Starting May 26, New Jersey’s sprawling health care industry can finally resume elective surgeries and invasive procedures at hospitals and outpatient, ambulatory care centers. But the state is imposing limitations.

The thinking behind the ban in late-March was to redirect medical resources toward addressing the projected surge of COVID-19 patients. For hospitals, doctors and medical providers, it was all hands on deck – a state of war.

For now, medical services can move away from a sole focus on treating patients with the virus, which as of May 20 infected roughly 150,000 New Jerseyans and claimed roughly 11,000 lives.

“The consumer wants to be convinced, but the clinician needs to be convinced,” Barry Ostrowsky, the president and chief executive officer of RWJBarnabas Health, told lawmakers during a May 18 Senate committee hearing.

“The clinician needs to be able to say to a patient ‘it’s now safe, or it’s now appropriate, or you don’t have to worry about going to the facility to get that which you need’.”

The state’s Department of Health and Division of Consumer Affairs, which both play a role in regulating the state’s health care industry, rolled out guidelines on May 19, to give providers several days to prepare for the new changes.

Needless to say, the use of personal protective equipment by patients, physicians, and other staff – gloves, face masks – is a big piece of reopening. Facilities need to have a plan in place to ensure patients have consistent access to PPE.

And medical facilities need a plan in place for thoroughly sanitizing facilities for non-COVID patients.
Both hospital and outpatient surgeons need to prioritize services that, if delayed, could cause the most patient harm, the guidelines state. At-risk populations that would benefit the most from those procedures should be prioritized as well.

The DOH said that outpatient surgery centers should prioritize procedures that were scheduled and had to be cancelled as a result of Murphy’s executive order.

Hospitals meanwhile, would use a five-level sliding scale. Those who need critical care and might just have a matter of days to live without the procedures would be the top-priority, according to the DOH.

After that are patients who could only put off the procedure for a matter of weeks.

Even lower-priority are certain procedures that could be delayed indefinitely, and then minor procedures that would have a minimal health impact.

Staff and patients should be screened for any symptoms, and hospitals should administer temperature checks. And they should wear face coverings, except in the cases where the nature of the medical procedure precludes patients from wearing the covering.

Patients should be tested no more than 96 hours before their scheduled procedure and should self-quarantine between the time of the test and the procedure itself, or at least adhere to social distancing and wear masks during that time frame.

In addition, patients should be advised to immediately notify the health care facility if they’ve been in touch with a person suspected of having COVID-19 or who showed symptoms of the illness, or if they themselves began showing symptoms.

Telemedicine should be used as much as possible, according to the Division of Consumer Affairs. While remote consultations between health care providers and patients have been use more widely – especially during the pandemic — industry leaders warned that it does come with limitations. In some cases, in-person visits cannot be replaced by video chats.

Nonetheless, Robert Garrett, the CEO of Hackensack Meridian Health, maintained that telehealth would play an increasing role in a “new delivery model” of medicine.

For “basic health care,” he told lawmakers during the May 18 hearing, “we don’t see many of the patients really revert to traditional in-patient visits post-COVID.”

When patients do come to medical facilities, waiting room time and capacity should be reduced. In its guidance, the Division of Consumer Affairs states that patients should be made to wait in their cars, outside the office or in separate rooms, rather than congregate in a single waiting area as was typical leading up to the pandemic.

Appointments should be spaced out to make compliance with social distancing easier, and magazines should be removed from the waiting areas.

Medical facilities also must demonstrate that they have a contingency plan in place to handle the widely expected second wave of COVID-19 cases and ensuing patient surge, the Health Department said.

That means hospitals will regularly report data on their capacity and COVID-19 cases, and have staffed intensive care, critical care and medical surgical beds.

Both hospitals and outpatient centers must have the ability to quickly switch off non-urgent care and redeploy staff, beds, ventilators and personal protective equipment toward patients with the virus.
Ambulatory surgical centers should not see patients with COVID-19. Visitations should be strictly limited, allowing only for one parent or guardian to accompany an underage patient during a pediatric visit, and for one support-person for same-day procedures and outpatient visits. Labor and delivery would also be an exception.