COVID testing on elective cases

[castafari]

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The hospital system where I work has been doing COVID testing on all non emergent cases over the past several months. However, due to cost, and the fact that we are not finding many asymptomatic COVID cases, the CMO now wants to stop doing COVID testing pre op. Just wanted to see what is going on at your shop. My anesthesia group feels this is unfair to make a unilateral decision like this, especially since its our lives on the line during airway management, and every case we do is an aerosolizing case during intubation. Thanks.

 

[coffeebythelake]

The hospital system where I work has been doing COVID testing on all non emergent cases over the past several months. However, due to cost, and the fact that we are not finding many asymptomatic COVID cases, the CMO now wants to stop doing COVID testing pre op. Just wanted to see what is going on at your shop. My anesthesia group feels this is unfair to make a unilateral decision like this, especially since its our lives on the line during airway management, and every case we do is an aerosolizing case during intubation. Thanks.

We have been testing all elective cases within 72hrs of OR. All nonelective cases with the exception of level 1 emergencies (who we conservatively presume have covid) also get tested before OR. Do you hospital have enough PPE? N95 masks and face shields?

 

[sigrhoillusion]

The hospital system where I work has been doing COVID testing on all non emergent cases over the past several months. However, due to cost, and the fact that we are not finding many asymptomatic COVID cases, the CMO now wants to stop doing COVID testing pre op. Just wanted to see what is going on at your shop. My anesthesia group feels this is unfair to make a unilateral decision like this, especially since its our lives on the line during airway management, and every case we do is an aerosolizing case during intubation. Thanks.

I heard if you don't test, there are less cases...

 

[Tramadeezy]

Remind the CMO that when an outbreak at your hospital can be traced to an elective case that wasnt tested because of cost their name will be plastered all over the 5 o clock news. Career will be over. Should do the trick.

 

[abolt18]

The hospital system where I work has been doing COVID testing on all non emergent cases over the past several months. However, due to cost, and the fact that we are not finding many asymptomatic COVID cases, the CMO now wants to stop doing COVID testing pre op. Just wanted to see what is going on at your shop. My anesthesia group feels this is unfair to make a unilateral decision like this, especially since its our lives on the line during airway management, and every case we do is an aerosolizing case during intubation. Thanks.

You should just invite this CMO to join you in intubating every one of these elective cases for the next month and see if (s)he has a change of heart.

 

[abolt18]

We have been testing all elective cases within 72hrs of OR. All nonelective cases with the exception of level 1 emergencies (who we conservatively presume have covid) also get tested before OR. Do you hospital have enough PPE? N95 masks and face shields?

We do this.

 

[MirrorTodd]

We're testing everyone. Military though. Ask your CMO how much revenue would be lost by having to quarantine the anesthesia, surgical, nursing, ancillary staff etc who get exposed to the cases that slip through and end up showing symptoms?

 

[coffeebythelake]

The big question here is why. Is it because it costs too much? Or is it because your hospital does not have access to enough testing kits. Both are bad and arguably you shouldnt be doing elective cases in either situation if they cannot do thr basics to ensure safety of patients and staff. If thr CMO decides to push through i suggest the anesthesiology department make a vote of non-confidence to the hospital admin.

 

[jwk]

We're testing everyone. Military though. Ask your CMO how much revenue would be lost by having to quarantine the anesthesia, surgical, nursing, ancillary staff etc who get exposed to the cases that slip through and end up showing symptoms?

I wonder how Covid affected the caseload at U of F with their 18 Covid + residents and fellows.

 

[jwk]

The hospital system where I work has been doing COVID testing on all non emergent cases over the past several months. However, due to cost, and the fact that we are not finding many asymptomatic COVID cases, the CMO now wants to stop doing COVID testing pre op. Just wanted to see what is going on at your shop. My anesthesia group feels this is unfair to make a unilateral decision like this, especially since its our lives on the line during airway management, and every case we do is an aerosolizing case during intubation. Thanks.

Wait - I just realized your post said cMo, not cEo. Does your cMo actually have a medical degree?

