March 18, 2020

'What's really elective?': Hospitals are cancelling surgeries to prepare for coronavirus patients

Daily Briefing

    U.S. hospitals are at the center of the country's novel coronavirus outbreak, and many are pushing back surgeries and cancelling clinical rotations as they prepare for an influx of patients with COVID-19, the disease caused by the virus.

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    Background

    As cases of COVID-19 continue increasing in the United States, health experts are concerned that U.S. hospitals—especially those at the center of outbreaks—will not have enough staff, equipment, or beds to treat an influx of patients with the disease. According to an infectious disease specialist with the University of Nebraska Medical Center, U.S. hospitals could see around 4.8 million admissions due to COVID-19, the Wall Street Journal reports.

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    In response to that concern, CDC is recommending that hospitals in counties that are experiencing a high volume of COVID-19 cases—such as counties in California and Washington, as well as New Rochelle, New York—cancel and reschedule all non-urgent procedures as needed. US. Surgeon General Jerome Adams on Saturday also recommended that hospitals "consider stopping elective procedures" so they can reserve their equipment and workforce to address COVID-19.

    Hospitals across US reschedule non-urgent surgeries due to COVID-19

    Now, facilities such as Brigham and Women's Hospital, NewYork-Presbyterian, the main facility of the University of California-San Francisco (UCSF), Massachusetts General Hospital (MGH), and certain health systems in Seattle are postponing non-emergency surgeries in order to free up beds, doctors, and nurses to treat COVID-19 patients and to protect existing patients from infection.

    In New Rochelle, NewYork-Presbyterian delayed elective procedures across 10 hospitals on Friday after seeing an increase in COVID-19 patients.

    Meanwhile, Arooj Simmonds, co-executive medical director of surgical services at Swedish hospital system, said officials on Friday decided to postpone elective procedures at its Seattle-area hospitals. "We have rooms, but if we don't have staff, we can't admit a patient to the room," Simmonds said, adding that nurses and doctors who typically work in ORs will be moved to areas where they are needed.

    In California, UCSF's main hospital last week started deferring elective surgeries that require a hospital stay. John Roberts, a transplant surgeon at UCSF, said the hospital is letting surgeons decide which procedures to postpone while officials continues to monitor the facility's number of COVID-19 patients.

    The University of Washington School of Medicine (UW Medicine) on Monday also started deferring elective procedures, though Eugene Yang, a cardiologist and professor at UW Medicine, said determining which procedures can be deferred sometimes can be difficult. "What is really elective, versus what can be postponed? In cardiology, that's a very difficult thing to answer," Yang said.

    In-person medical trainings canceled

    Hospitals in areas with COVID-19 outbreaks also are cancelling clinical rotations for nursing and medical students in an effort to protect students from contracting the disease and to preserve facilities' dwindling supplies of protective equipment for clinicians, Kaiser Health News (KHN) reports.

    For instance, Kaiser Permanente on March 5 temporarily discontinued student clinical rotations for nurses in its 21 medical centers in California. Adventist Health and Dignity Health, two other California-based health systems, also cancelled their nursing rotations this month.

    Because of the cancellations, nursing schools in Northern California are scrambling to find new rotations for their students, according to KHN.

    Educational groups have warned that the cancellations could be severely disruptive for students. In a letter sent to the Board of Registered Nursing, more than 60 officials from community colleges and nurse training programs in California wrote, "Many schools in California are experiencing serious clinical displacement. The effects of the lost clinical hours will be devastating to the students we serve."

    Still, schools in many other states are following suit. The University of Arkansas for Medical Sciences on Thursday immediately ended clinical rotations for students, and other universities—including the University of North Carolina School of Medicine, the University of Pennsylvania, and the University of Minnesota, also have temporarily suspended their clinical rotations.

    "We are in unprecedented times," said John Prescott, chief academic officer of the Association of American Medical Colleges, noting, "Medical education hasn't faced anything quite like this since the beginning of the second World War" (Evans/Mathews, Wall Street Journal, 3/16; Ostrov, Kaiser Health News, 3/17).

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