Hospitals Delay, Shift Surgeries to Outpatient Due to COVID-19

March 17, 2020 - As hospitals brace for a surge in patients from the COVID-19 outbreak, ambulatory surgical centers and other outpatient care facilities are taking on urgent cases to provide patients with much-needed inpatient care.

The COVID-19 outbreak has impacted over 185,000 individuals worldwide, including 4,600 Americans, according to the latest data from the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University.

But this could just be the tip of the iceberg. Public health experts from the Centers for Disease Control and Prevention (CDC) estimate between 160 million and 214 million people to contract COVID-19 over the course of the epidemic, which could last anywhere from a couple of months to over a year. Up to 21 million of infected Americans could need hospitalization in the worst-case scenario.

The CDC’s calculations are sober news for the healthcare system, which only has about 924,000 staffed hospital beds, per the latest numbers from the American Hospital Association.

In light of the COVID-19 outbreak, hospitals are preparing for an influx of patients needing inpatient care.

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Intermountain Healthcare and the University of Utah Health recently announced that the organizations will start to postpone certain non-elective medical procedures to prepare for an anticipated uptick in hospitalizations for COVID-19.

The organizations stated that the move will not only free up beds within Utah’s medical facilities, but also preserve supplies and make staff available to treat patients with COVID-19.

“While this change may create challenging situations for some people, it is a necessary and appropriate step given the anticipated growth in the number of Utah cases of COVID-19,” the organizations stated.

“This change also promotes social distancing, which is critical to slow the spread of COVID-19.”

The American Hospital Association (AHA) and other industry groups, however, have questioned guidance from the Trump administration calling for hospitals to delay or cancel elective inpatient procedures. The groups wrote in a March 15 letter that hospitals are unclear on what the administration means without "clear agreement on how we classify various levels of necessary care."

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"While modeling predicts a surge of the number of serious COVID-19 cases that will need hospital care, the hospital system must continue to balance the needs of caring for patients with COVID-19 while providing vital services to others in the community who need care," the groups continued. "Our ability to respond to patients must not be prevented by arbitrary directives."

Still many more hospitals will be delaying or canceling elective procedures to create capacity for those impacted by the novel coronavirus, and when rescheduling is not an option, the CDC is recommending that hospitals shift urgent inpatient care to the outpatient setting.

“Shift elective urgent inpatient diagnostic and surgical procedures to outpatient settings, when feasible,” the department states in the interim guidance to healthcare facilities.

Ambulatory surgical centers (ASCs) are one of the outpatient care settings stepping up to the plate.

An official statement from the Ambulatory Surgery Center Association (ASCA) tells ASCs to remain open for elective urgent services

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“ASCs can serve as alternative settings that provide surgical care for those patients who would suffer from a delay, while allowing our local hospital partners to create the incremental capacity needed during these dynamic times,” the organization explained in the statement.

To fill the gap in care created by the COVID-19 outbreak, ASCs should collaborate with hospitals and health systems to coordinate care based on the community’s specific needs, ASCA added.

The association also pointed out on its website that “there has been conflicting guidance about elective surgeries that indicates additional guidance is warranted.” In addition to keeping facilities open for elective surgeries, ASCA is also provided a list of guidelines for “the continuation of urgent/needed care in” ASCs, including assessing and optimizing each patient’s medical and social risk factors for planned surgeries and postponing cases where indicated.

This includes reassessing and reprioritizing all currently scheduled cases and delaying those based on the current and projected COVID-19 cases in the facility and community and when postponing the surgery will not result in “significant medical deterioration or materially impact the patient’s prognosis, morbidity or treatment plan.” ASCs should also make decisions to postpone surgeries with the patient, ASCA advised.

Additionally, ASCA provided the following guidance for ASCs:

• Implement rigorous screening for patients and visitors prior to entering the facility
• Maintain a safe environment for patients, employees, and visitors, including adherence to social distancing recommendations
• Implement enhanced cleaning as directed by CDC guidelines
• Work within the capacity of the supply chain to ensure that hospitals have priority for necessary equipment and supplies

“The ASC community stands ready to work with federal officials, state and local governments, and all our colleagues in the healthcare system to provide needed care during these challenging times,” the association stated.

“As the pandemic progresses, we will continue to assess our approach, in coordination with experts throughout the healthcare system, to best serve the needs of patients and communities.”