By Debra Wood, RN, contributor Apr 26, 2021
Some areas of the U.S. experiencing
a third wave of COVID-19 cases still have a surgical backlog; advanced practice
professionals are key to increasing access to care.
“The surgical PA has been shown to not only help increase access
with pre-op and helping in the recovery stage, it helps hospitals and surgeons
see more patients,” said Gerald Simons, MPAS, DFAAPA, PA-C, clinical assistant
professor in the department of PA education at Stony Brook School of Health
Technology and Management in Southampton, New York.
assistants and certified registered nurse anesthetists (CRNAs) can help
healthcare systems return to a more normal surgical schedule.
can absolutely help address the elective surgery backlog, particularly when
allowed to work to the full extent of their education, training and licensure,”
said Brett Morgan, DNP, CRNA, senior director of education and practice,
American Association of Nurse Anesthetists. “As elective surgeries resume, CRNAs
can step in as a full-service anesthesia provider.”
return of elective surgeries also will help hospitals financially. The American
Hospital Association released an analysis in February 2021 that hospital and
health system revenues could be down as much as $122 billion in 2021, as people
have delayed care, including surgeries. That is in addition to an estimated
loss of at least $323 billion in 2020.
volumes are not expected to return to 2019 levels for months to come, according
to a McKinsey & Company report released in October 2020. And
it may take more than a year to burn through the backlog, even by increasing
output by 10 percent.
people remain hesitant to access medical care. The Centers for Disease Control
and Prevention reported in September 2020 that “41 percent of U.S. adults had
delayed or avoided medical care” due to concerns about COVID-19. Many people
have lost their health insurance along with their jobs or part-time status. Delays
in care can adversely affect outcomes.
12 strategies for restarting elective surgery
The American College of Surgeons, American Society of Anesthesiologists,
Association of periOperative Registered Nurses and the American Hospital
Association issued a “Roadmap for Resuming Elective Surgery after COVID-19 Pandemic.” The guidance, released in April 2020 and updated in November 2020, includes:
1. Testing patients and staff for
2. Ensuring adequate personal
protective equipment (PPE) is available.
3. Prioritizing immediate patient
needs. For instance, cancer, transplant, cardiac and trauma cases should take
4. Collecting and managing data,
including quality of care metrics and bed, PPE and COVID-19 statistics.
5. Taking part in regional
cooperation (added to updated November 2020 guidance)
6. Addressing supply-chain issues
(added to November 2020 guidance)
Additional issues and strategies that may help address
the surgical backlog:
7. Bringing locum tenens physician assistants, nurse practitioners or CRNAs on board can help
hospitals, surgery centers and practices catch up on any backlog.
8. Data analytics can help in prioritizing what surgeries should take place
9. Availability of operating rooms, surgical inpatient beds and
intensive-care beds pose challenges to resuming surgeries, but so do workforce
issues, according to the McKinsey
10. Extending the workweek to include weekends and
evenings may help in chipping away at elective surgery backlogs, but that will
require more skilled professionals, peri-operative clinicians and nurses on
units as the patients recover. At the same time, hospital workforces may be
unstable, due to postponed paid time off, childcare needs, COVID-19 infections,
and provider burnout, per the McKinsey report.
11. Optimizing OR and inpatient throughput could
allow for more cases to be performed, McKinsey states, even with the additional
sanitization between cases that is now required.
12. Surgical navigators can help patients with
preparing for surgery and answer their questions. Calling patients to discuss
rescheduling procedures could prove helpful in speeding up a return to
in-person care. Providers also may need to focus on bringing
patients back during periods of low COVID-19 activity, according to McKinsey’s report.
practice locum providers
Surgical PAs talk with the patient preoperatively, perform minor procedures, assist
surgeons, write orders for post-op care and often follow the patient while in
the hospital, writing new orders as needed, and in private practice after
discharge in office practices.
big selling point of the surgical PAs is their ability to participate through
the entire perioperative experience,” Simons said. “You see a lot of them in
the OR, but for most of us, it is a package deal, where they are doing the
whole perioperative experience.”
PAs may run the wound-vac team in some settings, Simons said. They may perform
biopsies. Studies have shown that surgical PAs can improve access to care and
allow surgeons to see more patients and handle more complicated cases.
offices that use a surgical PA, patients are getting easier appointments,”
nurse practitioners can provide some of that care, at times serving as a first
assistant during the surgery, with some states requiring an additional
certification. But NPs can definitely follow the patient pre- and post-operatively.
provide anesthesia to millions of surgical patients and those undergoing procedures,
such as a colonoscopy, in a variety of settings.
are qualified to make independent judgments regarding all aspects of anesthesia
care based on their education, licensure and certification,” Morgan said.
are also trained to deliver care in a way that is particularly respectful of
resources and cost.”
2001, the Centers for Medicare & Medicaid Services (CMS) allowed states to
eliminate the requirement for physician supervision of CRNAs, and 19 states
have opted out. However, in 2020, CMS suspended the supervision requirement to
boost CRNA capacity during the pandemic.
“Many states passed emergency orders during the
pandemic, removing a significant roadblock toward ensuring states have the
necessary workforce capacity during the COVID-19 crisis and in the future,”
What do locum advanced
practice providers need to work in surgery
Surgical physician assistants must graduate
from an accredited, surgically-focused PA program and, usually, complete a surgical
residency, which provides an opportunity to gain experience to manage patient
care during the 12 to 16 month program. Physician assistant locums work with a
Employers seeking surgery physician assistant
locums require licensure in the state where the care is provided, physician
assistant certification or being board certified or eligible, and recent
CRNAs must have critical care experience
before beginning formal anesthesia education, Morgan said. Locum CRNAs can find
numerous opportunities, and must also be licensed in the state where they wish
to practice. Your locum tenens agency can help with job searches, licensing and
other onboarding issues.
to surgical schedules reminiscent of 2019 will take time, but advanced practice
providers offer a way to speed up the process.
Locum Tenens Physician Assistant Jobs and Salaries
Locum Tenens CRNA Jobs and Salaries
Locum Tenens Nurse Practitioner Jobs and Salaries
Staff Care, an
AMN Healthcare company, specializes in placing locum tenens physicians and
advanced practitioners in part-time and full-time assignments across the U.S.
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