Hospitals Curtail Elective Surgeries In Anticipation Of COVID Surge

Hospital Good Sam nurses in scrubs.jpg

Several major hospitals have begun postponing some elective surgeries to make way for an expected influx of COVID-19 patients amid an already record-setting surge of coronavirus cases in Oregon.

Legacy Health, Oregon Health & Sciences University and Kaiser Permanente Northwest are instituting new limits on elective surgeries to clear the decks for additional COVID cases.

Unlike last spring, when Gov. Kate Brown ordered hospitals to halt all elective procedures, this is a voluntary step. It gives hospital administrators flexibility to pick and choose which procedures to perform, helping manage overall capacity without blasting another huge hole in facility budgets.

Oregon’s five major health systems typically move in concert with one another. But the normal unanimity is not apparent in this case. Providence Health & Services and PeaceHealth said they haven’t made any decisions to limit surgeries.

The voluntary action by hospitals is the latest indication that Oregon, which so far has fared relatively well compared to most states, is now bracing for its darkest months of the pandemic. Saying the state is at a “crossroads,” Brown and hospital administrators this week urged Oregonians to help slow the spread of coronavirus while hinting it might become necessary to delay some elective procedures at hospitals.

But in fact, at least one system already had, while another notified doctors Wednesday of its decision to hoard bed capacity.

Legacy Health, which operates Legacy Good Samaritan and Legacy Emanuel medical centers in Portland, hopes to reduce the number of elective surgeries that require a hospital stay by 25%. Outpatient procedures and day surgeries will not be impacted.

“We will monitor the situation and adjust as needed,” Trent Green, the chief operating officer, wrote in an email to doctors and staff Wednesday. “If the number of hospitalized patients continues to grow, we may cancel more surgeries. As hospital volumes lower, we will add back elective surgeries.”

Kaiser Permanente Northwest is similarly implementing a “scheduling pause” at its eastside Sunnyside facilities and Westside Medical Center through Dec. 31.

“We’re seeing a significant increase in the COVID-19 positivity rate, which may result in further constraints to inpatient bed availability through the rest of the year,” spokesman Michael Foley said in an email.

OHSU implemented voluntary restrictions late last week. A spokesperson said officials will determine on a daily basis the maximum number of elective surgeries that can be performed while also maintaining “appropriate capacity to care for all the patients we serve.”

Meanwhile, Providence, the state’s largest health system, has opted not to reduce surgeries – yet.

“Providence did not cancel surgeries today; (it) is not canceling tomorrow (and it) continues to monitor the situation and plan ahead,” Gary Walker, a Providence spokesman, said in an email.

Hip and knee replacements are examples of the kinds of voluntary procedures that will be curtailed at some hospitals under the current plan. Considered sufficiently major, they typically require at least a one-night stay.

If someone is in acute pain because of a bad joint, the surgery would take place, said Brian Terrett, a Legacy spokesman. But if the procedure can be put off, doctors may well be contacting patients about doing just that.

COVID cases have been steadily rising for two months and recently spiked to unprecedented levels in Oregon, averaging 817 cases a day over the past week. It often takes days or weeks for people infected with coronavirus to require hospitalization – and Oregon has already seen active hospitalizations roughly double in the past two weeks, rising to 290 on Wednesday.

Despite the surge, hospitals in the metro area and the northern Oregon coast reported having 39 of 350 intensive-care beds available, and 198 of 1,926 non-ICU beds available. Coronavirus cases currently take up only a fraction of those beds, and hospitals can take other measures to free up additional space.

State health officials warned last month that Oregon could reach capacity in hospitals by mid or late December. But officials during a Tuesday news conference did not address how that projection has changed in the past week, as cases spiked and some metrics suggested Oregon now has one of the highest coronavirus transmission rates in the country.

And yet as the action this week shows, hospital and state officials alike are concerned that the growing surge could quickly jam up hospitals.

Hospitals suffered deep financial wounds last spring when elective surgeries were banned. Some claimed their revenue plummeted as much as 60%. In response, some hospitals cut their workers' pay, laid employees off or put them on furlough.

Procedures like hip and knee replacements are enormous money makers for these operations.

Net patient revenue is still down from normal levels, largely because some likely candidates for those kinds of elective surgeries are avoiding hospitals for fear of being exposed to COVID.

-- Jeff Manning

This story was first published by The Oregonian/OregonLive and is posted here through an agreement involving the sharing of stories related to the pandemic.

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