Hospitals Need to Cancel Elective Procedures: This is a pandemic – No time for business as usual.

Hospitals that continue performing elective procedures during the COVID-19 pandemic are irresponsible and short sighted. In Wuhan, one study showed 41% of new infections were transmitted in the hospital – to previously hospitalized patients and healthcare workers. If we learn anything from colleagues around the world who are forced to ration medical care, it’s that we must act swiftly to minimize unnecessary exposure to our hospitals. Patients will die in this pandemic. So will doctors, nurses and other healthcare workers. Cancellation of elective procedures is an important step to help flatten the coronavirus curve.

As an anesthesiologist and medical ethicist working on the front lines of this pandemic, I’m keenly aware of the ethical dilemmas facing healthcare workers, like never seen in modern medicine. The COVID-19 pandemic will stress hospital resources to their breaking points. This demands thoughtful consideration about resource utilization, saving critical personnel, equipment and protective gear for those who need them most. We cannot allow elective surgeries to use resources that should be saved for critically ill patients. It’s time to preserve as many hospital beds, intensive care beds, ventilators and personal protective equipment as possible. Many hospitals run on very lean supply chains, choosing to maintain only a few days or weeks’ worth of some equipment, like N95 respirators. That means there may not be enough personal protective equipment to go around.

Operating rooms are the economic engines of hospitals across the country and cancelling procedures will admittedly cause a massive financial impact on hospitals. Each year in the United States, more than 53 million elective surgeries and colonoscopies are performed, leading to $472 billion in outpatient revenue to healthcare systems. As a result, some hospital administrators may delay the decision to cancel elective cases, fearing the deep financial impacts this will have on the bottom line. Finances must, however, be a secondary concern. If we wait, it will cost significant human life.

As an anesthesiologist and medical ethicist working on the front lines of this pandemic, I’m keenly aware of the ethical dilemmas facing healthcare workers, like never seen in modern medicine.

Every unprotected patient interaction places healthcare workers at risk for infection, which will pull us off the job. Healthcare workers like me are at unique risk of being infected with coronavirus, especially when performing life-saving airway procedures, like inserting a breathing tube. We must wear extensive protective gear to prevent ourselves from being infected in viral hot zones. Today, most offices and surgery centers are not equipped with suitable gear to screen or test patients who are worried about infection. Data from South Korea, where widespread coronavirus testing has occurred, indicates that an  asymptomatic or mildly affected person who shows up for elective surgery may actually be shedding lots of virus.

We can’t afford to have the healthcare workforce out of commission. That means aggressively reducing exposure to the virus and maintaining adequate personal protective equipment available to each provider.

From babies to the elderly, elective and non-essential surgeries often meaningfully impact patients’ lives or are important for health screening—like colonoscopies. But today, healthy people should stay away from hospitals and doctors’ offices. These cancellations will be devastating for patients who have waited for months and planned their lives around a surgery date. Social distancing, broadly and properly understood, includes delaying truly elective care for a more opportune time – in the future when COVID-19 is under control.

The Surgeon GeneralCenters for Disease Control and the American College of Surgeons agree that all non-essential procedures should be cancelled. Do the right thing and aggressively cancel everything non-essential.

  • Surgeons: responsibly cancel your elective cases.
  • Anesthesiologists and CRNAs: Work collaboratively with surgeons to prioritize needs and refuse to anesthetize elective cases.
  • Hospitals: Be leaders and support this process as fast as possible.
  • Patients: If your upcoming surgery hasn’t been cancelled, call your doctor and reschedule for the future.

We will work hard through the pandemic taking care of critically ill patients. And when the pandemic is over, we will work just as hard to get all these surgeries back on the schedule.

 

Photo credit: A medical tent has been set up outside Norwood Hospital in anticipation and preparedness for patients needing testing and treatment for the coronavirus disease (COVID-19) in Norwood, Massachusetts on March 12, 2020 (Joseph Prezioso/AFP via Getty Images)

 

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About the Author(s)

Alyssa Burgart, MD, MA

Dr. Alyssa Burgart is a Clinical Assistant Professor in the Department of Anesthesiology at Stanford University. In addition to her work as an anesthesiologist, Dr. Burgart is a clinical ethicist, core faculty at the Stanford Center for Biomedical Ethics, Co-Chair of the Lucile Packard Children’s Hospital Ethics Committee, and ethics consultant at both Packard and Stanford Hospitals. Follow her on Twitter (@BurgartBioethix).