Monday, May 11, 2020 | 2 a.m.
The elective surgeries and regular doctor visits that were mostly limited for the past two months to conserve resources to fight COVID-19 and limit the spread of the virus are expected to soon ramp up in Southern Nevada.
“We’re going to see a wave of noncoronavirus patients coming into ambulatory surgery centers and into hospitals who need surgeries that may require a short hospital stay, said Dr. Daniel Burkhead, owner of Innovative Pain Care Center in Las Vegas. “People have been putting off going into health care facilities for at least the last two months. Now that it’s acceptable to return to some of these treatments, I think we’ll see this wave of patients come in and want to get themselves treated.”
Burkhead specializes in evaluation, diagnosis, and treatment of different types of pain, with conditions ranging from degenerative disc disease to complex regional pain syndrome, all of which may require some sort of elective surgery.
It’s important to note that an elective procedure doesn’t mean it’s not necessary, and if delayed too long, future consequences could be inevitable, Burkhead added.
“We now have a term called 'essential elective surgeries,'" he said. “Although these surgeries might be deemed ‘elective,’ like a hip replacement, you’re not going to die from having a bad hip, but an elderly person that is in need of a hip replacement might require opioids to treat the pain, which may lead to other problems.”
Burkhead said that while he does anticipate a surge in new patients, he worries that some of the more vulnerable patients will continue to put off appointments, fearing for their health and safety as the threat of another eave of virus infections remains likely.
All of that is dependent on hospitals having good separation procedures between COVID-19 and non-COVID-19 patients, Burkhead said.
Hospitals across the Las Vegas Valley reconvened necessary elective surgeries on May 4.
University Medical Center has all the necessary supplies and testing capacity it needs to proceed with medically necessary elective surgeries, spokesman Scott Kerbs said.
“Our world-class health care professionals and support staff will continue to work together to ensure patients receive the high level of care they deserve in a safe, controlled environment,” he said. “As a result of UMC’s proactive efforts to procure vital supplies and expand testing capacity for our community, we now have the ability to help meet the growing need for medically necessary elective procedures in Southern Nevada.”
A joint letter to staff from chief medical officers from UMC, North Vista Hospital, Dignity Health, Sunrise Health and The Valley Health System outlines protocols in treating patients who need elective procedures. They include: testing patients for COVID-19 three days before their procedure, screening hospital staff, maintaining visitor restriction policies and keeping post-operatively admitted surgeon patients in an entirely separate unit from COVID-19 patients.
The VA Southern Nevada Healthcare System is adopting similar protocols. “The safety of all of our patients and employees continues to be our top priority,” said spokesman John Archiquette. “We are currently assessing the best way to expand services in the safest way possible and working on a plan that will consider guidance from federal, state and local governments. In the meantime, we will continue to maximize the use of personalized telehealth, phone consults and wellness checks. We know these services have been a valuable link to our veterans during this challenging time.”
Burkhead said his facility has made a considerable number of changes to procedures and protocols as well, “most of which have to do with social distancing and control of flow through the center itself,” he said. “Most surgical centers and operating rooms are very adept in infectious control measures.”
Still, there are additional measures he’s added to further mitigate the spread of any aerosol kind of transmission.
Burkhead said his facility increased its already ubiquitous cleaning schedule, incorporating new bleach cleaning products into the ambulatory surgery center to ensure every surface is decontaminated.
The rate in which procedures will be done will also be significantly slowed down, he added.
“We’re working at about half the pace that we would normally work at, just in an effort to allow time for disinfection, and to ensure we don’t have more than one patient in the same area at the same time,” he said.
Beyond hospital stays and elective surgeries, these widespread changes extend to typical doctor’s visits as well.
The traditional doctor’s office waiting room also appears to be a relic of the past, with some doctor’s offices removing chairs to ensure there is no more than one person in the room at a time.
“As things start to loosen up and the restrictions get relaxed, we, like many other offices, are looking at what are the best practices to enable our patients to come back in a safe manner,” said Dr. Thomas Hunt, who owns a family practice near Summerlin.
Hunt said he’s altering the way he schedules his appointments, and opting to use telehealth in place of the traditional doctor’s visit when appropriate.
“I know that my surgical colleagues have a large backorder on procedures in surgery and it’s going to take a while for them to catch back up,” he said. “In primary care, there have been patients putting off their care as well, so we’ll just have to do our best to get them in. We’ll just need to make sure it’s safe and in a phased-in manner.”
Even when the virus is eventually contained, Hunt believes there will be some things that are here to stay, particularly in the area of telehealth, which up until now faced a lot barriers in becoming more widespread.
“What we’re seeing now is the government very quickly relaxed on all of the federal regulations that were hindering this and started to reimburse practices continuing to see their patients, even if it was through telemedicine.”
Telemedicine still has its limitations, however, Hunt said, and will never be a replacement to office visits, just an addition.
Moving forward, the challenge will continue to balance the need to mitigate risk of infection with making sure patients get the necessary care they need, Burkhead said, noting that his practice has over 600 procedures among four physicians that have been on hold since mid-March.
To address the backlog, Burkhead said physicians are skewing their schedules to do more procedures and fewer office visits — delegating those to telehealth and physician assistants — until they catch up with the backlog.
“It is a large backlog, and if we’re working at 50% of the pace, then obviously that’s going to create some additional delays, but in our opinion, we feel that the delays in procedures are necessary in providing the ultimate health and safety for our patients and staff.”