Since the first community-transmission of Covid-19 was identified in the United States on February 26, 2020,1 the medical community has experienced an upheaval like never before. Looking to the experiences abroad, urgent steps were taken to reduce surgical cases and preserve inpatient capacity for a potential surge of Covid-19 patients.2 Many patients in need of nonurgent but essential surgical care were delayed those services. At the University of California, San Francisco (UCSF), we recognized the need to avoid adverse outcomes associated with delaying much-needed cancer, cardiovascular, and musculoskeletal procedures. As the chance of a surge decreased, we looked to increase operating room cases.
The challenge for operating rooms is to achieve greater utilization levels to address both the backlog of cases and to serve new patients requiring surgical care. National bodies, including the federal and local governments and professional societies, have made recommendations and even mandates around when and how to resume non–Covid-19-related surgical care,3,4 attempting to ensure that sufficient hospital capacity is reserved for a second surge of Covid-19 patients while upholding provider and patient safety. The latter largely hinges on testing capacity and protocols but, importantly, the nuances of perioperative testing require adaptive changes that may be dependent on a receptive perioperative culture