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Elective procedures at Utah hospitals are back on the table

Working group of hospital administrators will continue to assess how to balance patient needs with health care resources

LDS Hospital in Salt Lake City is pictured on Monday, Feb. 24, 2020.
LDS Hospital in Salt Lake City is pictured on Monday, Feb. 24, 2020.
Kristin Murphy, Deseret News

SALT LAKE CITY — The tumor bulging from the woman’s thigh didn’t constitute an emergency.

Which is why, Dr. Gerald J. Willden explained, when the COVID-19 outbreak hit Utah, the surgery she’d scheduled to remove it was postponed.

“Eventually, she presented to the ER with increasing pain,” said Willden, who told the story in a Zoom press conference announcing how and when hospitals in the state will resume offering elective procedures as of this week. “She and her doctors talked about ways to improve her pain.”

Very quickly, her situation became one that doctors felt compelled to act on because she was suffering. And, as another doctor pointed out, “Patient pain matters.”

Cases like the woman with the tumor illustrate how difficult it has been for doctors to grapple with what constitutes an “elective procedure” after the state opted to place a moratorium on anything that could be considered non-emergent as it tried to conserve health care resources for the surge in COVID-19 patients, while also limiting the exposure sick and otherwise vulnerable people might have with the new coronavirus.

As Utah’s cases look to be on the decline, Gov. Gary Herbert announced a number of ways state officials hope to restart different aspects of the economy, with one of those being other medical procedures that were postponed.

“This does not mean the pandemic is over,” Herbert said in a news conference earlier in the day, “just a step toward recovery.”

As soon as the governor issued an order allowing elective and non-emergent procedures, a group of hospital administrators who’d been part of the Utah Hospital Association COVID-19 Chief Medical Officer work group, which has been meeting on these issues, offered strict guidelines for determining which procedures could go forward and under what circumstances.

Considerations range from assessing a hospital’s supplies, staff and training to whether or not the patient needs extensive hospitalization and supplies.

“What we tackled was a very challenging issue,” said Dr. Michael Baumann, chairman of the group who leads HCA/Mountain Star. “It’s been a pretty contentious about six to eight weeks. ... But now we’ve moved to what is most important — care delayed. This provides a nice path forward.”

Dr. Sam Finlayson, University of Utah said doctors will look at the procedures they’ve postponed, and then begin “contacting those in need of surgery and prioritizing them.”

Willden said that while Utah’s 21 rural hospitals have been spared high numbers of COVID-19 cases, they’ve still had to postpone elective surgeries, and that’s been difficult for a myriad of reasons.

Dr. Sam Finlayson, University of Utah, pointed out that this decision “isn’t just a matter of flipping a switch. We’re looking at our entire process caring for patients.”

The group acknowledges there might be some fear on the part of those who need procedures, and they want to assure the public that hospitals are safe for all patients because of the precautions taken by staff and doctors.

Among the requirements for non-COVID-19 procedures are that patients must submit to a coronavirus test, and only one person can accompany a patient to a procedure or surgery.

“We know patients have suffered for this,” said Baumann. “We have tier-three patients who have gotten potentially worse. This will allow us to safely and effectively take care of them.”

Bauman said if people have put off procedures out of fear like visiting a catheter lab that might check their heart health, they should contact their doctor to see if it’s a good time to deal with any issues.

“We need to remember that pain is a major issue,” Baumann said. And if pain “exists or persists,” doctors need to help patients find solutions.

Dr. Arlen Jarrett, Steward Healthcare, a company that has 40 hospitals throughout the country including five in Utah, said it is known definitively whether harm to patients has occurred because of “delaying cases.”

“The broad answer to that is yet to be determined,” he said. “In four, five, six, seven weeks, we’ll start to see reports of how things look.”

Herbert called the decision to resume elective procedures “common sense” and “rational.” This effort, Herbert said, will “help find a balance to open this part of our economy and not risk the health of those we associate with.”

Utah Hospital Association President Greg Bell noted that the governor’s assertion that allowing elective surgeries and procedures to resume was part of the state’s economic re-start, but said when the group met, their concerns were centered on the safety and health of patients and staff.

“This is a clinically driven decision,” Bell said. Herbert said getting hospitals up and running “as vital parts of the economy. ... This was based on safety.”

Both those involved in the work group and Herbert said this is a situation that will require constant monitoring and communication.

“If we find hospital trends go up and supplies for health care needs go down, we’ll have to make some adjustments,” Herbert said. “We’ll continue to monitor and be vigilant.”

The cooperative effort to solve the unique issues caused by the pandemic were addressed with an equally unique collaboration between hospitals, even competitors.

“It’s truly a Utah moment,” said Dr. Mark Briesacher, Intermountain Healthcare. “When we come together like this. We want to keep moving in a direction of opening things up, keep having conversations.”

Those conversations will continue weekly and will include constant monitoring of admissions, testing availability, and supplies of protective equipment and medicines.

“We have a good plan for going in both directions,” Briesacher said. “I want to reassure everybody, that if we see this increase, where more people are getting sick (with COVID-19), then we’ll go in the other direction.”

He praised the work of public health officials, including those leading health districts and the Utah State Health Department.

“It’s a really important moment for health care in Utah,” he said.

Jarrett said Steward Healthcare, which has nine hospitals in Massachusetts, one of the country’s hardest-hit areas, said its staff members have learned lessons at every facility.

“We’ve seen a significant surge in the past couple of weeks,” he said of New England hospitals. “In some cases, we’ve sent nurses from Utah.”

The lessons they’ve learned, he said, convince him they’re doing the right thing by returning to some combination of business as usual and monitoring the COVID-19 realities.

“We’ve done something that really people haven’t done before,” Jarrett said. “We’ve had some very robust conversations, worked through all of the things they’ve talked about. ... Our surgeons and providers are anxious to get back to serving patients. But we want to do it thoughtfully and carefully. We want to be careful not to undo the things that have taken place because of social distancing.”

Contributing: Wendy Leonard