Hospitals and surgery centers in Santa Barbara County are getting ready to resume performing elective procedures and surgeries, which have been postponed or canceled in the early weeks of the COVID-19 pandemic response.
Some local facilities expect to start scheduling procedures next week.
So-called elective procedures range from medically necessary and time-sensitive to optional, and the most urgent surgeries have been happening all along, medical professionals say.
Local facilities feel ready to resume more elective surgeries for three key reasons: Hospitals have not been overwhelmed with COVID-19 patients; they have adequate amounts of personal protective equipment; and they have the capacity to pre-test all surgery patients for the novel coronavirus.
The decision to cancel or postpone elective procedures led to a huge drop in patient visits, and it’s the main reason hospitals have extra capacity to treat COVID-19 patients right now.
COVID hospitalizations have remained steady in Santa Barbara County for the past two weeks — around 40 patients total with 10-15 in intensive care units.
Public Health officials credit the community’s social-distancing efforts with the stable rate and declining number of new cases.
The decision to restart elective procedures will be balanced with a careful eye on hospital capacity.
A large increase in community COVID-19 cases could cause hospitals to stop those surgeries again, said Dr. Scott Robertson of Marian Regional Medical Center.
“One thing we’re watching, as social distancing gets relaxed, we think there will be more cases,” said Dr. David Fisk of Cottage Health. “At some point, it will be relaxed and we will be watching our bed capacity very, very carefully.”
“We certainly think relaxing social distancing would be premature in our community at this point,” he added.
“I think it’s important that people understand the fact that medical institutions started to lighten up is way different than declaring everything is OK,” said Dr. Kurt Ransohoff of Sansum Clinic.
Plans to Restart Scheduling Elective Procedures
Most local medical facilities halted their elective procedures in mid-March, around the time the statewide stay-at-home order was issued.
Cottage Health, which operates hospitals in Santa Barbara, Goleta and Santa Ynez, has been doing some elective procedures for cases that “just can’t wait,” but plans to schedule more of them starting next week, said Fisk, head of its infectious controls and prevention who also works as an infectious disease physician there and at Sansum Clinic.
“When we go for that, and if we do May 4, we’ll be doing so in a very, very cautious fashion, not going back to our previous, full-bore, full capacity,” Fisk said.
Individual surgeons at Cottage will determine which of their cases are handled first, using guidelines from professional organizations such as the American College of Surgeons, Fisk said.
“Say for example some tumors that have been put off, that would have to go sooner and would take higher priority over other cases, such as surgeries for bariatric weight loss,” Fisk said.
As of Monday, Cottage Health was conducting novel coronavirus screening for everyone who is admitted to its three hospitals, and it will be testing all patients who come to the hospitals for an elective procedure.
“That’s a major expansion of testing and we have to make sure we have adequate supplies for that. And we have to make sure staff members are healthy enough to do this, too,” Fisk said.
Sansum Clinic, which operates a network of primary care and specialty clinics in southern Santa Barbara County, will start rescheduling surgeries at half of its usual capacity next week.
The organization furloughed about 500 employees when it halted elective procedures and some patient visits in mid-March.
“We’ve been open, of course, the whole time, so we’ve even been doing surgeries during this time, but we’ve only been doing things that are really emergent, cancer surgery or a broken bone or in excruciating pain or a bad infection; We stopped all the truly elective stuff,” said Ransohoff, CEO and chief medical officer of Sansum Clinic.
“The standard we’ve been using is, if something bad were going to happen in the next two months if we don’t do it, then we just do it.”
Sansum’s surgeons make decisions on which procedures to schedule first, along with the surgery center medical director, anesthesiologists, and administrative staff, Ransohoff said.
“We would start to do essential but not urgent surgeries. If someone has a bad cataract and can’t drive at night, that case we would not have been doing, but we may start to do that sort of thing.”
Sansum Clinic staff will test surgery patients for the novel coronavirus a few days before the procedure is scheduled, so results come back in time.
In the North County, Marian Regional Medical Center also plans to start scheduling more elective procedures in early May.
Robertson, the chief medical officer for Dignity Health’s Central Coast Division, described elective surgeries being considered as medically necessary, time-sensitive procedures, not optional ones, such as some cosmetic procedures.
“Currently we have an adequate amount of PPE. Obviously as we continue to do more cases in the hospital, our consumption rate will increase,” he said. “If we get to the point we are not comfortable with how much resupply we’re getting, we may have to dial back the number of cases we’re doing.”
An increase in the number of COVID-19 cases in the community could also cause them to postpone elective cases again, due to hospital capacity concerns, Robertson noted.
Marian will use a governance committee — including surgeons, hospital-based clinicians and anesthesiologists — to decide which surgeries move forward.
The hospital plans to test all incoming surgery patients for the novel coronavirus.
“If it’s a positive test, if the case can be safely delayed, then we would delay until the resolution of their illness. There are cases where we may not be able to safely postpone them,” Robertson said, adding that the test result is important to know for provider safety and patient care.
Marian’s emergency department has seen a 50-percent drop in patients recently, and doctors are worried people with serious medical issues are afraid to go to the hospital, Robertson said.
“Some of it is related to the shelter-at-home, and people not going out and doing things are then less likely to get hurt, but certainly for clinicians, it’s concerning that patients are afraid to get the care that they need and they really shouldn’t be,” he said.
“All of our facilities, we have extraordinary precautions in place, so when patients come to our hospitals seeking care, they are not exposed to COVID-19,” he said. “All of our hospitals are safe to go to if you’re having a medical emergency.”
Lompoc Valley Medical Center stopped performing elective surgeries and procedures on March 20, and plans to restart in early May and “ramp up as soon as possible thereafter,” CEO Steve Popkin said.
The facility will be conducting COVID-19 testing for all patients having elective procedures at the facility, he added.
— Noozhawk managing editor Giana Magnoli can be reached at gmagnoli@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.
