COVID-19 second surge guidance document for hospitals produced

Published: 24/09/2020

Potential impact on planned surgery if second surge is large

Anaesthetists potentially stretched across planned surgery and critical care services  

Even a much smaller surge combined with winter pressures might significantly challenge NHS capacity and resources

The Royal College of Anaesthetists is warning of the impact of a large COVID-19 second surge on planned surgery. This is one of a number of scenarios in a guidance document published for hospital clinical leaders on preparations for a possible second surge of COVID-19, developed in partnership with the Faculty of Intensive Care Medicine, the Intensive Care Society and the Association of Anaesthetists, and endorsed by the Royal College of Surgeons of England.

Suspending planned surgery during the first COVID-19 wave helped cope with the influx of COVID-19 patients. Although essential at the time, it delayed operations, impacting on many people’s health.  The ability to continue providing planned surgery in a second surge will depend this time on the size of the surge, and therefore the availability of anaesthetists, who have a central role in enabling both planned surgery and providing additional support for intensivists in critical care units caring for COVID-19 patients. 

The guidance recommends that clinical leaders in hospitals continue to develop and stress-test staged plans for changes that can be made to increase the availability of critical care facilities while protecting, as far as is possible, planned surgical activity and – importantly – preserving training and promoting the mental and physical health of healthcare workers.

The guidance covers five key categories:  

  • Staff: ensuring that sufficient numbers of trained and well-looked after staff are deployed to cope with medical and critical care activity while preserving planned surgical activity.
  • Space: ensuring that there is sufficient room in hospitals to maintain planned surgery whilst coping with increases in critical care patients.
  • Stuff: ensuring that sufficient equipment, drugs, disposables and personal protective equipment are available, for both planned and critical care activity.
  • Systems: making sure guidelines, protocols and operating procedures used or developed during the first surge are reviewed and, if necessary, updated in preparation for the second surge.
  • Training: ensuring there is minimal further disruption to the training of anaesthetists and critical care doctors.

Professor Ravi Mahajan, President of the Royal College of Anaesthetists, said:

With the number of confirmed cases of COVID-19 rising rapidly, it is key that hospitals prepare now for a second surge. Whilst we were able to provide excellent care for patients with COVID-19 during the first surge, the suspension of planned services had potentially severe consequences for thousands of people, many of whom are still waiting for their treatment.

“In the first wave of COVID-19, the ability of anaesthetists to cross-skill meant that significant numbers were able to move across to support critical care following the suspension of planned surgery. However, to enable planned surgery to continue amidst rising COVID-19 cases, decisions will need to be taken as to the level of planned surgery that will be possible whilst still needing to care for the sickest patients with COVID-19.  

“We must remember that any second surge is also likely to have the backdrop of winter pressures to contend with, as more patients are admitted to critical care during the winter than any other time of the year. The guidance document will help hospitals in their planning and the development of systems that are stress tested. Without preparation, planned surgery risks becoming a ‘house of cards’ that could collapse at short notice if the second surge gathers momentum.

“However, no amount of system planning can account for low numbers of healthcare workers. We know from RCoA membership surveys1 that a large number (64% of respondents) have to some extent suffered mental distress due to COVID-19.  Anaesthetists and other healthcare staff worked incredibly hard during the first wave, and many are still showing signs of fatigue and demoralisation. The NHS must also concentrate on the wellbeing of their healthcare workers - without sufficient numbers of trained and healthy staff, then space, equipment and systems are of little value to patient care.”


1. View from the Frontline of Anaesthesia during COVID-19 – membership surveys