CORONAVIRUS

University of Iowa hospitals to resume elective surgeries following governor's order

'We are prepared'

Medical assistant Shannon Jensen (right) carries a swab for a coronavirus test taken from a patient in their car back to
Medical assistant Shannon Jensen (right) carries a swab for a coronavirus test taken from a patient in their car back to her colleague Katrina Rogers to be bagged and sealed at a temporary pre-procedure screening facility at the Family Medicine Clinic of the University of Iowa Hospitals and Clinics in Iowa City on Monday, April 20, 2020. (Andy Abeyta/The Gazette)
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IOWA CITY — As health care providers across Iowa prepare next week to resume elective surgeries and procedures — curtailed in March by the state’s COVID-19 response — University of Iowa Hospitals and Clinics leaders cautioned Friday it will not mark a return to “normal.”

“I think that we’re heading into a new phase of the COVID epidemic, and I think we’re beginning to understand in Iowa what the new normal looks like,” UIHC Chief Executive Officer Suresh Gunasekaran told reporters.

COVID-19 — caused by the novel coronavirus that has ravaged the globe, accounting for more than 886,200 confirmed cases and 50,780 deaths in the United States as of Friday — is not going anywhere any time soon, he said.

“The new normal is that for a significant period of time, I think we’re going to have COVID in our community, but we’re also going to have to take care of other medical conditions right alongside of it,” Gunasekaran said. “We can’t keep delaying medically-essential services in the name of reserving capacity for COVID. You don’t have to make choices — either/or.”

Shortly after Gov. Kim Reynolds announced Friday that elective surgeries can resume. UI Health Care issued a statement affirming its plans to do so.

“We are prepared,” according to a statement.

The governor’s allowance includes a caveat that hospitals and clinics meet a “stringent list of criteria” before resuming elective procedures and surgeries — like having enough personal protective equipment and a plan for continued COVID-19 precautions.

“Safety protocols we have put in place are a blueprint for how to keep patients safe while providing additional medically-necessary care, including surgeries,” according to a UIHC statement. “Many of our patients from across the state have complex health care needs and should not continue to delay care.”

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The state’s March order to halt elective surgeries has exacerbated the fiscal impact on health care providers, with UIHC reporting surgeries down 75 percent since the outbreak began — contributing to its estimated $45 to $50 million COVID-19-related losses and costs a month.

In Cedar Rapids, Mercy Medical Center, UnityPoint Health-St. Luke’s Hospital, Surgery Center Cedar Rapids and Physicians’ Clinic of Iowa have reported broadening impacts — with the Surgery Center ceasing all operations, and Unity Point revealing a 60 percent drop in surgical volume.

“Our facilities are facing unprecedented challenges and volume declines as a result of the pandemic,” Unity Point spokeswoman Sarah Corizzo said. “Earlier this week, UnityPoint Health announced temporary staffing changes. It was a difficult decision that will affect our operations but one that was needed to continue to meet the health care needs of our community for the future.”

The UI’s Gunasekaran said resuming elective surgeries will help his campus’ bottom line by filling some of operating rooms and its vacant beds — which used to be near capacity on a daily basis. Today, half of the UIHC’s about 850 adult and pediatric beds are open, and the financial impact has been “huge,” Gunasekaran said.

“For most hospitals, surgeries are a significant revenue source — not just because of the revenue off the surgery, but also because that has folks in the hospital,” he said. “This is causing us to lose tens of millions of dollars per month as the hospital stays empty. So I think that there are pretty serious financial implications associated with this.”

The main impetus for resuming the surgeries and operations, however, is best patient care, according to Gunasekaran.

“What we really have seen is patients whose health risks get greater and greater by delaying procedures,” he said. “We see patients that are in such significant pain that you have to prescribe them opioids or other things in order to tide them over for this period of time. And essentially what we’re looking at is this is not an optimal standard of care for the diseases that we’re managing, and by delaying, we are basically worsening the outlook for that patient.”

Gunasekaran projected COVID-19 could persist as a concern for months, if not a year, and Iowa’s health care system must find a new normal that balances the needs of all patients with the public good and hospital finances.

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“I think the mind-set now is, let’s do right by our patients,” he said. “Under normal circumstances, we would never delay these surgeries.”

Gunasekaran said he believes the surgical shutdown was necessary to gauge the state’s preparedness for COVID-19 and ramp up its response capacity. At UIHC, for example, the pause allowed leadership to roll out and ramp up new employee practices, tools and technology including temperature screenings, face shield mandates and virtual health care.

“I don’t think it’s possible to emphasize how hard we have worked. We have implemented so many new measures to make sure that our providers, our employees, and our patients are safe,” he said.

The hospital has, over the past few weeks, rolled out its own COVID-19 testing clinic and lab, expanded treatment and research opportunities and cared for hundreds coronavirus patients without bringing them into the hospital.

As of Thursday, the hospital had 32 COVID-19 inpatients and had admitted a total of 106.

The campus also has gone to lengths to secure and preserve personal protective equipment — which the governor stressed must remain in ample supply.

And Reynolds’ order still advised to delay procedures when possible.

Comments: (319) 339-3158; vanessa.miller@thegazette.com

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