By Ed Stannard With virus slowing, hospitals performing elective surgeries
Now that the peak of COVID-19 hospitalizations appears to have passed in Connecticut, people who have been waiting for nonemergency surgeries are beginning to be seen.
In a health system that was as hard-hit as Yale New Haven Health, with seven hospital campuses from Greenwich to Westerly, R.I., it will take months to take care of all the patients whose procedures were postponed.
For some patients, that will be just fine, because they are leery of going into the hospital until they feel assured they won’t risk exposure to the coronavirus. Ensuring safety for
patients and staff is the highest priority as hospitals turn from caring for seriously ill COVID patients and emergency cases to surgeries that are considered “elective” only in that they safely could be delayed.
Stamford Hospital began heart and vascular procedures, treatments to reduce patients’ pain, and endoscopies on May 13. On May 18, four operating rooms were opened in the main hospital and one at its Tully Health Center. Bridgeport Hospital began elective surgeries this past week.
And the four hospitals and ambulatory care centers of Nuvance Health — Danbury, Norwalk, New Milford and Sharon hospitals, began elective surgeries and endoscopies on Wednesday.
At Yale New Haven Health, the medical staff is gearing up to treat cancer, perform heart bypasses and neurological procedures, along with screenings such as mammograms and colonoscopies, and patients began being admitted last week in some hospitals.
Scheduling the most urgent, non-emergency cases “is an art, not a science,” said Christopher O’Connor, chief operating officer of the Yale New Haven Health System. “While they could be safely delayed in March … time is now more important for them.”
When referring to elective surgeries, “many people would think of cosmetic surgeries and maybe some orthopedic cases that can be scheduled out,” O’Connor said. In fact, the vast majority of cases that could be delayed without threatening a patient’s life or health were put off.
“The reality is that we won’t get to the truly elective cases for probably a couple of weeks … and that’s really tough for the public to understand,” he said.
Cynthia Sparer, senior vice president for operations and executive director of Women’s and Children’s Services at Yale New Haven Hospital, said the hospital’s medical leadership team divided cases into four categories, ranging from urgent to routine. The highest category included “the patients with the greatest risk, the greatest complexity, the greatest need,” she said.
When it comes to the most routine case, “we had thousands of these patients,” Sparer said. “We’ve already started to see those first categories of patients coming through. It will take us months to get through the backlog.”
Kathleen Silard, president and CEO of Stamford Hospital, said the COVID-19 cases were down to 29 on Friday, from a high of about 150. Once the hospital saw admissions decline for 14 days, had an “effective testing policy” and at least 30 days of personal protective equipment on hand, the staff was able to begin setting priorities for elective procedures, she said.
“We always have to have surge capacity available if, God forbid, there’s a surge in COVID patients,” she said. “We’re doing the things that really need to be done now. But over time we’ll be advancing to a completely elective schedule as the numbers continue to go down and we’re assured that we’re providing a safe environment for patients and our employees.”
Silard said Stamford likely would be back to a full schedule in June.
In order to get to the point of admitting surgical patients, all the hospitals increased their cleaning and safety procedures to provide social distancing for patients
“Everything we’re doing, we’re doing carefully. In our parlance here, it’s not flipping a lightswitch, it’s slowly turning the dimmer switch,” Sparer said. “The byword of everything we’re doing here is safety. Social distancing has to be at the forefront and you can’t achieve social distancing if you’re trying to push through volume at the old rates.”
Yale New Haven Health CEO Marna Borgstrom has said that the health system has lost $1.5 million a day because of additional costs of treating COVID-19 patients and the loss of revenue from elective surgeries, which health insurance covers at a higher rate than medical care.
“We’ve had over two months now of care that’s been deferred,” including open-heart surgeries and “follow-up for people with very complex conditions,” Sparer said.
“At the height of the volume of COVID patients we were seeing, the percent of surgical cases we were doing was 10 to 15 percent of our normal rate,” Sparer said of Yale New Haven Hospital. The hospital is at 30 percent now, “and we can see as we head into midJune that we can get ourselves up to … 50 percent.”
O’Connor said that of the Yale New Haven Health hospitals, “Bridgeport was out of the gate first” this past week, with surgeries and screenings, including colonoscopies. “New Haven is starting in earnest [this] week,” as will Lawrence and Memorial in New London. “Each hospital is having a different ramp-up structure,” he said.
While the most serious cases will get the highest priority, the nature of scheduling the operating room and staff, there may be some more elective procedures, such as knee replacements, that can be squeezed in between. “We’re going to try to fit some of them in,” O’Connor said.
Greenwich Hospital “also began doing radiology, including mammograms [last] week,” O’Connor said. Holly Hill, the hospital’s ambulatory surgical center, started doing screenings Wednesday.
Yale New Haven Health also is opening its freestanding endoscopy centers, including one in Fairfield. Milford Hospital, part of Bridgeport Hospital, “which has been COVID-free for the entire time,” is another site where “we felt most comfortable doing those types of procedures.”
Besides need to catch up on cases where “delaying for too long can create an unnecessary delay in treatment,” O’Connor said, screening exams are important in cases where “we don’t know what we’re going to find.”
He said Yale New Haven Hospital’s “case volume is huge compare to Bridgeport, Greenwich and New London,” which will force more delays. “The other factor here is I think patients are appropriately concerned about coming into health care. There’s a degree of consumer confidence that we have to build back” by creating “a clean, safe environment.”
In order to accomplish that, a lot of the changes have been made in waiting areas and in check-in and checkout procedures, including not requiring a co-payment when checking in. Appointments are made to keep people from gathering in the waiting room. Masks are provided to those who don’t have them. Specially marked parking locations have been created in the parking garage.
All patients are tested for the coronavirus, and the health system is working to have a faster turnaround on tests. Now, Yale New Haven Health sends its tests to the Mayo Clinic in Minnesota, which has a two-day turnaround rate.
“There is a continued high vigilance for any patient who may have come into contact with someone with COVID, so we’re going to err on the side of caution,” O’Connor said.
“Everything requires social distancing,” he said. “We still have a no-visitor policy, which I believe we’re going to have to look at soon.” Now, one person can be with a mother during childbirth and limited visitation is allowed for end-of-life patients.
Silard said Stamford Hospital is using a Xenex system, which uses xenon ultraviolet light to disinfect the hospital, as well as wiping down all surfaces.
One tool doctors and other clinicians have used is telehealth, which “has been important in keeping connections with our patients,” Sparer said. “It can be very vital to keeping communications going.” Caregivers are able to monitor their patients’ health and adjust medications.
Another positive change has been there is less need for medical staff in the intensive-care units to treat COVID-positive patients, O’Connor said. “We’re pulling staff back because we had redeployed some of our operating room staff to help care for COVID patients,” he said. “These staff haven’t been sitting around twiddling their thumbs. … These are some of the most highly trained clinicians that we have.”
Silard said one of two COVID intensive-care units had been returned to general use. “That allows us, of course, to safely ramp up the procedure and surgery schedules,” she said.
All the hospital officials encouraged anyone who needs hospital care to arrange to be seen.
“Don’t put your health on hold. We’ve put extensive measures in place to promote safety and the patient experience,” said Dr. Jeffrey Nicastro, Nuvance Health’s chairman of surgery, in a news release.
“Our staff adheres to a comprehensive screening process for all patients, which will now include our procedural patients. This includes safely and effectively providing care from arrival to the procedure and through discharge to home or to next-steps care. Our process ensures every step to resuming elective surgeries and procedures is seamless and safe.”
“We’re very concerned about people seeking care,” Silard sad. “We want to make sure that people are getting the primary and preventive care that they need.”