been eliminated.

Another concern in building capacity in elective surgery is in reference to the paper published in The Lancet that showed COVID-19 patients at greatly increased risk of dying following surgery.

One of the great wins as a result of COVID-19 has been the introduction of telehealth for consultations. It has been challenging for initial consultations, particularly in orthopaedics. However, for follow-up appointments where patients require X ray results, and particularly for the non-metro patients it been an enormous step forward for patients to be able to engage through telehealth.

In saying that, one of the difficulties through the general and specialist practices have been a reduction in new patient numbers. There are many patients who have not sought care in the last three months for their medical conditions because they potentially considered waiting for the COVID-19 risk to reduce.

The medical device reps are still valued in theatres especially with complex sets where both the surgeon and the perioperative nursing staff need help. In saying that, hospitals did not wish to unnecessarily expose medical device reps to risk during the COVID-19 crisis. There is a new possibility to provide theatre support via video links rather than having medical device reps be physically present.

Annette Holian would like to see flexible work introduced into the hospitals for perioperative nurses, anaesthetists, surgeons, and perhaps have theatres being utilised on a regular basis in the evening and weekends.

“I’d really like to see more fractional appointments at the public hospitals. We’ve got a lot of young surgeons at the moment who can’t get into public hospitals. Rather than give other surgeons overtime there is the opportunity to have new employees who have fractional appointments at the hospital.

“One of the other big opportunities for industry is to really look at reducing our surgical waste in operating theatres and reducing our carbon footprint. It’s time for us to really think about what effect we’re having in all our packaging, particularly in our consumables that are single use,” said Annette Holian.

Lynne Simpson
Group Procurement Manager – Ramsay Healthcare

Ramsay Healthcare’s procurement department has been extremely busy securing product for surgeries through their hospitals.

From a Ramsay private health perspective, with the cessation of elective surgery the business declined to 25% of its capacity. With the resumption of elective surgery, as QLD and WA have no restrictions, the Ramsay hospitals are performing at 100% capacity. The main challenges are securing surgical products and ensuring a safe environment for staff and patients. NSW hospitals are aiming at 75% capacity by the end of June and VIC hospitals at 100% capacity by the end of July.

Regarding the supply chain, Lynne Simpson discussed the challenges regarding the quality of the PPEs that are being received during the last four weeks. There are supply issues for surgical gowns, masks and gloves coming out of China.

Ramsay Healthcare’s policies still do not permit medical device reps into the hospitals or theatres. Considerations for the future include processes to ensure social distancing and relevant cleaning between cases in theatres as hospitals increase to full capacity as well as controlling the appropriate supply of PPEs.

There may be changes to how medical device reps engage with surgeons and nursing staff post-COVID19 with Ramsay Healthcare. There have been internal discussions on digital strategies and how medical device reps can support surgeons and nursing staffing remotely from a digital platform with regards to education and product use.