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PM announces freeze to all non-critical elective surgery

Prime Minister Scott Morrison has announced all non-critical elective surgeries will be suspended across private and public hospitals as the health sector braces for a looming public health emergency in response to the COVID-19 pandemic.

Editor’s note: This story is being regularly updated

The measure comes after RANZCO on Wednesday morning united with other prominent medical colleges to advocate for a stop to all elective surgery, except for urgent cases.

The group will now consult and identify the critical procedures that cannot be postponed, with RANZCO president Associate Professor Heather Mack emphasising that “urgent, sight-preserving, eye surgery needs to continue”.

At a midday press conference on Wednesday, Morrison said all elective surgery, other than Category 1 and urgent Category 2 cases, will be cancelled in public and private hospitals. The measure was scheduled to come into effect at midnight Wednesday 25 March, however this was later extended to 1 April.

“Cancellation of elective surgeries will allow the preservation of resources, including personal protective equipment and allow health services – private and public – to prepare for their role in the COVID-19 outbreak,” he said.

Morrison said this measure had largely been implemented for Category 1 and 2, but would further scale back Category 2 procedures.

Mobilising private hospitals

In a statement on Wednesday, RANZCO joined the Royal Australasian College of Surgeons (RACS), the Australian and New Zealand College of Anaesthetists (ANZCA) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) to announce that a continuation of non-emergency elective surgery would unnecessarily put patients and staff at risk of infection with the coronavirus.

In the joint statement, RACS president Dr Tony Sparnon said there must be a consistent national approach, which prioritises the health, safety and wellbeing of all patients and medical staff, given the dramatic escalation in COVID-19 cases.

“All non-urgent elective surgery in public hospitals should be cancelled. Private hospitals should be mobilised to accept urgent surgery,” he said.

ANZCA president Dr Rod Mitchell warned the continuation of elective surgery is consuming vital reserves of medicines and other important hospital resources.

“It is also reducing the time available for doctors and nurses to prepare for the management of the expected large numbers of critically ill patients,” he said.

“Personal protective equipment is already in critical short supply and must be conserved. This is essential to secure the safety of our health workforce.”

The colleges said they reaffirm their respect for the role of the Australian and New Zealand governments, health departments and health administrators in coordinating responses to this public health crisis.

ASO alert to ophthalmologists

The announcements follow an alert from the Australian Society of Ophthalmologists (ASO) on Tuesday evening that warned ophthalmologists to brace for a suspension of elective surgery if health authorities seek to divert key resources to critical care clinics.

ASO president Dr Peter Sumich revealed Department of Health representatives had been contacting day surgery centres to investigate their resources, which would be called upon if needed.

“My gut feeling is that elective surgery will proceed this week but will be a week-to-week proposition. You should be prepared to have a pause for a few weeks,” he said prior to the RANZCO announcement.

Generally, Sumich said elective eye surgery was a low risk interaction and the resources ophthalmologists used were purpose specific. Eyecare providers also don’t generate hospital beds from complications and the day surgeries are not suitable for hospitalisation at this stage.

“However, if we move to the next stage where ventilators and monitoring equipment are commandeered for use by critical care centres then it will become clear that surgery will cease,” he said.

“Personal protective equipment (PPE), gowns and masks are in short supply and our colleagues in the critical care centres may require them. Heart breaking as it sounds, there are also hospitals being prepared as palliative centres who will also have requirement for PPE. We will all have colleagues in nursing and medicine who are bravely working in care centres who need protection.”

Sumich also discussed the role of ophthalmologists as an “essential service”. Due to ophthalmology being predominantly private, he said ophthalmologists also act as the acute care service for vision loss, eye pain and unstable medical eye disease, which would otherwise fall to public hospitals at a time when they cannot cope.

“Therefore maintaining at least a basic service is worthwhile for systemic support,” he said.

“Cataract surgery would not be regarded as an essential service if ceased for a few weeks unless the visual disability had reached a stage of a personal safety risk for the patient.”

Supporting optometry

Sumich also reinforced the ASO’s support for optometrists to remain operational during the crisis. On Monday, he met with the CEOs of the major optical chains to discuss workforce planning.

“We will be contributing to a national eye care plan to the Minister’s office at some stage and optometrist for a vital link in the care pathway,” he said.

“Many of the services optometrists provide will remain necessary. I have agreed to advocate for our optometry colleagues as essential providers if we go to the next round of workforce limitation.”

 Clinic life

The ASO also outlined the specific measures ophthalmologists should be undertaking to ensure their clinics comply with the government’s social distancing measures, as well as sanitation.

“It is up to individuals to decide if their clinics are populated in a way which poses a risk to staff or patients. Common sense dictates spacing of appointments and deferral of any non-essential visits. Accompanying visitors can be asked to wait outside and clinic delays can be managed with SMS texts to call up patients outside,” Sumich said.

“We already have the advantage of challenge-ready mindsets and I feel confident that individuals will be able to triage any changes in the situation and make decisions without hesitation.”

He added: “Of course, it is important to gather all information before deciding on a course of action. However, it is also important to realise that actions can be altered as information changes.”

To help members and staff through this COVID-19 crisis, the ASO is collaborating with the Practice Managers Advisory Group to create an ASO toolkit for practices. This toolkit will be sent to members soon.