Guidelines relating to the COVID-19 pandemic

>>Guidelines relating to the COVID-19 pandemic

Guidelines from BreastSurgANZ Council relating to the COVID-19 pandemic

These guidelines for Breast Surgeons should be considered in the context of your local resources and guidance provided by local Departments of Health and Individual Institutions.

Maintain Communications

  1. Ensure you have remote access to your institution and use institutional email if possible, as forwarding to external emails may be problematic
  2. Set up a unit/HOU WhatsApp group for timely communication – see link to AMA information

Strategies to enable service provision under a shutdown of non-essential activity

  1. Move to Telehealth consultations for the majority of patients : see link to MBS item numbers (eg. Follow up patients (105) telephone only 91833, videoteleconference 91823)
  • HOW:?? Decrease the number of patients having to come into the practice
  • Screen which of your routine patients need review via phone consult
    In essence this is to enable an examinationor if the patient is in considerable distress requiring more personal support.
  • Ensure careful documentation for bulk billing
  1. Provide in person consultations for confirmed cancers, where:
    • Highly suspicious for cancer
    • Post op – some may be able to be done with Telehealth/GP
  2. Defer routine review of asymptomatic breast cancer patients, including their imaging, for 6 months or as appropriate.
    Keep a careful register of all deferred patients and enter a recall in your medical software system eg. GENIE
  3. Triage of new referrals – deferral of all benign referrals except if the patent has high anxiety or uncertainty

In order to facilitate “social distancing” in your practice/waiting room

  1. Limit the number of accompanying persons to one per patient and insist they wait outside the practice prior to the consult
  2. Place a barrier such as an empty blocked chair between patients
  3. Give patients option to wait in the car or an appropriate outside area & be called in when ready to be seen
  4. In multiple doctor practices, consider how many doctors consult at the same time
  5. Remove magazines, tea and coffee, toy boxes etc
  6. SMS prior to appointment
    Example: Appt with _____ on ________.If U have cold/flu symptoms recent overseas travel pls delay yr apt by 2 weeks &call ______ (This fits within the 160 character limit of Genie).  You can also ask all patients to ring and limit to a longer advice message on your answering machine.
  7. If feasible, consider asking your patient to self-isolate for 2 weeks prior to surgery and throughout chemotherapy
  8. If feasible, leave the operating theatre after timeout and throughout the time of intubation. Remember to wear full PPE whenever in the theatre.

Consideration may need to be given to who is operated on & when

  • Clip all new cancers sent for biopsy, in case their surgery may be delayed
  • Consider neoadjuvant endocrine therapy for ER+ve cancers if surgery needs to be delayed
  • Minimise time patients spend in hospitals – day case, HITH
  • Limit complexity of surgery – consider deferral of immediate reconstruction, contralateral risk reducing mastectomy
  • Deferral of all risk reducing surgery:
  • Only Cat 1 patients warrant surgery
  • DCIS: low and intermediate grade defer
  • extensive high grade may be the exception

As treatment plans may differ from normal, frequent MDM & rigorous documentation

  • Plan for multiple scenarios within your MDT
  • Need to accurately quantify the value of (neo)adjuvant chemotherapy and CK4,6 inhibitors
  • HER2 + : consider minimal chemotherapy/Subcut Herceptin
  • TNBC : still overwhelming advantage in T2/N1 for chemotherapy
  • If early apparent cCR may consider curtailing neoadjuvant chemotherapy and proceed early to surgery
    See link to MJA article for more information

Look after yourself

  • PPE : ensure you can comply with current recommendations, see link to NSW Health advice for example
  • Rest and support yourself , family and colleagues

Look after your staff

  • Put in place measures for your staff to work from home
    • Remote access to practice server/software
    • Diversion of phone calls

Please consider your own practice needs and developments with COIVD-19 in adopting or varying from these recommendations.

BreastSurgANZ Council