Some hospital systems located in states that are seeing huge spikes of COVID-19 are continuing to perform elective procedures and developing strategies to avoid a total shutdown.
The experiences of hospitals in states such as Florida and Arizona could inform how systems will handle new surges of COVID-19 cases, especially if a second surge of the virus arrives in the fall. Hospitals have been reticent to shut down surgical procedures, which are pivotal to their bottom line and also impact patient care.
“We are not turning it all the way off,” said Marjorie Bessel, M.D., chief clinical officer for Banner Health, referring to elective procedures. "Our surgeries are needed and medically necessary and people need to have those surgeries done."
The 28-hospital system has a large footprint in Arizona, which is experiencing a major spike in cases. Bessel said 45% of Arizona COVID-19 patients are in a Banner Health facility.
Like many states, Arizona’s governor required hospitals to shutter elective procedures to ensure there is enough capacity and personal protective equipment (PPE) for COVID-19 patients. The governor lifted the shutdown May 1, and Banner has slowly ramped up delayed or canceled elective procedures.
“We attempted to reduce the backlog of people who had been waiting or wait-listed,” Bessel told Fierce Healthcare. “We didn’t quite get back to full normal operations, but we got close.”
That progress has been hindered now as COVID-19 cases soar in the state.
But instead of doing a full shutdown, Banner is implementing a tiered and step-wise approach to surgeries.
“One of the things that we are going to try is to do surgeries for patients that don’t need an inpatient stay,” Bessel said. “We are gonna try that and see how that works for us.”
The system is also tightly monitoring the patients that need an intensive care unit stay after their surgery. Banner can transfer patients to other facilities to ensure it has enough capacity.
“We look at our [patient] census almost hourly throughout the day and the night and make these adjustments to best meet the needs of those in the community,” she said.
Tampa General Hospital in Florida resumed elective procedures back in early May and is still performing surgeries as COVID-19 cases rise. The hospital told Fierce Healthcare that it treats COVID-19 patients in a “negative-pressure unit that is separate from other areas of the hospital.”
The hospital has 81 of these rooms and 100 hospitals and has a surge plan to adjust capacity when necessary.
Another important factor for hospitals is to communicate with patients about what is going on. Tampa General, for instance, issued a release on when it is appropriate to go to the emergency room and outlined the procedures for screening patients of COVID-19 to assuage fears.
Hospitals’ own internal processes have also gotten better amid the COVID-19 pandemic.
“In the operating area, COVID-19 has made us more efficient,” said Michael Zinner, M.D., CEO of the Miami Cancer Institute, which is part of 11-hospital system Baptist Health South Florida. “It has taught us how to move things out of the general operating room into ambulatory and more efficient in the turnovers. It has taught us how to adapt.”
Some states could decide to shut down elective procedures again, which is a move Texas has decided to make in four counties in the state.
Getting and keeping enough PPE
One of the key reasons that states ordered hospitals to shut down surgeries was to preserve enough PPE for COVID-19 care.
But hospital systems say they are in a better place now in terms of PPE than they were at the onset of the pandemic, when a buying spree caused hospitals to fight among each other to get supplies.
“We are a heck of a lot better than we were two months ago,” Zinner said.
He added that Baptist Health even bought a stake in a domestic PPE manufacturer, a move Banner Health made as well.
“Besides the current spike, we were preparing for what we think will be a surge in the fall,” Zinner added.
Another important development for hospitals now is there are guidelines for how to reprocess PPE.
“We have found ways to reprocess some PPE safely so you can reuse it without losing efficacy and take it through a decontamination procedure,” said Michael Calderwood, M.D., an epidemiologist at Dartmouth-Hitchcock Medical Center in New Hampshire.
He pointed to using ultraviolet light and hydrogen peroxide as among methods facilities can use to reprocess their supplies.
The type of PPE that is used in surgeries is also sometimes different than the equipment used to treat COVID-19 patients, Bessel said.
“They use a procedural mask for most of the cases, while the masks in shortage has been the N-95 respirators,” she said.