22 May 2020

Dear Fellows and Members,

Over the last number of weeks, we have seen a decline in hospital admissions, critical care bed occupancy and deaths from COVID-19, enabling the HSE to consider how best to resume planned surgical activity.

While there is considerable concern over the potentially severe impact of COVID-19 on patients that acquire their infection in the perioperative period, there is also a mounting expectation from clinicians, the HSE and the public that we return to what is considered a ‘normal’ service as soon as possible and prevent the risk to patients for whom surgery is a key part of the treatment of non-COVID conditions.

There is also likely to be pressure to aim for supernormal levels of activity in order to ‘catch up’ with cases postponed during the peak of COVID-19 infection. It is essential that when the resumption of planned surgery takes place, care is delivered safely, efficiently and in a sustainable manner, taking into account the staffing, environment and equipment needed to operate, in addition to monitoring the continuing impact of care of COVID-19 patients on postoperative critical care capacity.

The relaxation of restrictions will mean entering a new phase of the pandemic. There is a possibility that we may see a second surge in viral infection. Any increase in surgical activity may need to be reversed if this surge occurs, and planning must take this into account.

It is clear that returning to more normal levels of surgical activity will be highly challenging. Many hospitals have used operating theatres, theatre recovery areas and surgical ICUs to accommodate patients, but normal surgical activity should not resume if these remain as temporary ICUs for logistic and infection control reasons.

It is inevitable that continuing to manage the ongoing demands of COVID-19 patients alongside resumed surgical activity will require additional investment. Identifying ring-fenced surgical beds in a COVID-free area that is isolated from other patients will be a key element of this.

Since the resumption of high priority planned surgery, it is clear that the return to pre-pandemic activity levels will not be rapid. There must be regular reviews of the ability of the health system to accommodate increased capacity without jeopardising the safety of patients and the health of staff. The RCSI National Clinical Programmes in Surgery and Trauma and Orthopaedics are coordinating the College’s approach nationally with the Clinical Programmes working with the HSE Acute Hospitals division and the National Clinical Programme for Anesthesia.

The National Clinical Programme in Surgery is working on a range of guidelines to add to the 18 COVID-19 guidelines they have already produced. In the coming weeks they plan to publish the following National Guidelines:

overarching RCSI NCPS Model for a return to urgent elective surgery
perioperative pathway during COVID-19 including discharge
pathway to move cystoscopy into primary care
pathway for lap chole during COVID
pathway for naso-endoscopy in OPD
pathway for day case tonsillectomy

Our weekly webinar series continues to grow in popularity and is one of the key feedback mechanisms we have to guide the College in our approach to COVID-19. I wish to acknowledge all of those Fellows and Members and others who have engaged with these online webinars and the other online materials posted on the RCSI web pages.

Next week’s webinar will involve a discussion with our perioperative colleagues on what they consider to be the challenges ahead and how they can be addressed. Professor Deborah McNamara will provide a perspective from the National Clinical Programmes. Professor Paul Ridgeway, Associate Professor of Surgery at TCD/Tallaght Hospital, will give a Clinical Directors Perspective. Bernard O’Reilly from Cork University Hospital will give the perspective of a Chief Operating Officer and Professor Zena More, Head of RCSI’s School Of Nursing will share her thoughts on the future of perioperative nursing. You can register for the webinar here.

The unprecedented challenge of COVID-19 has brought healthcare leadership sharply into focus. RCSI is a global leader in the provision of professional education and training across the full spectrum of healthcare professionals. Based on feedback from our Fellows and Members we have adapted our leadership programmes for the current environment and expanded the offering to ensure we are meeting the needs of all our perioperative stakeholders. You can get more details of the programmes here.

From a College perspective we now have a clear roadmap from the Government and based on this we have now set-out an ‘RCSI Re-opening Roadmap’, which starts this week with a phased return of lab-based researchers, with priority given to those working on COVID-related projects and other essential research. We continue to develop plans to allow us to effectively deliver full teaching programmes next year, as uncertainty in relation to the future effects of COVID-19 remains a reality.

Best wishes,

Mr Kenneth Mealy, RCSI President