Hospitals Resume Scheduled Surgeries, But Closely Watch For 2nd Surge
Throughout the coronavirus pandemic, hospitals in California have postponed scheduled surgeries, like tumor removals and heart valve replacements, to keep beds and staff available.
But now that the curve has flattened and some restrictions are being lifted, hospitals in the region are gradually rescheduling those procedures, while still trying to stay ready for another surge. Some hospitals are still weighing the decision to bring surgeries back.
Dr. Stephanie Hall, chief medical officer at Keck Medical Center of USC, said the decision to resume a limited number of elective surgeries and procedures last week was complicated.
"Everybody is struggling: 'When is the right time? When is it safe? When is it ethically feasible?' Because there's not only the public health demand, but there's also the issue of individual needs," she said.
While the procedures are often referred to as "elective," Hall said they're medically necessary. The term refers to surgeries that can be scheduled in advance.
"It may not be highly critical to do at a certain time, but it's a necessary surgery in order to cure the problem," she said.
She told us that Keck Medical Center made the decision to resume elective procedures after monitoring the number of COVID-19 cases in L.A. county, the number of COVID patients the medical center was treating, and the amount of personal protective equipment such as masks and gowns.
The decision to conduct surgeries can change at any moment. Hall said decisions will be made on a daily basis.
"If there is a rapid transmission rate going on in the community, that's really not the right time," she says.
But resuming surgeries is a complex task.
Patients are required to test for COVID-19 at least three days before their appointment, and if they test positive, must reschedule. Keck Medical Center is expanding its hours to increase social distancing, while keeping the same overall number of patients. COVID-19 patients and staff who treat them are on completely separate floors, and even use separate elevators.
AT OTHER HOSPITALS: DOING SURGERY, WATCHING FOR A SURGE
The UC Health system, which includes UCLA hospital, announced last week it would gradually resume non-emergency procedures, but warned that resuming services doesn't mean the pandemic is over.
"The potential for a surge of critically ill patients with COVID-19 is still a reality throughout the state, said Dr. Carrie L. Byington, executive vice president of UC Health, in a recent press release. "UC Health's medical centers remain vigilant for a shift in conditions and are ready to quickly respond as needed."
Cedars-Sinai Medical Center says it's resuming non-emergency surgeries and procedures, and prioritizing patients based on medical needs — for example, performing surgeries on patients with cancer and heart disease, and on orthopedic patients who are in pain.
SOME HOSPITALS STILL OPTING OUT
While Gov. Gavin Newsom announced on April 22 that scheduled surgeries can resume, not all hospitals have restarted them just yet.
Kaiser Permante told us in a statement Monday it's looking forward to resuming "non-urgent and elective" services "as soon as feasible," and that the majority of their current surgeries are for "urgent and emergent conditions."
L.A. County's Department of Health Services, which runs LAC+USC, UCLA-Harbor, and other county facilities, told us in an emailed statement they're in the process of devising a plan, but have not yet resumed elective surgeries.
"DHS will resume surgeries in high-priority services first, and open to other services gradually with singular focus on patient and staff safety," a spokesperson said.
As aspects of stay-at-home orders begin to lift, doctors and hospital administrators are concerned about what can happen next, and if hospitals will start to see more COVID-19 patients.
As Hall, of Keck Medical Center put it: "We're all very concerned about a second surge. We have to be prepared to say, okay, we're going to go back and pull back a little bit in order to stay safe."