Southern Nevada hospitals are postponing surgeries deemed nonessential to conserve resources and make room for patients suffering from the novel coronavirus.
University Medical Center of Southern Nevada began “winding down” elective procedures March 23 in line with recommendations from organizations including the American College of Surgeons, also known as ACS, public relations manager Scott Kerbs said in an email.
“This will assist us in preserving hospital capacity, resources and personal protective equipment,” he said.
The hospital will consider ACS “Tier 1” and “Tier 2” procedures elective, though exceptions will be made under extenuating circumstances. Tiers one and two include low and intermediate acuity surgeries like carpal tunnel release and procedures for low-risk cancers. Most cancers and “highly symptomatic patients” fall under “Tier 3,” which will be considered non-elective under the county-run hospital’s guidelines.
HCA Healthcare also began recommending the delay of surgeries it considers nonessential March 16, said HCA communications manager Antonio Castelan.
The hospital system, which operates Sunrise, Southern Hills and MountainView hospitals in Southern Nevada, will ultimately determine delays on a case-by-case basis. The financial impact on the hospitals as a result of pushing back surgeries is not yet clear, Castelan said in an email.
“It is too early to say, if the postponing of elective surgeries will take a financial toll on our hospitals,” he said. “We have no data presently showing the number of elective surgeries postponed.”
Kerbs said UMC still plans to perform the stalled procedures “when the time is right” and will, once the crisis has passed, “schedule weekend and evening surgeries to help meet demand for elective procedures.”
The American College of Surgeons issued recommendations March 13 that hospitals and other medical facilities “enact plans to minimize, postpone, or cancel elective operations at the current time,” according to a news release. Those delays should last until there is confidence that the national health infrastructure “can support a potentially rapid and overwhelming uptick in critical patient care needs.”
The Centers for Disease Control and Prevention have also suggested health facilities reschedule elective and nonurgent visits as needed.
Whether hospitals follow that guidance is generally up to them, as is the decision of what is considered “elective” surgery. In recent days, however, more than two dozen states have taken action to halt elective procedures as they brace for the impact of COVID-19 cases, according to Modern Healthcare.
“Our recommendations will likely change as we progress through this pandemic,” said Dr. Clifford Ko, medical director for the ACS Division of Research and Optimal Patient Care. “If a place has a lot of cases versus a place that has none, their interpretation of the guidelines will be different.”
While some hospitals have discussed delays of just a few weeks with patients, others in areas that anticipate a greater impact of COVID-19 patients are halting elective procedures for eight to 12 weeks, he said.
The delays are not just to clear out the necessary emergency room and intensive care unit beds for COVID-19 patients.
Across the country, personal protective equipment and other medical supplies are being conserved to help the sickest patients. Putting elective surgery patients in confined spaces with COVID-19 patients also places the surgery patients at unnecessary risk by exposing them to the SARS-CoV2 virus, which causes the disease, Ko said.
Staffing and time management are also a concern.
“‘Elective’ doesn’t mean that it’s not needed. It just means that it can be postponed safely,” he said.
The Nevada Hospital Association is advocating for emergency COVID-19 funding at the state and national levels, but the organization does not have a recommendation on postponement of elective procedures, said Director of Administration and Communications Amy Shogren.
Among ACS’ recommendations is that hospitals “develop a Surgical Review Committee to act as an administrative body to provide defined, transparent, and responsive oversight for triaging surgical cases during the COVID-19 pandemic,” according to a press release issued Wednesday.
Gordon Absher, spokesman for Dignity Health’s St. Rose Dominican Hospitals, said their facilities are following the college’s guidelines.
“Every elective surgical case is reviewed by a multidisciplinary team to assess the urgency of each case,” he said in an email.
Valley Health System spokeswoman Gretchen Papez said via email that the hospital operator is complying with CDC recommendations and working to identify procedures that can be postponed safely.
“This includes cases that require the need for potential blood transfusions since blood components are in serious short supply across the nation and in Southern Nevada,” she said.
A shortage of blood supplies is among a series of complications facing American hospitals as they prepare for patients suffering from COVID-19 disease. Lack of personal protective equipment, the possibility of the disease spreading to health care workers and uncertainty about the supply of beds and ventilators are causing concern among health care workers around the nation but particularly in COVID-19 hotspots like New York and Washington.
A number of Southern Nevada hospitals are monitoring their supplies of personal protective equipment and soliciting donations for new, health care-grade or commercial-grade masks, gloves and gowns as competition increases to purchase the items from suppliers.
As they take additional precautions, HCA, UMC and Valley Health Systems have restricted visitor policies in Southern Nevada and enacted health screenings of visitors. Dignity Health did not immediately respond to requests regarding its visitor policies.
Kerbs said UMC is also enacting a number of other policies including free meal options for team members and first responders, adjustments to staff parking areas and a reduced number of entrances.