 

[castafari]

Wait - I just realized your post said cMo, not cEo. Does your cMo actually have a medical degree?

Yes he’s a physician

 

[castafari]

The big question here is why. Is it because it costs too much? Or is it because your hospital does not have access to enough testing kits. Both are bad and arguably you shouldnt be doing elective cases in either situation if they cannot do thr basics to ensure safety of patients and staff. If thr CMO decides to push through i suggest the anesthesiology department make a vote of non-confidence to the hospital admin.

Yes, we have a shortage of tests. Also the study they quoted as evidence states $15k worth of tests to find one asymptotic covid positive. They argue it’s a waste of money

 

[nimbus]

We stopped testing cataracts at our surgery center because of a testing shortage. So I don’t do cataracts.

At the hospital everybody is still tested.

 

[castafari]

We stopped testing cataracts at our surgery center because of a testing shortage. So I don’t do cataracts.

At the hospital everybody is still tested.

Our surgery center has never tested any patients . The surgeons didn’t want any roadblocks getting in the way of their cases

 

[coffeebythelake]

Our surgery center has never tested any patients . The surgeons didn’t want any roadblocks getting in the way of their cases

Your surgeons sound like tools.. Easy for them to say when they aren't the ones potentially getting massive covid exposure.

We are in the middle of a pandemic. In many places the numbers are going up not down. And they want to do elective cases without testing anyone? That is absolutely absurd.

I am also curious what your state medical and anesthesiologu societies has said about this.

 

[castafari]

Your surgeons sound like tools.. Easy for them to say when they aren't the ones potentially getting massive covid exposure.

We are in the middle of a pandemic. In many places the numbers are going up not down. And they want to do elective cases without testing anyone? That is absolutely absurd.

I am also curious what your state medical and anesthesiologu societies has said about this.

State medical society? I doubt anyone cares. It’s all about the money around here

 

[coffeebythelake]

State medical society? I doubt anyone cares. It’s all about the money around here

What state do u work

 

[castafari]

What state do u work

FL

 

[deleted162650]

FL

Say no more.

 

[GassYous]

No one comes into our ORs without being tested. Emergency cases go to a negative pressure room with everyone in full ppe. It just takes one positive patient to infect a bunch of staff and have half the ors shut down.

 

[linkin06]

We have been testing every elective case, but yesterday I had a case where I was sitting in the OR waiting for a test to come back, and the RN rolls the patient in. I ask, “is the covid test back?” She says she doesn’t know, checks and finds out it will be another 40 min. She then tells me that they were told since we are all wearing masks anyways, they’ve been told to continue. I was confused why we even do the test

 

[coffeebythelake]

We have been testing every elective case, but yesterday I had a case where I was sitting in the OR waiting for a test to come back, and the RN rolls the patient in. I ask, “is the covid test back?” She says she doesn’t know, checks and finds out it will be another 40 min. She then tells me that they were told since we are all wearing masks anyways, they’ve been told to continue. I was confused why we even do the test

Stupid stupid decisions made by the hospital admin. Thr only thing they think about is $. Is your OR negative pressure? Is there an ante room? Is it possible that your OR could contaminate neighboring ORs if patient is covid positive?

 

[jwk]

We have been testing every elective case, but yesterday I had a case where I was sitting in the OR waiting for a test to come back, and the RN rolls the patient in. I ask, “is the covid test back?” She says she doesn’t know, checks and finds out it will be another 40 min. She then tells me that they were told since we are all wearing masks anyways, they’ve been told to continue. I was confused why we even do the test

That's when you walk out and say "call me when the test is done".

 

[chocomorsel]

We stopped testing cataracts at our surgery center because of a testing shortage. So I don’t do cataracts.

At the hospital everybody is still tested.

My hospital doesn’t test MAC cases. Makes no sense to me. Only GAs get tested.

 

[coffeebythelake]

My hospital doesn’t test MAC cases. Makes no sense to me. On GAs get tested.

Makes no sense.

