Elective surgeries are resuming in hospitals and surgery centers across Tennessee Monday, May 4, which will give physicians and case managers an enormous relief and a fresh challenge.

“It’s easy to burn a barn down; it’s not so easy to build it back up,” said Dr. Richard Aycock, chief of staff at Methodist Le Bonheur Healthcare. “That’s kind of what we are doing.

“Stopping it was easy. That was flipping a switch.”

Lee: hospitals can resume elective surgeries Friday

Baptist testing every patient admitted to its hospitals

Aycock is a member of a three-person team at Methodist guiding the reopening with advice from a larger cross-disciplinary team. It requires a plan to fit every one of its hospitals – “We are one Methodist,” he said – and that can expand and contract as COVID cases in the community rise or fall.

Most of the medical experts advising the Shelby County COVID-19 Task Force expect an uptick in the number of new virus cases as business begins to reopen, starting today.

For Aycock and dozens of other hospital administrators, the challenge will be weighing – in the moment – and for days going forward – the number of new cases against hospital beds, ventilators and the supply of personal protective equipment and keeping it all in balance. For instance, some surgeries require vastly more PPE – personal protective equipment – than others.

“We’re going to start slow,” Aycock says. “Anywhere between 20 and 50% of our capacity, depending on the procedure.” Every day, the planning team, which includes Methodist Le Bonheur CEO Michael Ugwueke and Dr. Carl Sanchez, will look at a dashboard of the statistics, adjust the controls and remember to breathe as the system takes the first steps to return to normal while the pandemic still thrives.

Late Friday, Methodist announced it was also reinstating well-patient visits across its system.

Baptist Memorial Healthcare is in for a similar exercise as it ramps up today, starting at about 50% of where it was three months ago in elective surgeries.

“We will judge our capability to carry through with the demand, and we will also be monitoring for any sign of infection or outbreak,” said Dr. Paul DePriest, executive vice president and chief operating officer.

“We are testing every patient admitted and every patient that is going to undergo a procedure, particularly an invasive procedure, within 48 hours of surgery.”

Every surgical center and hospital has an internal way to get quick-turnaround tests or has made arrangements with local labs and tried out the plans last week. Without a negative test, no elective surgery may proceed.

At OrthoSouth and Campbell Clinic, two of the largest orthopedic practices in the region, surgeons are expecting longer than normal workdays to get through six or more weeks of delayed surgeries.

“We’ve got painful knees and hips. We’ve got people having trouble with moving around. We’ve got shoulders and back problems. It’s an extensive list,” said Kim Jenkins, OrthoSouth CEO.

“We had our hands tied, and we understand why,” he says, ticking of a list of precautions clinics have had to institute to see patients since early March.

“We’ve scheduled time between appointments to allow time for cleaning and distancing. We’re screening everyone in our facilities – patients, employees, vendors. We’re taking temperatures, asking screening questions at the door, everyone, every time.

“No one has brought a dog or a pet in, but if they did, we’d screen the pet,” he said.

On top of these measures – there will be social distancing in waiting rooms, face coverings for everyone and strict limits on visitors – surgery centers are adding more regulations to perform operations. 

“In addition to what the governor and his oversight commission ordered, we have seven other regulatory oversight bodies we have to comply with,” said Dr. Fred Azar, chief of staff at Campbell Clinic, holding an official-looking sheaf of papers in his hand.

“We went through all these documents and basically formed a policy and procedures plan. It’s like a narrative which goes through every phase of the patient experience when they come to see us.”

Included are the number of minutes that must elapse – for airflow safety – after one patient leaves and the next is brought in. There is a rule that patients bring their own pens to register and in certain cases, the one family member allotted per patient may no longer see X-rays and other diagnostic results in the waiting room.

“We may actually call the family member,” Azar said. “It just depends on the situation.”

The rules are predicated on the reality that a positive case could pass undetected through all the testing and screening.

Methodist, Baptist and the other hospitals in the city have been performing urgent and emergency surgeries through the pandemic, including in emergencies, on COVID-positive patients.

Adding elective surgeries means more people in hospitals, part of the reason that Baptist last week started testing every patient coming in the door.

About the same time, it also notified its 300,000-plus patient base that elective surgeries would resume.

“We’re asking them to re-engage with their physician about when it would be safe to resume more normal and elective surgical care. Those conversations have gone very, very well,” DePriest said.

“About 75% are following the advice of their physicians and are willing to move forward with procedures in a time frame that is acceptable.”

Still, he expects that at least through July, elective surgeries will be about half what they used to be at Baptist.

“I would say the greatest limiting factor has been the patients and their families, together with their physicians and the whole health community that has really stopped and taken measure of what is the best thing to do today,” he said.

“Those discussion are what is going to drive the volume of surgery that gets scheduled and gets carried out in the next two weeks, month, two months. People are making intelligent decision based on how much risk they want to put themselves under in the face of a COVID pandemic.”