Starting this month, patients in about 20 states are being scheduled for their non-emergency procedures like hip and knee replacements, tumor removals and organ transplants, which had been delayed as a result of the COVID-19 outbreak, according to CNBC.
In anticipation, the Centers for Medicare & Medicaid Services (CMS) in April announced a set of guidelines for “Opening Up America Again” including the “ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals.” CMS administrator Seema Verma said at an April 19th briefing of the White House’s Coronavirus Task Force, that hospitals must “be able to screen patients and healthcare workers for the COVID virus, and we need to make sure that patients feel safe when they come in to seek healthcare services…”
As reopening continues, there are still staggering daily death counts and new numbers of COVID-19 cases, making it essential to screen patients for symptoms prior to them entering hospitals and facilities. Resurgence of the virus must be prevented through careful management of social interactions and that includes face-to-face healthcare delivery. Screening of patients and staff will become part of the “new normal” as communities work to address urgent care needs and prevent further spread of the virus.
“Many are Suffering”
“It is important to remember that elective doesn’t mean unnecessary”, said Lisa Romano, RN, MSN, Chief Nursing Officer of CipherHealth, and former ICU nurse. “It simply means it was a scheduled procedure – not unplanned, as in cases that enter through the emergency room. These ‘elective’ patients did not suddenly get better. Many are suffering clinical and emotional consequences as they wait to have their procedure or test. And many have already begun to experience consequences as a result of delays in treatment and diagnostic testing.”
Until that time when the whole country is open, who decides what surgeries and procedures count as “elective,” and how effective are the alternative treatments?
Defining “Elective” Procedures
Texas was one of the first states to roll back restrictions on elective procedures, but is still postponing some that are not deemed medically necessary. As a general surgeon, Dr. Michael H. Kleinman, MD, FACS, at Memorial Hermann SW Hospital in Houston, TX, said many of his surgeries have been put off as “elective” — meaning any surgery that is scheduled. “The various surgical specialties have all issued specific guidelines (available through the American College of Surgeons) regarding which procedures should be put off, and which are acceptable,” he said.
Dr. Kleinman explained that at his hospital, “Chemotherapy is still being done, although there have been delays and disruptions as hospitals converted operations to enhance screening and COVID-19 precautions.”
Unlike Texas, Louisiana is only starting to consider its plans for gradually reopening the state this month.
Dr. Catherine S. O’Neal is an infectious disease specialist in Baton Rouge, Louisiana. While she is working tirelessly on treatment of COVID-19 patients, she is equally as concerned about those patients with chronic diseases and the effect that delays in care are having on these high-risk patients. She told ABC News, “We must continue to care for those patients and not allow another healthcare crisis to develop in those most vulnerable”.
How Effective is Telemedicine as a Replacement for In-person Visits?
While surgeries considered “elective” are still being put off in some states, many doctors are turning to telemedicine to treat, or at least console, their patients while they await surgery.
But how effective is this alternative?
Lisa Romano believes that telemedicine has emerged as a critical offering, not just a nice-to-have option. “Telemedicine is a safe and effective way to provide care for those not requiring hands-on interventions. It also allows for ‘triage’, as the provider determines if each patient’s care needs require hospitalization or can be managed at home. Use of telemedicine ensures patients get rapid assessment, preserves clinical resources for care of the critically ill, and minimizes the risk of exposure for both the healthcare provider and the patient. It does not, however, eliminate the need for face-to-face care and treatment.”
CMS administrator Seema Verma points out, “The reality is that not everything can be addressed by telehealth,” offering breast cancer and cataract surgeries as two examples.
Dr. Kleinman feels treating human patients through a video camera requires a great deal of compassion and empathy, as the ability to lend a comforting touch or facial expression, use eye contact or body language, is greatly reduced if not eliminated completely. “Not all health care providers have the social skills to do this,” he said. “Scripting will help but I don’t know of anyone providing tutorials in how to relate to patients and assess via camera.”
Screening is Essential
As more states begin to reopen, the restrictions on elective procedures will ease and those who have received a diagnosis requiring surgery will be scheduled. In the meantime, in states like New York, “all general hospitals, ambulatory surgery centers, office-based surgery practices and diagnostic and treatment centers (are mandated to) increase the number of beds available to (COVID-19) patients, including by canceling all elective surgeries and procedures,” as defined by the Commissioner of Health.
As the queue continues to build and healthcare resources remain constrained, there could still be further delays in treatment requiring triage, screening and the use of telemedicine.
“Hospitals should be preparing now to reach out to those patients who have had procedures delayed to assess their current clinical state as well as the presence of newly arisen social determinants that may have serious clinical consequences. Use of automated outreach tools to pre-screen patients before they enter the hospital or facility to avoid ‘new peaks’ of the virus is essential,” Romano said.
We at CipherHealth have been proactively working to meet the needs of hospital and healthcare workers during the pandemic with new programs and communications specifically tailored for the crisis — to help those currently being treated for the virus, as well as those whose elective surgeries become rescheduled as the country slowly reopens. Contact us or email us at [email protected]m to learn more.