The Impact of Covid-19 on the Delivery of Services by Surgical Units

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Impact of Coronavirus: The Covid-19 curse has certainly had serious effects on the American health care system. Hospitals have been forced to postpone or cancel elective, non-essential medical, surgical, and dental procedures to preserve resources for treating COVID-19 patients.

According to a recent study published on BMJ Yale, hospital services, such as the surgical department, have suspended non-urgent or elective surgical procedures. These surgeries are those that can be delayed without adverse effects to the patient. The researchers from the University of Calgary, Canada, sought to shed light on the impact of Covid-19 on surgical services during and following public health emergencies. The researchers also tackled the consequences of these changes for both patients and healthcare workers.

Elective and Non-Essential

When Covid-19 landed in the United States last March, the Centers for Medicare and Medicaid Services (CMS) released guidelines recommending postponing or cancelling elective, non-essential medical, surgical, and dental procedures to preserve resources for treating COVID-19 patients. While the guidance wasn’t mandatory and did not define what “elective and non-essential” surgeries were, it was left to the local authorities to choose what services they would curtail.

In the absence of clear instructions on how programs should operate the recommendations to alter surgical service delivery, surgeons and surgical units do not know what to do. Hospitals in Indiana are planning to postpone elective surgeries beginning next week. The state’s governor has the order saying it was necessary to free up hospital capacity amid steep recent increases in serious COVID-19 illnesses. Governor Eric Holcomb said that hospitals were being directed to postpone all non-urgent inpatient surgeries beginning Dec. 16 through Jan. 3.

Overwhelmed and Beyond Exhausted

The state halted elective medical procedures for most of April following the CMS directive, but Holcomb lifted that restriction as concerns eased about the availability of equipment and protective gear. However, Indiana’s hospitals are currently treating more than quadruple the number of Covid-19 patients than they were in September, with health officials worried about hospitals being overwhelmed. Holcomb said:

“Our nurses and our doctors, understandably, are overwhelmed and beyond exhausted […] to go into one of the toughest environments that anyone in our state’s history has had to face on a day in, day out basis.”

For the current study, the scientists searched academic databases and grey literature sources to identify studies that examine surgical service delivery during public health emergencies, including the COVID-19 pandemic. They also looked at the impacts on patients, health workers, and healthcare systems. The team collated and reviewed 132 studies, out of which 111 described reorganization of surgical services while 55 described the consequences of reorganizing surgical services, and six reported actions are taken to rebuild surgical capacity in public health emergencies.

Non-Covid-19-Related Deaths

According to the study findings, the reorganization of surgical services, such as case triage, PPE regulations and practice, outpatient and inpatient care, hospital environment, and workforce composition, had large reductions in non-urgent surgical volumes. Meanwhile, there were increased surgical wait times, impacted surgical and medical training, and adverse patient outcomes, such as increased pain. The team stated:

“Reorganization of surgical services in response to public health emergencies appears to be context-dependent and has far-reaching consequences that must be better understood to optimize future health system responses to public health emergencies.”

While both patients and physicians agree there may be negative health consequences associated with reductions in elective services, physicians seem to have a more pessimistic outlook. A survey of primary care physicians in May found that 38 per cent believed that reduced patient visits during the pandemic will lead to an increase in non-Covid-19-related deaths once the crisis has passed, while 60 percent believed that some patients who avoid going to the doctor now would suffer avoidable illness later.

Fear of Contracting the Virus | Impact of Coronavirus

Some experts have predicted that delays in elective surgery, particularly for routine diagnostic procedures such as colonoscopies, mammograms, and biopsies, could result in a growing disease burden “that surgeons will inevitably need to address.” Among patients reporting skipping or postponing care during the pandemic, just 11 percent said their conditions had worsened as a result.

Patients postpone routine health care for various reasons, including fear of contracting the virus, unemployment or loss of income, and lost health insurance coverage. Fear of the virus will undoubtedly subside when an effective vaccine becomes widely available. Still, the other factors will likely continue to exert an impact on consumer demand beyond the crisis itself.