Carilion Clinic News

A Multi-disciplinary Approach from Carilion Clinic's Bone Health Clinic

By John R. Tuttle, MD, MS

Carilion Clinic has begun its ramp up process to return towards full elective procedure capacity. Many considerations have been taken into account during this process in an effort to maintain safety for all involved. For example, we have elected to CV19 PCR test all pre-operative patients 72 hours prior to their elective procedure. These patients must isolate themselves prior to their operation. All individuals are screened at the door of our surgery centers prior to entering, including temperature check, as well as with a comprehensive screening form covering symptoms and exposure. A mask is provided to all individuals to wear at all times while in the facility. A Covid risk consent is reviewed with all patients prior to scheduling and the consent form is then reviewed and signed by them on the day of surgery.

We have divided patients into Phase 1, Phase 2, and Phase 3 categories based on their risk and resource utilization profile. For this purpose, all surgeons have graded their patients and procedures with MeNTS scores. Phase 1 criteria include a MeNTS score <60, age <65, ASA 1, 2, or 3A, non-smoking status, no CHF/DM/COPD/liver or auto-immune disease, and no recent chemotherapy treatment. In addition, no patients residing or requiring rehab facilities, nursing homes, or other communal homes qualify for Phase 1. The Phase 1 procedures are outpatient only. Phase 2 criteria expands on Phase 1 by adding short 23 hour stay procedures, ASA 3B, CPAP use, and well managed DM, CHF, COPD, or liver disease. Phase 3 will be all other patients.

The operating rooms at Carilion Clinic are starting out at approximately 25% of their capacity for elective procedures with the plan to increase 25% every two weeks. Traditional block time has been replaced and is now assigned based on the acuity and volume of the cases from each Surgery Department.

Ambulatory office visits have resumed as well at 30 minute visit intervals. The waiting rooms have been closed and all patients are brought directly from their cars to their visit rooms with minimal contact with staff. Masks are worn at all times and vitals have not been acquired unless specifically requested by the patient or physician. To increase access, we have extended our hours of operation from 8 am to 8 pm and run a full clinic day every Saturday. As efficiencies improve our goal is to decrease visit intervals to 20 minutes starting in June. We have continued to offer virtual medicine visits at 15 minute intervals throughout the day as well to improve patient access and safety.

This pandemic has been difficult to contend with, as data and official recommendations and requirements are ever changing. However, the Orthopedic Department at Carilion Clinic has worked through these difficult times together and found a renewed sense of purpose in caring for our patients. It must be noted that while no one would wish for a pandemic like this to happen again, we are now certainly prepared for it.