Surgeons call for same-day testing, as one third unable to undertake operations

With more than one million people waiting over 18 weeks for hospital treatment, a new survey of 1,741 UK surgeons finds one third have been unable to re-start surgery [1].  This comes one month after NHS England outlined how elective surgery should safely be able to resume [2].

Among those surgeons who are unable to re-start elective procedures, one third (33.4%) say lack of access to fast COVID tests for patients remains a barrier [3].

The Royal College of Surgeons of England is today calling for surgical teams across the UK to have access to same-day test results for patients, on the basis of these findings. The survey found time taken to get test results varied widely across the UK [4]:

• Just 10% of surgeons could get test results for surgical patients within 8 hours.
• A further 31% of respondents could get test results within 24 hours
• A further 34% could get results within 48 hours
• A further 13% could get results within 72 hours

Professor Derek Alderson, President of The Royal College of Surgeons of England said:

“The speed at which tests results can be returned is a crucial factor in enabling more elective surgery to take place safely. The aim should be for surgeons to have access to same-day test results, so that they can test patients both before and on admission, and again upon discharge – nine in ten surgeons we asked agree [5].

“If patients have a negative COVID result on the same day of their surgery and have isolated for a fortnight as recommended, then the surgical team can proceed with greater confidence. Operating on a patient who has COVID-19 is not a good idea, so the more we can do to reduce that risk, the better.”

Testing was not the only barrier surgeons cited, but it is likely the fastest to solve.  Other major barriers included ‘a lack of capacity in interdependent services such as diagnostics, anaesthesia and sterile processing’ (46%) and a ‘lack of staff’ (35%) [3].

Full findings are included in a report published today, ‘Elective surgery during COVID-19’.  In the report, The Royal College of Surgeons of England flags the importance of creating ‘COVID-light sites’ to improve patient safety, and reiterates its call this week for contracts with the independent sector to be extended as one route to achieving that.

Professor Alderson added:

“COVID-light sites must be established across the UK, both in the NHS and, where necessary, the independent sector. We need these protections in place to keep surgical patients safe, and right now a quarter of surgeons still don’t have access to a COVID-light site [6]. We have a window of opportunity this summer, before a potential second wave or the arrival of flu in the autumn.”

 “If we don’t get organised now, then tens of thousands of people will be waiting until next year for an essential operation. Part of getting this country back to work is finding a way safely to treat those patients who are off work because of a health condition.  We know that a joint replacement can enable someone to go back to work, so it’s both a duty for us as doctors to help address their pain, and key to both that individual’s wellbeing and wellbeing of the country.”

• Download the survey report

Notes to editors

The Royal College of Surgeons of England is a professional membership organisation and registered charity, which exists to advance surgical standards and improve patient care.

For more information, please contact the RCS Press Office:

• Telephone: 020 7869 6047/6052
• Email: pressoffice@rcseng.ac.uk
• For out-of-hours media enquiries: 020 7869 6056

[1] Survey respondents were asked: “Has elective or planned surgery been possible in your Trust/Health Board at any time in the last four weeks?”. They said (N = 1,718)

• “Yes” – 64.9%
• “No” – 32.5%
• “Don’t know” – 2.6%

[2] NHS Operational Framework for urgent and planned surgery, 14 May 2020 https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/05/Operating-framework-for-urgent-and-planned-services-within-hospitals.pdf

[3] Surgeons who reported that they had not been able to undertake planned or elective procedures in the last four weeks were asked: “If no, what are the reasons elective surgery has not re-started? Tick as many as apply.” They said (N = 536):

• “Lack of access to testing/swift results needed to establish patients are free from COVID-19” – 33.4%
• “Lack of sufficient PPE to undertake surgery” – 20.5%
• “Lack of staff” – 35.5%
• “Lack of capacity in interdependent services (e.g diagnostic services, anaesthesia, sterile processing etc.)” – 46.3%

[4] Survey respondents were asked: “Within your Trust/Health Board, how long does it take for results of COVID-19 tests on surgical patients to come back?” They said (N = 1,580):

• “Within 8 hours” – 10.3%
• “Within 24 hours” – 30.8%
• “Within 48 hours” – 34.3%
• “Within 72 hours” – 12.7%
• “Longer than 72 hours” – 1.8%
• “Don’t know or N/A” – 10.2%

[5] Survey respondents were asked: “We are keen that, as access to testing, and speed of results improves, testing should be available to surgical teams before admission, on admission and (for patients in hospital more than 24 hours) before discharge. Do you support this approach?”. They said (N = 1,580):

• “Yes” – 89.9%
• “No” – 5.7%
• “Don’t know” – 4.6%

[6] Survey respondents were asked: “Some areas have been able to create ‘COVID-light hubs’, with repeat testing, enhanced cleaning and separate pathways, to allow surgery to continue safely. Are you able to access COVID-light facilities for your patients?”. They said (N = 1,580):

• “Yes, within my Trust/Health Board” – 34.2%
• “Yes, by referring patients to another Trust/Health Board” – 1.6%
• “Yes, by using NHS capacity in the independent sector” – 26.0%
• “No” – 25.9%
• “Don’t know” – 12.3