With the leveling off of COVID-19 cases and with hospitals having sufficient beds and ICU capacity to handle other medical procedures at this time, Care New England, Lifespan and other hospital facilities in the state have resumed performing non-emergency procedures.
Dr. James Fanale, president and CEO of CNE, sees the action taken by the two largest health care systems in the state as not only providing a lifeline to the community but also to the two institutions.
As a result of COVID-19, CNE and Lifespan postponed non-emergency procedures, devoting attention to a projected surge in virus cases demanding 6,000 beds. In addition to freeing up space in Kent Hospital in anticipation of the surge, CNE and Lifespan made a full-court press to open field hospitals at the Rhode Island Convention Center and former Citizens Bank offices in Cranston. CNE was responsible for overseeing the conversion of the Citizens Bank space into a 335-bed field hospital in less than two weeks.
So far, neither of the field hospitals have been needed – and not only is Kent caring for COVID patients, but it is now is capable of handling cases that were postponed. CNE estimated 1,000 to 1,200 cases were postponed.
“Kent is safe,” Fanale assured, urging people to use the facility for their medical procedures. He pointed to the high volume of obituaries in local newspapers and suspected some of those deaths may be attributable to treatable conditions, but because people were fearful of COVID-19 they avoided the hospital.
In response to an email inquiring how the hospital would go about resuming non-emergency procedures, CNE said: “We developed a comprehensive plan to reopen surgical services here at Kent keeping patient, provider, and staff safety at the forefront. Our plan has several stages as well as built in trigger points to re-enter mitigation. We asked our surgeons to ‘prioritize’ their cases based on disease severity and clinical symptoms. In our first phase, we are beginning with outpatient surgeries by priority level. In our second phase, we will add inpatient surgery by priority levels. Once the postponed cases have been completed, we will enter the third phase as we return to our routine surgical schedule. We anticipate about 4-6 weeks to accommodate postponed cases. The triggers to re-enter mitigation include PPE supply, hospital bed capacity, ICU capacity, and ventilator capacity.”
Delay of non-emergency procedures and preparations for a surge in the virus have come at a high cost.
According to Joseph Iannoni, executive vice president and CFO of CNE, the system lost $47.6 million in revenue combined for March and April related to COVID-19.
Additionally, CNE said: “All surgical specialties will have procedures that will be done based on priority level. In our first phase focusing on outpatient surgery, cases may include orthopedic knee surgery for pain and impaired mobility, urologic surgery for obstructing stones, or gynecologic surgery for pre-malignant lesions. In our second phase adding inpatients, cases may include spine surgery for symptomatic patients in pain, colorectal surgery for diverticulitis, and gynecologic surgery for women with symptomatic conditions. We will plan to resume routine elective bariatric surgery and plastic surgery during phase 4.”
In addition to following the recommendations of the CDC and the Rhode Island Department of Health for patient safety, CNE listed the following measures:
1. COVID testing for all patients preoperatively
2. Universal mask wearing for all patients, providers, and team members
3. Daily temperature and symptom checks for all team members (providers/staff)
4. Adherence to social distancing measures in the hospital with visual cues
5. Meticulous cleaning processes throughout the hospital
6. For inpatients surgical patients, placement in “Covid-Free” post-operative surgical units
Any hospital staff member who tests positive for COVID-19 is placed out of work, and must meet strict return to work criteria based on CDC and RIDOH guidance.
It was no coincidence that the state’s two largest health care systems announced the resumption of non-emergency procedures at the same time.
Fanale said Lifespan was appraised of the CNE plan and they cooperatively agreed to the plan with state approvals.