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Essential Care

HSS Suspends Nonessential Onsite Care

HSS, the largest provider of musculoskeletal healthcare in the United States, has suspended all nonessential onsite treatments. At this time, all non-urgent, non-critical appointments will be postponed or transitioned to virtual care. You will be contacted by your clinician's office if your existing appointment needs to be rescheduled or if we need further information from you to properly assess the urgency of your existing appointment. If you are not contacted, your appointment will proceed as scheduled. If in doubt or if you wish to use the virtual care option, please call your provider.

By suspending all nonessential surgeries, we have made our bed capacity, supplies and people available to help our community in this fight against COVID-19. We have implemented rigorous COVID-19 prevention measures to safeguard our patients and staff during the widening outbreak. We are committed to do everything possible to protect our patients, our staff and our communities.

HSS will lift this suspension as soon as deemed responsible.

Essential Surgeries

HSS remains available for your urgent orthopedic needs and is providing essential surgeries - procedures where the treatment is time-sensitive for medical reasons. HSS continues to care for admitted patients and will provide necessary postoperative and follow-up care for patients who will have essential procedures at one of our facilities. A team of HSS physician leaders have developed a list of conditions and treatments by sub-specialty that meet criteria to be considered essential.

HSS COVID-19 Essential Surgeries

Effective March 17, 2020

The most senior sub-specialists in all services lines and pain management at HSS systematically and collaboratively defined essential procedures (approximately 20% of care provided by HSS under normal circumstances). Listed below is a “master list” of essential procedures applicable to all service lines, followed by additional essential procedures specific to individual service lines.

All service line essential procedures

  • Any infection, chronic or acute, requiring surgical intervention
  • Any surgical wounds requiring surgical intervention
  • Compartment syndrome
  • Dislocation of native or prosthetic joint requiring reduction in the OR
  • Malignant or benign tumors with impending fracture or neurovascular compromise
  • Fractures (periprosthetic or native bone)
  • Tendon injuries requiring surgical intervention
  • Any loose body in the joint or displaced cartilage causing a locked joint
  • Any injury to the lower extremity where the patient has an inability to bear weight or walk
  • Any vascular or neurologic injuries
  • Any injury where prompt intervention significantly improves outcomes

Adult Reconstruction and Joint Replacement

  • Joint manipulation

Spine

  • Progressive weakness on physical exam or weakness with active denervation on EMG
  • Myelopathy with cord at risk
  • Fracture or trauma with spinal instability
  • Cauda Equina Syndrome

Sports Medicine

  • Peri-articular and avulsion fractures

Pediatrics

  • Pin removal (post fracture or osteotomy)
  • Frame removal
  • Clubfoot tenotomy
  • Guided growth plate removal

Trauma

  • Poorly compensated nonunions (e.g. those that effect the ability to perform ADL’s and/or ambulation)

Limb Lengthening and Complex Reconstruction

  • Nerve decompression in setting of compromised neurologic exam
  • Removal of external fixation
  • Bone grafting of bone transport docking sites
  • Stabilization and correction of unstable limb with deformity

Foot and Ankle

  • No additional essential surgeries

Hand and Upper Extremity

  • Lacerations with critical injury to tendons, nerves, arteries
  • Ligament tears where timely treatment is necessary
  • Brachial plexus or other significant nerve injury or problem

Hip Preservation

  • No additional essential surgery

Memorial Sloan Kettering

  • Any urgent surgery for children under 18
  • Neoadjuvant therapy awaiting surgery
  • Primary sarcomas

Rheumatology

  • Infusions which are required to maintain disease mitigation are considered essential

HSS COVID-19 Surgical and Outpatient Guidelines

Effective March 17, 2020

Surgical guidelines:

In response to the COVID-19 pandemic, HSS will reduce the number of surgeries and procedures performed at its main campus and ASCs in the tri-state area to protect patients and staff and better serve our community as follows:

  1. Postpone all non-essential surgeries and procedures, with allowed essential procedures outlined in detail by service line in separate document
  2. For those patients deemed to require an essential procedure, surgeons and proceduralists will consider the following risk factors to determine course of action, including potentially using more conservative measures in the short term to reduce risk to both patient and clinical staff
    1. Residence outside the tri-state area
    2. Age over 60
    3. Comorbidities, including:
      1. Cardiovascular disease: CAD, atrial fibrillation, HTN
      2. Pulmonary disease: Asthma, COPD, interstitial lung disease, bronchiectasis, O2 dependency
      3. Diabetes
      4. ESRD
      5. Immunocompromised
    4. Need for ICU bed following procedure
    5. Need for SNF following discharge
  3. For any surgeries not on the approved essential surgery list, medical staff will need to obtain approval from their service line chief

 

Outpatient guidelines:

HSS will modify current outpatient operations to reflect surgical guidelines, best serve our patients, as well as provide needed services to the community in light of the pandemic. Changes will be made as follows:

  1. Orthopedic clinics:
    1. Continue in-person clinical visits for new patients being evaluated for an essential procedure or for first postoperative visit
    2. Any acute injuries can be assessed in clinic or OIC
    3. Move all possible clinic visits for new patients to telehealth
    4. Move all possible follow up visits to telehealth
    5. Postpone all joint injections indefinitely, plan to manage with oral medications
  2. Pre-surgical screening:
    1. Move all possible visits to telehealth
    2. Make sure to cancel visits for procedures that are now canceled
  3. Physiatry/Primary Care Sports/Pain management:
    1. Move all possible visits to telehealth
    2. Postpone all joint injections indefinitely; plan to manage with oral medications
    3. Prepare for an influx of low-acuity patients avoiding the emergency department, to be seen primarily at satellite clinics
  4. Medicine:
    1. Cancel all visits deemed to be routine/non-essential
    2. Move majority of visits to telehealth
    3. Cancel all infusions except those deemed essential for the disease mitigation
    4. Consider moving clinic outside of main hospital for immunocompromised patients who must be seen in person
  5. SPU
    1. Postpone all unnecessary interventions
    2. Retain some capacity for infections, catheter removal, and other emergencies
    3. All efforts to manage pain issues should be attempted with oral medication and other modalities
  6. Physical therapy:
    1. Continue PT for all recent HSS surgical patients who require in person PT
    2. Transition all patients who are eligible to telehealth visits
    3. Evaluate all new PT patients via telehealth to assess need and ability to accommodate

Locations for Essential Services

Essential surgeries and postoperative treatments are still taking place at the main hospital. Essential outpatient services at our locations are listed below.

How do I schedule essential care?

Our team is ready to help you find a specialist to provide essential care. If you know who you want to see, please call the HSS clinician's office directly.

If you can be better treated through HSS Virtual Care or another option, we will connect you with the HSS specialist who can best meet your needs.

COVID-19 Precautions

Please note that we are taking extensive precautions to be sure our patients, visitors and staff remain safe during the COVID-19 outbreak. 

  • Appointments are required to allow for COVID-19 screening and social distancing. 
  • Upon arrival for an appointment, patients will undergo a temperature check and a screening about recent travel, illness symptoms and exposure to others with diagnosed or possible COVID-19 symptoms.
  • All sites and HSS staff are equipped with required personal protective equipment.