 

[Consigliere]

My hospital doesn’t test MAC cases. Makes no sense to me. On GAs get tested.

Well everyone knows that only patients undergoing GA can transmit Covid-19. Sheesh!

 

[abolt18]

We have been testing every elective case, but yesterday I had a case where I was sitting in the OR waiting for a test to come back, and the RN rolls the patient in. I ask, “is the covid test back?” She says she doesn’t know, checks and finds out it will be another 40 min. She then tells me that they were told since we are all wearing masks anyways, they’ve been told to continue. I was confused why we even do the test

Our hospital has somehow implemented the rule that any outpatient coming in for surgery must have a negative test within 72 hours, but any inpatient going to the OR, even for elective cases, may proceed to the OR as long as their test has been performed (but not necessarily resulted). Completely idiotic! Makes zero sense. I've had several attendings completely refuse to proceed until the result is back for non urgent cases, and I appreciate that.

 

[nimbus]

My hospital doesn’t test MAC cases. Makes no sense to me. Only GAs get tested.

Yeah that was the rationale at the surgery center. Since they’re not expected to get airway instrumentation, those patients were considered to be lower risk of spreading covid. The GAs are still getting tested.

 

[coffeebythelake]

Yeah that was the rationale at the surgery center. Since they’re not expected to get airway instrumentation, those patients were considered to be lower risk of spreading covid. The GAs are still getting tested.

I guess they have never seen a MAC patient cough?

 

[coffeebythelake]

Our hospital has somehow implemented the rule that any outpatient coming in for surgery must have a negative test within 72 hours, but any inpatient going to the OR, even for elective cases, may proceed to the OR as long as their test has been performed (but not necessarily resulted). Completely idiotic! Makes zero sense. I've had several attendings completely refuse to proceed until the result is back for non urgent cases, and I appreciate that.

Idiotic! I'm glad your attendings are taking that stance. Unless the patient is crashing and burning they need a covid test resulted before the OR. And if they are level 1s without covid result we wear full PPE

 

[vector2]

FL

 

[GassYous]

Yeah that was the rationale at the surgery center. Since they’re not expected to get airway instrumentation, those patients were considered to be lower risk of spreading covid. The GAs are still getting tested.

But how is covid spreading in the community if no one's having their airway instrumented on the streets?

 

[kmurp]

I’m in NY where testing all within 5 days is required for elective cases. We have had cancellations due to no results. Based on the study in the Annals of Int Medicine, I’m not convinced testing helps as the sensitivity is so low in early infection, but what do I know.

 

[coffeebythelake]

I’m in NY where testing all within 5 days is required for elective cases. We have had cancellations due to no results. Based on the study in the Annals of Int Medicine, I’m not convinced testing helps as the sensitivity is so low in early infection, but what do I know.

The question should not just be about the false negative rate of covid testing (and yes it is well understood that these tests are probably somewhere 70 to 80% sensitive), but whether the sensitivity is due to presence of detectable virus in nasopharynx (is the test false because no virus was swabbed vs some issue with reagent, etc), and whether tha corresponds to an increased likelihood of infectivity

 

[chocomorsel]

I guess they have never seen a MAC patient cough?

I had a patient cough in my face today and I had my goggles sitting on top of my head. Horrible breath. Caught me off guard.
Hope I don’t get it through my eyes.
I feel safer in the Covid Unit honestly. Everyone there is tested. And we have face shields . Should have swiped some because when I have a face shield it’s easier to keep on than goggles.

 

[coffeebythelake]

I had a patient cough in my face today and I had my goggles sitting on top of my head. Horrible breath. Caught me off guard.
Hope I don’t get it through my eyes.
I feel safer in the Covid Unit honestly. Everyone there is tested. And we have face shields . Should have swiped some because when I have a face shield it’s easier to keep on than goggles.

agree, gotta stay safe. i've become almost paranoid about this stuff.

