WSOA ASC Position Letter

Below is the letter that the Washington State Orthopaedic Association sent to Governor Jay Inslee regarding ambulatory surgery centers.

March 26, 2020

Dear Governor Inslee:

With the rapid spread of COVID-19 cases our health care system will be facing an unprecedented surge in the need for urgent and emergent medical care in the coming weeks. The number of patients that will require assessment for respiratory illness and potential treatment and hospitalization could very easily exhaust our emergency medical resources, hospital and ICU beds and all the components required to manage this pandemic. To make matters worse, there is a national shortage of protective equipment that caregivers for that will need in order to protect themselves from being infected by this potentially deadly virus.

While this is going on, we will still see a number of medically “well” patients with injuries that will need care. These may include fractures, tendon lacerations and other injuries which may require urgent surgical treatment. Although this type of care can be provided in a hospital setting, it may be a more effective use of limited hospital resources to triage these patients to an ambulatory surgical center (ASC). ASCs have already distinguished themselves for the efficiency and low cost of care as well as excellence in safety and patient outcomes.

The Washington State Orthopaedic Association believes that outpatient surgical centers may well play a crucial role in providing needed care during the pandemic when hospitals are being strained to cope with the patients with viral illness. We believe that outpatient surgical centers should be supplied with necessary protective equipment (PPE) to allow them to accomplish that mission. We also believe that surgical centers should make maximal effort to conserve such equipment to the benefit of everyone in the health care system.

The American College of Surgeons addressed this in a March 13 document entitled “COVID-19: Recommendations for Management of Elective Surgical Procedures” by stating that during the COVID-19 pandemic hospitals may “shift elective urgent inpatient diagnostic and surgical procedures to outpatient settings when feasible.” The CDC has also made that recommendation.

WSOA is aware of several ASCs that have largely or completely shut down. There also have been reports of hospitals requesting that privately owned ASCs give up their PPE so as to maximize the hospital supply. While we understand the need for that equipment at the hospitals, we wish to remind that ASCs may well play a very important role in managing the upcoming crisis.

We would also suggest that “cohorting” healthy patients with musculoskeletal injuries at ambulatory surgical centers would decrease the likelihood of disease transmission by separating them from the hospital environment where COVID-19 patients will be screened and treated.

We appreciate your attention to this matter.

Nicholas Rajacich, MD, FAAOS
President, Washington State Orthopaedic Association