Patient confidence is a hot-button topic as the country eases restrictions and moves forward with a phased reopening across all 50 states.
Public trust is critical in any health crisis, but perhaps never more so than in this COVID-19 era. Since the official declaration of a pandemic on March 11th, an analysis by TransUnion Healthcare of more than 500 hospitals reveals that the total visits to hospitals nationwide declined 32% to 60% in visit volumes in the month of March, as compared to overall pre-virus volumes. But now, after several months of this battle, hospitals and providers are cautiously finding their way back to open their doors to non-COVID-19 patients safely and to limit risk of exposure to the virus.
Challenges and all, glimmers of hope keep emerging:
- Touting "points of positive progress," Indiana Gov. Eric Holcomb cleared the way for some medical procedures that had been on hold to start taking place at the end of April, reported WDRB News. Hospitals were advised to start conducting clinical work diagnosing, screening and treating life-threatening medical conditions.
- Minnesota Gov. Tim Walz signed an executive order on May 19th to provide a “roadmap” for safely resuming elective surgeries in the state as early as the last week in May. “Doctors who create a plan to keep patients and healthcare professionals safe may begin offering these procedures,” said Gov. Walz, according to WCCO CBS Minnesota. The decision for elective surgeries to gradually resume includes building up the state’s hospital room capacity and emergency equipment stockpile. State Senator Julie Rosen called the move “Great news for the hospitals, clinics and medical professionals who work to keep us safe and healthy every day.”
- Having faced some of the worst outcomes of the outbreak, New York’s Gov. Andrew M. Cuomo spoke about the progress made on Long Island. He announced that hospitals in Nassau County would resume performing elective surgeries as of May 19th. Rockland County was also given the green light to resume elective surgeries on May 21st. The state has launched a pilot program to allow visitors in specific hospitals on Long Island and a few other areas, reports Newsday. “Increased activity only leads to increased cases if precautions are not taken,” said Gov. Cuomo.
Our current reality is such that people have been hesitant to seek urgent care for strokes, heart attacks and other emergencies. COVID-19 brought on a real fear of going to an emergency room, which itself has been a high health risk. As for those patients anxious for a surgery that was delayed, there’s another looming issue to contend with, which is logistics. The pandemic created potential bottlenecks for care and some patients are now being assigned an ‘urgency score.’ Within these parameters, the surgery type, what resources will be needed and how to spell out a patient’s risk factors all come into play in the scheduling process.
Questions are being raised as we return to elective surgeries and other procedures. This is an ongoing conversation point not only among our clients and providers who staff facilities on short-term and long-term assignments, but also among other medical experts we speak with about next steps. I would guess that the questions being asked among peers, are likely in keeping with your approach:
- Is the patient in pain?
- Is the procedure urgent?
- Is the patient’s quality of life manageable without surgery at this time?
- Is COVID-19 still virulent in the facility’s community and surrounding area?
Of the patients who had an elective procedure deferred, nearly 50% indicate they will only reschedule once they no longer believe there is a high risk of COVID-19 infection or once guidelines advise it is safe, according to the TransUnion Healthcare analysis. But there is also another critical proviso to consider: Patients who were displaced and waiting a month ago for elective surgeries, may no longer be able to wait and will need to be moved up on the list as soon as possible. Further delaying critical procedures comes with a potential price for patients. “If you delay these procedures, that itself can lead to problems and complications,” states the American College of Surgeons.
Instilling Patient Confidence
Patients need assurances to help them gain confidence during these times. To proceed with vital surgeries and non-essential procedures, hospitals around the country are reaching out through social media campaigns and other advertising channels. Many hospitals during the pandemic have adopted a tiered approach to prioritize elective surgeries, reports ABC News. Messaging includes informing patients that once in the operating room, it's one of the safest places to be. As one chief of medicine was quoted by ABC News: "We've always had universal safety precautions for everyone in the hospital and operating room. Now, they are enhanced.”
There are two prongs to the patient confidence issue:
No. 1 What will it take for facilities to create a path forward for patients who seek treatment but are still waiting for their rescheduled surgeries?
No. 2 What kind of a confidence boost will provide reassurance to patients to visit a hospital in our new COVID-19 environment to safely undergo elective surgeries or other procedures?
Getting pending procedures going again will require good communication, having safety protocols in place and other precautions. What will the communication look like? Will social media messages, emails sent to patient mailing lists and website announcements be enough? “Patients want details and they want data,” reports Medical Economics. “This level of detail includes certain highly visible aspects of infection prevention, like the use of PPE and policies and procedures for cleaning rooms and equipment. Ensuring these aspects of care are communicated and are visibly occurring can reduce anxiety in patients and their families.”
“If you delay these procedures, that itself can lead to problems and complications,” states the American College of Surgeons.
Engaging and providing reassurance to patients and their families that it is safe to undergo an elective surgery is being communicated by providers and facilities through statements like this: “Please know that our facility is following all recommended guidance from public health authorities, including best practices for hygiene, infection control and medical professional team health.” Resuming surgeries requires a comprehensive plan. Any plan will have to cover testing, surgery location, infection prevention and more. According to Medical Economics, a plan that also fails to account for patient and family perspectives, can lead to an erosion of trust and patients receiving their care elsewhere.
Patient response has varied, according to a Colorado physician in OrthoSpineNews. “Some people want to get surgeries done ASAP because they have been waiting and are in pain. Some want to have surgery now because they have been furloughed, but still have healthcare benefits. Some prefer to wait and see.”
"We've always had universal safety precautions for everyone in the hospital and operating room. Now, they are enhanced.”
Some Good News
For patients, hospitals and providers, the call to curtail elective procedures in the midst of the rising pandemic back in March was hard hitting on a human and an economic level. But as is the case with each new day, the good news now is that non-emergency procedures are being reopened and scheduled. These include hip and knee replacements, tumor removals and organ transplants, reports CNBC. These procedures represent something that was sorely needed by patients, hospitals and providers.