COVID-19 testing prior to elective and emergency surgery and interventions

As with any respiratory illness, there may be an increased risk of complications to a COVID-19 positive patient undergoing a General Anaesthetic (GA).

Planned (elective) and non-emergency surgery and procedures requiring a GA should not be performed without knowing the COVID-19 status of the patient. This is to allow the treating team to plan effectively and ensure the ongoing safety and wellbeing of our patients, employees and community.

This applies to all patients, of all ages, including:

  • Maternity patients requiring a GA
  • Patients undergoing Diagnostic Imaging procedures requiring a GA
  • Patients undergoing Cardiac Interventional procedures requiring or at risk of requiring a GA
  • Bronchoscopy patients (irrespective of the sedation type)

Changes to Elective Surgery process

As part of updated Department of Health and Human Services guidelines, all planned elective surgery and interventional patients living or working within Restriction 3 areas and who are undergoing a General Anaesthetic (GA) will now need to be swab tested for COVID-19 and confirmed negative prior to their procedure.  All elective or planned patients testing positive for COVID-19 will have their surgery deferred and re-scheduled until a negative result is produced.

Elective surgery patients will need to isolate immediately post-swab and for those screened at a non-Monash Health facility, will be required to bring confirmation of a negative result to their admission, or risk being re-scheduled.  The Elective Surgery Team will be liaising closely with patients and surgeons to ensure all patients that arrive for surgery have undergone the screening and that the swab results are back. The swab test results for patients screened at a Monash Health testing site will be available within SMR.

All elective patients coming to Monash Health will have tested negative for COVID-19.  If you have any concerns, please discuss with your clinical colleagues looking after the patient and escalate any concerns before cancelling or re-scheduling.

Changes to Emergency Surgery process

As per Department of Health and Human Services protocol, and as a method to optimise post-operative care,  emergency department patients who need to go to theatre for surgery as a priority will now undergo COVID-19 screening and swab testing immediately prior to their surgery or procedure.  Please note that a swab result does not need to be known to proceed to surgery or intervention in the emergency context. Instead the patient proceeds to emergency treatment based on the screening tool which then dictates the PPE and precautions required.

Most emergency surgery or emergency interventional patients are often time critical or urgent due to clinical deterioration, so we ask that early dialogue and communications occur between medical, surgical, anaesthetic and nursing/midwifery teams to ensure these patients have a smooth passage to their definitive emergency care, and that a pragmatic approach is adopted that takes into account the screening processes that are in place to assist with PPE and access to care in the absence of a swab result.

Most patients will screen negative due to the low community spread in our communities – that is, there is no increased epidemiological risk or symptoms – and therefore these emergency theatre patients will be managed with standard Personal Protective Equipment requirements.  As before, any patient in the emergency department who does not pass the COVID screening tool will be treated as suspected COVID until a swab result is available and appropriate Personal Protective Equipment (PPE) precautions implemented.

Any patient that is currently an inpatient and subsequently requires a new acute surgical review and is scheduled into the theatre during their admission (i.e. they have not come through the elective or Emergency Department routes) are also required to have a COVID-19 swab, but should continue to theatre if they are an emergency and screening tool applied to determine the PPE precautions required.  The Surgical team doing the review and assessment should check for a COVID-19 swab, and if not completed, order one. The pre-operative checklist will also include the swab being taken as part of checking the patient is ready for theatre.


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