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College of Rural and Remote Medicine calls on caution before resumption of elective surgery

The AMA has been in contact with the Federal Government to propose steps needed for the resumption of elective surgery – initially for low-risk, high-patient-benefit procedures.

Elective surgery in Australia was suspended in Australia in March to free up beds and health workers to cater for an anticipated surge in COVID-19 patients, and to save scarce personal protective equipment (PPE) such as masks, gowns, and gloves.

AMA President, Dr Tony Bartone, said on April 20th, 2020 that doctors should be supported to make clinical decisions about which surgeries can proceed in the best interests of patient and clinician wellbeing and safety. The Prime Minister has announced that category 2 and some category 3 elective procedures that were previously halted will gradually recommence from 27 April.

These will include: IVF post-cancer reconstruction all procedures for under 18s knee, hip and shoulder replacements cataracts endoscopy and colonoscopy dental procedures including braces and dentures The gradual restart will see 25% of the operating capacity start and this will be reviewed on 11 May. For more information on how this applies to you, please contact your doctor.

Rural medical organisations are however warning that hospitals, particularly the smaller rural ones, need to gear up now, to prepare for COVID-19 emergencies. The Australian College of Rural and Remote Medicine (ACRRM) and the Rural Doctors Association of Australia (RDAA) have said that good preparation will save lives. “Encouraging progress has been made, but there remain many gaps in the preparations for some hospitals,” said RDAA President, Dr John Hall. “There has been a really impressive amount of training going on, with many rural doctors and hospital staff participating in simulation activities right across Australia. “It is essential that all State health departments support their rural hospitals with the appropriate supplies of PPE, critical care drugs, equipment and simulation training. “If hospitals are left under-supported or under-prepared for a COVID-19 patient they quickly become a ticking time bomb, putting staff, patients and the community at risk of the fallout. “For any small rural hospital which has not yet participated in simulation activities, or placed orders for the appropriate supplies, that clock is ticking. “There needs to be sufficient stock of PPE on hand – BEFORE the first case presents,” Dr Hall said. “This is more than masks. If you admit a patient that needs intubation or resuscitation, clinical guidelines state the doctor must wear a face shield. This is a key item of PPE and we are hearing reports that supplies are running short. “Many rural hospitals have aged care residents onsite and there must be strategies in place to minimise the risks. This may include changes to rostering to minimise the crossover of staff between the services, continued education and review on staff wearing PPE, as well as fit-testing for masks.

The AMA however advise that they have strongly supported the swift response taken by the Government to the COVID-19 threat saying "we wish to see a continuation of Australia’s successful results to date."

AMA President, Dr Tony Bartone said “Indeed, it is due to the success of the Government’s response to COVID-19 that we now see available capacity in both our public and private hospital systems.

“The rationale to cautiously and gradually restart elective surgery authorised by doctors is to assure patient wellbeing. Many elective surgeries are for health conditions that will only worsen over time.

“A gradual loosening of restrictions is also consistent with the Government’s and the AMA’s view that patients should not ignore existing health concerns, and seek medical care when needed.

“Restarting some elective surgery in a responsible way also ensures that our facilities do not lay idle, and reduces patient wait times.

“We support a graduated restart of all Category 2 elective surgeries across all specialties, in addition to the current Category 1. Following an assessment of a gradual restart, where practicable, Category 3 procedures could then be considered.

“Doctors should be authorised to make decisions about what surgeries can proceed in the best interests of patients and clinicians.

“The AMA supports treatment proceeding as determined by doctors. It would be logical to restart procedures at low risk of spreading COVID-19 and of high benefit to the patient, and this would include IVF treatments.”

Dr Bartone said that one of the determining factors in maximising the operation of the private hospital system – be it for work directed by State Governments or private elective surgery work - will be the adequate supply of PPE.

“Hospitals must have an adequate supply of PPE for all medical and hospital staff, and this is a necessary precursor before any surgeries are undertaken,” Dr Bartone said.

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