NICE has published a guideline on the arrangements the NHS should put in place for patients needing elective surgery and other planned treatments and procedures (including diagnostics and imaging) during the COVID-19 pandemic.
The latest in its series of COVID-19 rapid guidelines, the new NICE guideline makes recommendations about how services should be organised in order to balance the risks associated with COVID-19 with the potential harms that can arise from delays in elective treatment and diagnostic procedures. It promotes a flexible approach based on individual circumstances and the type of procedure and aims to support the prompt recovery of elective care, while advocating shared decision-making, balancing the risks and benefits.
The guideline emphasises the need to discuss with people having planned care factors such as older age, sex and whether they are from a black, Asian or other minority ethnic group, or have any underlying conditions that could increase their risk of getting COVID‑19 and of having a severe illness, because these may influence their decision to go ahead with their planned care.
In order to minimise the risk of COVID‑19 transmission to other patients and healthcare workers, the guideline says that people having planned care involving any form of anaesthesia or sedation should follow comprehensive social-distancing and hand-hygiene measures for 14 days before admission. They should also be advised to have a test for SARS‑CoV‑2 within 3 days before admission and self-isolate from the day of the test until the day of admission.
For all other planned procedures, including diagnostic tests and imaging, people should be advised to follow comprehensive social distancing and hand hygiene measures for 14 days before having planned care.
For people who are at greater risk of getting COVID‑19, or having a poorer outcome from it, the guideline says they should be advised that some types of surgery, for example cardiac, carry additional risks for people with COVID-19, and that they should consider self-isolating for 14 days before a planned procedure.
The guideline says that people should be informed that their planned care is likely to be postponed if they test positive for SARS-CoV-2, have symptoms of COVID-19, are not clinically well enough or need to self-isolate after contact with someone with COVID-19 (for example, as identified by the NHS Test and Trace system).
People having inpatient surgery who stay in hospital for more than 5 days should be tested for SARS-Cov-2 between 5 and 7 days after admission, in line with current NHS England and Improvement advice. The guideline also recommends that all people going from hospital to other care settings are tested before they are discharged.
The guideline was produced in collaboration with NHS England and Improvement and a cross-specialty clinical group, supported by the specialist societies and Royal Colleges.