Thursday, November 26, 2020
Nov. 26, 2020

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UW Medicine to reschedule some procedures; hospitals agree to share surge

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Responding to a surge in COVID-19 caseloads, UW Medicine has decided to postpone surgeries that are not urgent but would require hospitalization afterward, according to an internal email and confirmed by a spokesperson.

UW Medicine’s action comes as Washington hospitals earlier this week reached an agreement on how to handle the ongoing rise of COVID-19 patients statewide — committing to one another that “no hospital will go into crisis standards alone.”

Crisis standards are when hospitals are so overwhelmed they cannot provide the typical standard of care, and they are left to triage resources and decide who will receive treatment and who will be left to die.

The hospitals’ commitment — which expand on agreements reached before the first surge of COVID-19 in spring — says all of the state’s acute care hospitals will make “concrete plans” to scale back on elective procedures as needed, reserve intensive care units for COVID-19 or emergency cases, and readily accept patient transfers from other parts of the state.

It aims to ensure hospitals will work closely with one another and communicate to prevent individual facilities from becoming overwhelmed when others have capacity.

“It’s essentially to try to manage — all across the system — the capacity,” said Cassie Sauer, of the Washington State Hospital Association (WSHA), which convened a videoconference Monday for the state’s hospital leaders. “In the places that have gone to crisis standards, those doctors and nurses, I’m not sure their soul will ever be the same.”

Sauer said hospitals hope to create more slack in the system by collaborating closely together and establishing clear communication. Hospitals must document if they deny the transfer of a patient and inform their chief executive officer if a transfer is denied.

Statewide, as of 4 p.m. Friday, 78% of acute care beds were occupied, according to WSHA. Nearly 84% of intensive care unit (ICU) beds and almost 75% of the ICU beds in airborne infection isolation rooms were in use — numbers higher than two weeks ago.

Sauer said many Washington hospitals, including UW Medicine and Swedish, are beginning to more aggressively scale back on elective procedures.

“All non-urgent patients who need to occupy a bed [post-operation] for any length of time will be rescheduled,” wrote UW Medical Center CEO Cindy Hecker and Harborview Medical Center CEO Paul Hayes in a message to colleagues Nov. 19. The rescheduling will begin Nov. 23 and continue through Feb. 1, according to the message.

Procedures for outpatients and in urgent or emergent cases will continue, Hecker and Hayes wrote.

UW Medicine spokesperson Susan Gregg said the hospital system is “actively contacting” patients whose surgeries will be postponed.

“Each individual case is being reviewed based on medical urgency and whether the patient would need to be hospitalized after the surgery,” Gregg said in a statement Friday.

UW Medicine was caring for 77 COVID-19 patients across its campuses as of Thursday. On Oct. 1, the hospital system was caring for 20.

Dr. Elizabeth Wako, chief medical officer at Swedish First Hill, said during a media briefing on Wednesday that Swedish had “reduced inpatient elective surgeries to allow us to expand urgent and emergent inpatient beds and increase access for COVID-19 patients.”

Other facilities had yet to scale back.

The census of COVID-19 patients within the CHI Franciscan system was rising, said Michael Anderson, the system’s chief medical officer.

“We are not restricting any elective surgeries right now,” Anderson said. “We’re watching our numbers closely.”

State Health Officer Dr. Kathy Lofy on Wednesday said the virus was spreading as quickly as it had in months, that hospitalizations were rising statewide and that she is particularly concerned about “the number of beds occupied in Western Washington.”

Another 2,132 coronavirus cases and 16 deaths were confirmed in Washington state on Friday. The state Department of Health in a Friday news release urged Washingtonians once again to limit holiday celebrations to their immediate household, adding that testing should be reserved for those with recent exposures to COVID-19 or with symptoms of the disease.

(c)2020 The Seattle Times

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