Triangle hospitals are delaying non-urgent surgeries to prepare for coronavirus
Hospitals and clinics in the Triangle have begun to postpone hundreds of surgeries and procedures to preserve supplies, staff and hospital beds for the coming fight with coronavirus.
The region’s three largest hospital systems — Duke Health, WakeMed and UNC Health — are all contacting patients to reschedule procedures that are not considered urgent. They say they’ve established criteria for assessing each type of surgery and are consulting with each patient’s physicians to determine what can wait and what can’t.
“The spread of COVID-19 in our state requires that we serve as good stewards of our resources and become very judicious with our supplies that will be needed for our physicians and staff to care for very sick patients,” Dr. Wesley Burks, UNC Health’s CEO, said in a written statement. “No surgery or procedure will be postponed that would cause harm to the patient if it is not done within the next four weeks.”
The delays can cause anxiety for patients. Betty Raynor Davis of Lancaster County, South Carolina, is scheduled to have surgery for her hyperparathyroidism at Duke University Hospital in Durham in two weeks and is worried it won’t happen. The condition causes several health problems, including renal failure, and she says her surgeon has told her they shouldn’t wait.
But after Davis saw through a Facebook group that other hyperparathyroidism surgeries were being canceled elsewhere in the country, she called Duke on Thursday. The woman she talked to had good news.
“She said, ‘Honey, we’ve been calling people all morning, left and right, but you’re not on the list.’ It was a sense of relief in a way,” Raynor said in interview Friday. “I am really anxious to get it done, and I’m still fearful that it’s going to be canceled.”
Hospitals across the country are putting off what are often referred to as “elective” procedures to prepare for coronavirus. The N.C. Department of Health and Human Services on Friday requested that starting Monday all hospitals and ambulatory surgery centers suspend all “elective and non-urgent procedures and surgeries,” defined as ones that if not done within the next four weeks would cause no harm to the patient.
Dr. Chuck Harr, the chief medical officer at WakeMed’s campus in Raleigh, prefers to call them non-time-sensitive procedures.
“Nobody is scheduled for surgery they don’t need,” Harr said.
The question is whether they need it in the coming weeks, when hospitals expect to be stretched thin treating coronavirus patients. As of Thursday morning, only three people were known to be hospitalized with COVID-19 in North Carolina, according to the state Department of Health and Human Services, but hospitals and state officials expect that number will rise significantly in the weeks ahead.
Harr said doctors are evaluating procedures on a case-by-case basis, rather than making blanket decisions about certain types of procedures. A gallstone procedure can wait in a patient who isn’t showing any symptoms, he said, but may be considered time-sensitive if the person is in pain. Same for knee replacement.
“If you have trouble getting around, but not a lot of pain, that’s non-time sensitive,” Harr said. “But if you can’t get out of bed, that’s probably time sensitive.”
All three hospital systems say they are notifying patients if their surgery or procedure needs to be rescheduled. They say if patients haven’t heard from their doctor or health care provider they should get in touch themselves before their next appointment.
Postponements have three goals
Hospitals say delaying non-critical procedures will allow them to preserve medical supplies, particularly “personal protective equipment” such as masks, gloves and gowns worn by doctors, nurses and other staff.
Many of those items are made in China, and hospitals say they’re having trouble keeping their stockpiles full. Linda Butler, the chief medical officer at UNC Rex Hospital, said orders for replacements are going partially or completely unfilled in some cases.
“Everyone is trying to be very judicious in how they use their supplies,” Butler said.
But Butler and other administrators say reducing the number of procedures they perform also frees up doctors, nurses and other staff to pitch in when coronavirus patients begin to need hospitalization. Harr said some of WakeMed’s primary and urgent care physicians have already been reassigned to staff its respiratory diagnostic centers, where patients who qualify can get coronavirus tests and treatment.
And finally, fewer patients in the hospitals means more rooms and beds that can be used by coronavirus patients. Rex is creating a special ICU that can house up to 16 critically ill respiratory patients, but Butler says the hospital has a plan for freeing space for up to 83 COVID-19 patients that includes clearing rooms on two floors that would normally be occupied.
“We have a quite thorough plan, should we need it,” Butler said. “We’re hoping we don’t, but we’re prepared.”
Harr said some patients are deciding on their own to delay surgery or other procedures, because they don’t want to put themselves or others at risk.
Davis, whose surgery for hyperparathyroidism is scheduled for two weeks from now, says she’s more concerned about the risks of not having the surgery. She’s 62 and says she and her husband are raising their young granddaughter.
“I want to be around to raise her,” she said. “I would much rather take my chances and have the surgery. It is my greater fear that it would be canceled. I trust our health care system.”
This story was originally published March 21, 2020 at 6:30 AM with the headline "Triangle hospitals are delaying non-urgent surgeries to prepare for coronavirus."
