Elective Surgeries Available at Green Spring Station

When the new coronavirus spread throughout the Baltimore-Washington area in March, elective and non-urgent surgeries scheduled at Johns Hopkins Children’s Center had to be postponed. Pediatric surgeons were still on hand but many of the anesthesiologists and nurses needed for these operations had been redeployed to intensive care units at The Johns Hopkins Hospital to provide care for the increasing number of patients infected with COVID-19. Three months later, hospital admissions began to decline to the point where the Children’s Center, in accordance with guidance from the Maryland Department of Health, could resume select elective surgeries. But with a significant backlog of surgical cases and concerns about a new severe surge of coronavirus infections in the region, how would that happen? Through innovative thinking, over-preparation and ongoing communications, say those leading the way.

“It’s very much a team sport that requires an immense amount of communication with surgeons, anesthesiologists, nurses, pre-op and post-acute care staff,” says pediatric anesthesiologist Rahul Koka, referring to the ambulatory surgery reopening initiative at the Children’s Center that began in early June. “My job is to make sure patients flow through in a timely manner, to log time for surgeons, figure out which procedures happen first, and above all else, ensure safety for both patients and providers,” says Koka, section chief for Pediatric General Anesthesia.

“We focus on shared decision-making with families, talk to parents to determine when they want to have the surgery for their child, and alternatives like waiting,” adds pediatric otolaryngologist and chief surgical quality officer Emily Boss. “Parents are feeling lots of anxiety and stress about their child’s problem, however big or small it is.”

Safeguards for ambulatory surgery staff include social distancing, masks and other personal protective equipment (PPE), and a daily morning check-in during which providers are screened and, if symptomatic, tested for COVID-19. Also, anesthesiologists have been divided into two teams — one team on service and the other off, in self-isolated quarantine, each week — to reduce their risk of infection.

“Now, if you become infected at work and don’t know it, you’re only going to take out one team,” says Koka. “We still have our other team ready to go.”

Precautions for patients and families include social distancing, appropriate PPE, a temperature check at the front door and testing if symptomatic. Also, changes implemented in Green Spring Station Pavilion III promote social distancing, ensuring each patient and family member has enough space to safely be together during a procedure.

“We’re promoting as much testing as possible to reduce any potential COVID-positive patients coming into our environment,” says Brian Giessler, chief administrative officer of Johns Hopkins ambulatory surgery centers. “We want to give parents and the public peace of mind that everyone in the building has been tested and is wearing the appropriate PPE to keep everyone safe.”

“We’ve revamped the entire preoperative experience,” says Koka. “The goal is to create this bubble of safety the moment the patient arrives.”

Families receive information about what to expect on the child’s MyChart electronic patient record and Johns Hopkins websites. Also, families are contacted by telephone to ensure they are fully informed of the surgical process before they arrive. With all this planning and preparation, how did week one go at Green Spring Station Pavilion III?

“The first week was scheduled with an abundance of appropriate caution allowing for long times for room turnover and making sure all of the staff were ready to go and restart,” says Boss. “Surprisingly, we found that we probably had built in too much time.”

Indeed, Giessler notes that the team did err on the side of safety. “From testing to screening to requirements for universal masking and providing our staff high level PPE, we really are going above and beyond in all areas to provide overlapping safety protocols,” says Giessler. “We wanted to minimize risk to the greatest extent possible.”