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May 18, 2020

Governor Issues New Proclamation on Non-Urgent Procedures

This afternoon, Gov. Jay Inslee issued a new proclamation regarding non-urgent procedures. The proclamation allows for the performance of non-urgent health care services and surgeries provided that certain criteria and procedures are met. The proclamation also emphasizes the importance of a health care provider's clinical judgment, stipulating that physicians and other providers should consider the needs of patients in the broader context of the pandemic, and urging providers to act with good judgment in delivering care.

The requisite procedures and criteria that must be in place before non-urgent health care services and surgeries may be performed include: 1) care phase assessment; 2) criteria for resuming non-urgent procedures; and 3) considerations for practitioners resuming non-urgent procedures.

1) Care phase assessment

The proclamation requires "each health care, dental or dental specialty facility, practice or practitioner" to develop a care plan that reflects the COVID-19 risk assessment and the clinical/operational capabilities of the organization and responsive to the criteria below. Expansion/contraction of care plans should be based on standards of care that are in effect in the health care facility, practice, or practitioner's relevant geography as determined by that region's emergency health care coalition, as follows:

  • Conventional care phase – All appropriate clinical care can be provided.
  • Contingency care phase – All appropriate clinical care can be provided so long as there is sufficient access to personal protective equipment (PPE), and for hospitals, surge capacity is at least 20%.
  • Crisis care phase – All emergent and urgent care shall be provided, including elective care that the postponement of which for more than 90 days would, in the judgement of the clinician, cause harm (see below for more on "harm"). The full suite of family planning services and procedures, newborn care, infant and pediatric vaccinations, and other preventive care, such as annual flu vaccinations, can continue.

The new proclamation allows for a more regional approach to addressing the COVID-19 pandemic. It requires local health jurisdictions, in collaboration with local health partners, to assess the COVID-19 risk in their communities. Information relevant to the county-level assessment is available here. Contact your local health department or local health jurisdiction for more information.

2) Criteria for resuming non-urgent procedures

The updated proclamation also details criteria for resuming non-urgent procedures before there is a vaccine, effective treatment, or herd immunity to COVID-19. The provisions include monitoring resources (ventilators, beds, PPE, etc.), conserving PPE, and on-site fever screening and symptom screening for all patients, visitors, and staff—to name a few. A complete list of these provisions is available on pages four and five of the proclamation.

3) Considerations for practitioners resuming non-urgent procedures

The proclamation requires that practitioners must, in addition to the above, consider:

  1. The level and trending of COVID-19 infections in the relevant geography.
  2. The availability of appropriate PPE.
  3. Collaborative activities with relevant emergency preparedness and/or local health jurisdiction.
  4. Surge capacity of the hospital/care setting
  5. Availability of appropriate post-discharge options addressing transitions of care

Practice guidance on resuming elective procedures

The WSMA has collaborated with the Washington State Medical Group Management Association to offer new guidance on the proclamation for medical practices. Download this new resource. If you have questions on this new WSMA resource or what the proclamation means for you and your practice, contact the WSMA policy department at policy@wsma.org.

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