CT Sinus Center: Promoting In-Office Procedures For Continuity of Care During COVID-19 Upsurge of Cases

CT Sinus Center: Promoting In-Office Procedures For Continuity of Care During COVID-19 Upsurge of Cases

With the upsurge of COVID-19 cases in many states across the United States, including Connecticut, many ENT practices like CT Sinus Center are thinking ahead on how to handle future elective surgeries and medical and surgical procedures. In an effort to provide continuity of care for all their patients, CT Sinus Center is promoting in-office procedures for acute and chronic sinus and nasal conditions. Their state-of-the-art treatment options can provide long-term solutions to alleviate symptoms and quickly get their patients back to a better quality of life.

These select in-office procedures can be done at any of their locations, with offices in Litchfield, Shelton, and Waterbury.

Nasal 

Sinus

CT Sinus Center’s leadership decision regarding this proposal is in line with previous guidance from the American College of Surgeons, Local Resumption of Elective Surgery Guidance, dated April 17, 2020, where they stated that “Certain select procedures may be appropriate for the office setting as long as safety concerns are identified and addressed.”

CT Sinus Center Following CDC-Based Guidelines

Since the onset of COVID-19 throughout the United States, CT Sinus Center has been following CDC-based, enhanced cleaning and sterilization regimens and enforcing proper use of Personal Protective Equipment (healthcare providers and staff wear surgical face masks at all times). To further ensure the health and safety of their patients they are also

  • Conducting Pre-procedure COVID-19 Testing
  • Limiting the Number of Patients Seen Per Day
  • Cleaning Rooms Thoroughly After Each Patient Visit
  • Social Distancing in Common Areas

Furthermore, CT Sinus Center staff is following the American College of Surgeons’ guidance that Aerosol Generating Procedures (AGPs), while they increase the risk to the healthcare worker, they may not be avoidable. For the protection of the healthcare providers, especially for patients who are or may be infected, AGPs should only be performed while wearing full PPE including an N95 mask or powered, air-purifying respirator (PAPR) that has been designed for the OR. Examples of known and possible AGPs include:

  1. Intubation, extubation, bag masking, bronchoscopy, chest tubes
  2. Electrocautery of blood, gastrointestinal tissue, and body fluids
  3. Laparoscopy/endoscopy

Given the potential risk of increased droplet formation with sinonasal procedures performed under local anesthesia in the office, consideration is made for treating these procedures in a similar fashion to those performed in an ASC (getting the patient tested and staff wearing personal protective equipment).

Basis for Decision

Nearly 7 months ago, on April 20, 2020, the Ambulatory Surgery Center Association was tracking State Guidance on Elective Surgeries as a result of a statement made by the US Surgeon General on March 14, 2020, stating that hospitals and healthcare systems should consider stopping elective procedures amid the COVID-19 outbreak. With that statement and further guidance released by the Centers for Medicare & Medicaid Services on March 18, 2020, to limit “non-essential adult elective surgery and medical and surgical procedures, including all dental procedures,” this prompted several state officials to come out with directives and guidance regarding elective procedures. Such guidance has ranged from recommendations that providers scale back elective procedures to mandates that elective procedures be canceled or postponed.

While Connecticut did not issue a specific order addressing prohibitions on elective procedures, the State of Connecticut issued a stay-at-home order effective March 23, 2020, through April 22, 2020, directing all non-essential functions in Connecticut to suspend in-person operations. Even though essential businesses such as hospitals and clinics were not affected, CT Sinus Center closed the practice for 1.5 months due to COVID-19. On May 4th, CT Sinus Center reopened its offices, as new nationwide guidelines were released that declared  “elective surgeries can resume, as clinically appropriate, on an outpatient and in-patient basis” at facilities that adhere to CMS guidelines.

Since reopening their offices in May, CT Sinus Center staff found that as they reconnected with many of their patients with in-office and telehealth visits, that many allergy patients were concerned of worsening allergy conditions due to inability to obtain routine injections and therapies, and the need to restart allergy therapies at lower allergen dose levels. Allergy patients and new patients now suffering from the blooming allergy season were ecstatic to return to the office to continue care and / or seek new treatments. Schedules filled quickly because they limited the number of patients seen, and expanded sanitizing efforts between patients as part of their new COVID safety procedures. Same issue with new sinus patients–our capacity to see new patients decreased and consequently pushed out available appointments.

To avoid a repeat of these effects on their patients, CT Sinus Center leadership is being proactive and working earnestly to figure out a plan for elective cases to go on as scheduled for the betterment of their patients and in providing excellent patient care services.

CT Sinus Center’s Contingency Plan

If the state of Connecticut, however, orders another shutdown of non-essential services with the exception of essential healthcare services, they will follow the guidance previously provided by the American Academy of Otolaryngology-Head and Neck Surgery dated March 24, 2020. In this guidance, the Academy strongly recommended that all otolaryngologists provide only time-sensitive or emergent care. This includes both office-based and surgical care. Additionally, the Academy recognized that “time sensitivity” and “urgency” is determined by individual physician judgment and must always take into account each individual patient’s medical condition, social circumstances, and needs.

With that in mind, the Academy provided further guidance to help otolaryngologists prioritize cases during the pandemic that would be consistent, practical, and implementable at the appropriate time, based on local conditions and regulatory guidance. Accordingly, procedures are prioritized using the following categories:

Emergent: There is an immediate impact on survival.

Urgent: There is potential for permanent harm or permanent worsening of the medical condition if the procedure or surgery is not performed in a timely manner (2 weeks) OR there is potential for exacerbation of pain, and/or chronic/acute medical conditions resulting in additional urgent/emergency care or inpatient care.

Time-Sensitive: Significant temporary impairment of the ability to work or perform essential activities of daily living but not likely to result in permanent harm, hospitalization, or emergency/urgent care.

Routine Priority: Mild temporary interference of the ability to work or perform essential activities of daily living but not likely to result in permanent harm, hospitalization, or emergency/urgent care.

In-Office Procedures FAQs

You would not be a candidate for an in-office sinonasal procedure if you are over age 65 and are considered overweight or obese or you have

  • Obstructive lung disease
  • Hypertension
  • History of heart attack or stroke
  • Previous cardiac intervention
  • History of prolonged operating room time during past surgeries

You would be an ideal candidate for an in-office procedure if you are

  • In overall good health
  • Not obese
  • Age 65 or younger
  • Having a minimally invasive or low-risk procedure

The main benefit of an in-office procedure is the decreased risk of hospital-acquired infections. Patients also experience a faster recovery because shorter-acting anesthesia is used for in-office procedures which allow for an easier recovery.

Other added benefits include:

  • Minimally Invasive Treatment
  • Reduced Bleeding
  • Lower Costs
  • Recovery at home
  • Personalized Care
  • Better Outcomes
  • Reduced Stress

An office-based procedure is generally any surgical or diagnostic procedure performed in a physician’s medical office that is invasive or involves subcutaneous penetration, excluding minor surgical procedures. Most jurisdictions classify procedures as “surgical” or “invasive” by reference to the type and level of sedation or anesthesia used.

According to a research study reported in Aesthet Surg J, complication rates in office-based surgical suites (OBSS) were less than ASCs, and hospitals. Furthermore, there was a lower risk of developing a complication in an OBSS compared to an ASC or a hospital.

Minimally Invasive In-Office Sinonasal Procedures at CT Sinus Center

CT Sinus Center offers many solutions for acute and chronic sinus and nasal conditions that can be performed in-office. If you are interested in in-office sinonasal procedures, call CT Sinus Center at (203) 574-5997 to schedule a consultation.