 

[kmurp]

The question should not just be about the false negative rate of covid testing (and yes it is well understood that these tests are probably somewhere 70 to 80% sensitive), but whether the sensitivity is due to presence of detectable virus in nasopharynx (is the test false because no virus was swabbed vs some issue with reagent, etc), and whether tha corresponds to an increased likelihood of infectivity

I wish I knew if a false negative patient was not very infectious due to low viral load I’m not sure. A bigger problem is the VERY low sensitivity of the test in asymptomatic patients. According to that study in the Annals, the false neg rate is 100% four days before symptom onset. We test our patients five days prior to the procedure.

 

[coffeebythelake]

I wish I knew if a false negative patient was not very infectious due to low viral load I’m not sure. A bigger problem is the VERY low sensitivity of the test in asymptomatic patients. According to that study in the Annals, the false neg rate is 100% four days before symptom onset. We test our patients five days prior to the procedure.

Do u have a link to thay study? Thx

 

[kmurp]

ACP Journals
This is the article

 

[Gas]

We are in upstate NY and test everyone. State requirement that everyone undergoing non-emergent procedure needs negative test within last 5 days. Plus ASA released a statement on perioperative Covid testing. For elective cases, patients come in few days before for test and then are told to self-isolate until results back. For our urgent/emergent cases, we have 15-minute and 45-minute rapid tests. We are running out of those, and the regular test takes about 4 hours. Since that will soon be our only option, we will have to wait 4 hours for cases that can wait - obviously anything life/death goes right to the OR.

ASA/APSF Statement on Perioperative Covid Testing

 

[AdmiralChz]

I work at a large, well-funded hospital system. We test everyone who requires service from the Anesthesia Dept preop. We have a great relationship with the hospital CMO and what we have been told is that it isn’t so much cost (which is substantial but our shop sounds certain the federal gov will be giving out more $$$ for it) but instead severe limitations on acquiring reagents for testing. As it stands we can do something like 50-60% of total testing capacity as they just don’t have the “ingredients” so to speak and they are very reliant on federal distributions of it. Apparently there isn’t much of it around even for very high bidders, not sure what that is about. As our local cases have gone up, it has been more challenging to get tests and results for inpatients that need semi-urgent surgery.

Sounds like a great time to be in the “testing reagent” business. I wonder if it’s made abroad like the rest of our damn equipment. So stupid.

 

[IlDestriero]

I’d tell him to flock off. We test everyone and have a positivity rate of 2-3%. Consistently. The goal is within 24 hours but we accept 72 and do our own testing at multiple sites. Every day a couple cases are cancelled because some asymptomatic kid tests positive. The other day we had 5. And that was just in the main OR. There could have been more at the ASC, NORA sites, etc.
I guess if you PAPR up, etc. for every patient and treat them all as positive, that would be fine. But that seems like it will lead to shortages of PPE. And paranoia.
Are you in an area with essentially no disease? Are there areas without disease anymore?

 

[IlDestriero]

Yeah that was the rationale at the surgery center. Since they’re not expected to get airway instrumentation, those patients were considered to be lower risk of spreading covid. The GAs are still getting tested.

Yeah, lower risk for the administrators. I’m surprised your surgeons are fine with that. They can’t be that stupid. But maybe that greedy.

 

[Ras Tafari]

My hospital stopped testing all elective cases a couple weeks ago and shifted to only testing patients that will be admitted after surgery or undergoing some head and neck surgery like T&A’s. The stated reason for this change was a lack of reagents for tests, plus a high false negative rate. We are also now required to wear a surgical mask at all times plus eye protection in patient-care areas (this includes nurses, techs, etc) and add the N95 plus face shield when instrumenting the airway. No negative pressure rooms, gowns, or other precautions, aside from trying to maintain social distance (yeah right).

 

[nimbus]

Yeah, lower risk for the administrators. I’m surprised your surgeons are fine with that. They can’t be that stupid. But maybe that greedy.

Yep. We used to test every patient until we ran low on tests. When the ophthalmologists were told they don’t have enough tests to test their patients, I don’t think a single one stopped doing cases.

 

[linkin06]

Unbelievable...richest nation in the world.

"It is what it is"