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Since mid-March, elective surgeries, defined as those procedures that are planned but not urgent or emergent, have been on hold.
This month, hospitals across Illinois slowly will phase them back into their schedules, with most starting May 11, per state guidance. Hospitals emphasized they would use an abundance of caution as they open up elective procedures.
That includes patients being tested for COVID-19 at least 72 hours before surgery, followed by a self-quarantine from the day of the test until the day of surgery.
Dr. Robert Payton is vice president and chief medical officer for Edward-Elmhurst Health, which hasn’t performed elective procedures since March 17.
Starting May 11, Edward Hospital will begin performing some of the more urgent elective procedures that can be done on an outpatient basis, Payton said.
For instance, a screening colonoscopy won’t be included, but a diagnostic colonoscopy might be, if the patient has a medical need for one. Procedures will be "gradually phased in,” he said.
“We’re not opening up all 18 operating rooms. But right now, we’re looking at opening up 30% to 50% of our operating rooms. We have to make sure you have enough PPE for staff. And we also have to make sure we are providing a safe environment for the patients coming into the hospital.”
If a patient tests positive for COVID-19 before the surgery, the procedure will be pushed at least 2 weeks.
“We want to make sure the symptoms are completely resolved,” Payton said.
On the day of the procedure, patients will be screened again by questionnaire and have their temperatures taken. If there are any signs of illness, the procedure again will be rescheduled, he said.
“We can’t afford the risk to the patient.”
The Illinois Department of Public Health recommended canceling all elective surgeries to decompress the health care system during the COVID-19 response, and to prevent potential exposure to the virus.
In late April, Gov. JB Pritzker said, “Because we are bending the curve, surgicenters and hospitals will be able to begin scheduling surgeries that had been delayed so we could maximize statewide capacity for COVID patients. Facilities will need to meet specific criteria including proper PPE and ensuring enough overall bed and ICU availability and testing of elective surgery patients to ensure COVID-19 negative status.”
Cathy Foes, marketing director at Perry Memorial Hospital in Princeton, said Perry will bring back outpatient procedures before inpatient procedures are considered.
The hospital will follow IDPH recommendations by having doctors determine the necessity of the surgery before it’s approved. The patient then will have a choice whether to proceed with the surgery.
When elective surgeries were put on hold in March, health care providers who worked with endoscopy procedures at Perry were shifted to conduct its COVID-19 screenings.
They now will be rotated back to endoscopy, and some workers who were furloughed or who opted to take paid time off will be brought back to the hospital to fill in for the screenings, Foe said
The state also could decide to put elective procedures back on the shelf.
Experience during the pandemic has shown that a regional health system becomes seriously stressed when regional bed or ICU availability drops below 20%, the IDPH said.
Therefore, all three of the these resource conditions must be met:
• Hospital availability of adult medical/surgical beds exceeds 20% of operating capacity for adult medical/surgical beds
• Hospital availability of ICU beds exceeds 20% of operating capacity for ICU beds
• Hospital ventilator availability exceeds 20% of total ventilators
If any of the three are not fulfilled, then elective procedures are not permissible, the IDPH said.
So, just because Edward Hospital will start scheduling some elective procedures doesn’t mean it won’t postpone them again.
“I’d like to stress we’re always monitoring our COVID situation in the community and in the hospital,” Payton said. “If we see a large surge of patients being admitted, we may have to scale back.”
What happens on May 11
CGH Medical Center in Sterling said it was targeting May 11 as well, and KSB Hospital in Dixon "expects to allow physician-triaged elective surgeries to increase modestly over the next few weeks in alignment with IDPH guidelines," said Nancy Varga, KSB's director of community wellness.
Hospitals in larger metro areas in northern Illinois also are aiming for May 11.
Two Northwestern Medicine spokespeople said the hospital system would have more communication this week on its procedures, but May 11 was its target date for ambulatory surgeries.
Ruth Colby is president and CEO of Silver Cross Hospital in New Lenox. “We are 100% opening elective procedures on May 11,” she said.
The only procedure Silver Cross won’t perform is screening colonoscopies, because patients aren’t harmed by delaying the procedure for a few weeks, Colby said.
“There are people who have been waiting for joint replacements and other surgeries who have been put on hold for up to seven weeks now."
Of course, patients who test positive for COVID-19 will not be denied procedures if they have an urgent need for them, Colby said.
During the past seven weeks, Silver Cross has performed procedures on COVID-19 patients, but their recovery typically is harder than for other patients, she said.
“Someone who is intubated and in bed ... it’s very unlikely that person will have surgery."
Silver Cross employees also will be screened.
“We are getting thermal scanners put in everywhere,” Colby said. “When employees walk by the scanner, they get their temperature checked. If they have a temperature, it’s unlikely they’ll be able to work.”
Colby wants patients to feel comfortable coming to the hospital for procedures and to understand hospitals have put a lot of safety measures in place.
“The COVID patients have been located in isolation units,” she said. “Our procedural care area has a negative pressure use ... if we have a patient with COVID-19 who needed surgery, one operating room is designed [for] that.”
In an email statement, Timothy Nelson, system director of communications and media relations for AMITA Health, said AMITA has assembled an interdisciplinary team across its health system to begin reemergence planning. This includes restarting essential procedures and surgeries.
“We’re still taking into consideration all factors that will allow us to safely restart nonemergent procedures, such as availability of PPE and COVID-19 tests,” Nelson wrote. “We will not restart these procedures until we know we can best protect our patients, physicians and associates.”
Safety for all those involved in elective surgeries is a paramount issue, including patients who are managing pain from delaying elective but ultimately necessary procedures, he said.
Barb Bortner, vice president of marketing and public relations for Mercyhealth, based in Janesville, Wisconsin, said in an email that the health system hears daily from patients who have had elective procedures delayed because of COVID-19.
Mercyhealth runs Mercyhealth Hospital and Medical Center in Harvard and managed care facilities in Algonquin, Barrington and Crystal Lake.
“Elective surgeries [can] be a variety of things, such as a hip or knee replacement, cataract surgery or even a growth that needs to be removed, to name a few,” Bortner said. “At some point, continuing to delay these surgeries can become unhealthy for the patient.”
They are proceeding in a gradual manner, with “careful thought and preparation” so that these services can be safely performed using appropriate protocols and precautions, she said.
In the email, Bortner wrote that Mercyhealth system has enough staff and equipment to resume elective surgeries and care for hospitalized patients.
“We will continue to closely monitor and manage our PPE."
Moving slowly, to start
Morris Hospital gradually will schedule elective procedures, said Janet Long, public relations manager at Morris Hospital & Healthcare Centers.
“We won’t be able to take care of everybody in the first week; the surgeons are helping to prioritize them,” Long said.
Even though visitor restrictions still are in place, people coming into the hospital for an elective surgery will need someone to accompany them, since patients are not allowed to drive after surgery.
State guidance says visitors still generally should be prohibited, but "if they are necessary for an aspect of patient care or as a support for a patient with a disability, they should be screened in the same way as patient."
“We want to limit, initially, the number of people coming into the facility,” Long said. “But we’re excited, of course.
"We want to take care of our patients and we want people to feel safe coming to us.”
• Ali Braboy, Goldie Rapp, Kathleen Schultz, Cassie Buchman and Denise M. Baran-Unland contributed to this story.