A major part of Bloomington-Normal’s health care system—elective procedures—will resume this month. But don’t expect to see a flood of pent-up surgeries on Day 1.
Elective procedures can resume May 11, under certain conditions. That’s a big deal, and not only because patients have been stuck waiting. These procedures are a major source of revenue for providers and a key part of what keeps health care running in McLean County.
"We're doing everything we can to make sure this happens in as safe an environment as possible."
“As a physician surgeon, you miss that interaction with all those people. I love my family and all, but 6 weeks at home—that’s a long time,” said Dr. Robert M. Lee, president of Gailey Eye Clinic in Bloomington. “We want to get out there and get people seeing better. That would be a lot of fun.”
You might be surprised at the range of procedures that have been on hold since COVID-19 hit.
At Chalian and Leak Urology Ltd. in Bloomington, the most urgent cancer patients were addressed during the stay-at-home order. But even intermediate-risk prostate cancer patients saw their surgeries delayed, said Dr. Vicken Chalian.
“Obviously, it’s created a little bit of anxiety and stress for those individuals to have their cancer surgeries postponed,” Chalian said. “But we’re explaining to them the situation in their specific disease process, and they’ve been very receptive.”
Chalian’s practice will slowly resume procedures mid-month, while largely staying with telemedicine instead of office visits through May.
VisionPoint Eye Center in Bloomington plans to reopen May 11 and run at about one-third of capacity, said Dr. Daniel Brownstone. VisionPoint will be able to expand the type of semi-urgent patients they can help, including those with diabetic retinopathy or glaucoma, he said.
VisionPoint has a backlog of around 270 patients waiting for cataract surgery, including the unlucky who already one eye done and were waiting on the other when the stay-at-home order abruptly took effect. Cataract procedures are expected to resume May 18 when OSF HealthCare’s surgery center reopens, Brownstone said.
“We’re gonna have dedicated days where all we’re doing is cataract surgery,” he said. “There’s not going to be patients in there getting their gall bladders done. They’re gonna try and separate everything out so they can indeed follow the proper protocols to make sure the patients coming in are safe as can be. And of course they’re gonna be dousing the room with disinfectant between every single patient.”
At Obstetrics and Gynecology Care Associates in Bloomington, most regular exams have been postponed since mid-March without issue. They've also used virtual visits when possible.
But “many gynecological issues only rarely fall under emergent or urgent,” putting many procedures on hold, said Dr. Joe Santiago.
“Let’s say a lady came in with pelvic pain. Now it’s important for her, of course. And that’s where the rub lies. From my standpoint I think that’s pretty important to get to the bottom of those concerns and get to the issues so she feels better. But under these times, that’s not really considered urgent or emergent,” Santiago said. “They don’t really see pain or heavy bleeding as urgent or emergent.”
HOSPITAL AUTONOMY
Santiago noted that hospitals, like OSF St. Joseph and Advocate BroMenn in Bloomington-Normal, still have a lot of discretion about which types of procedures they will allow. Santiago said it’s unclear to him exactly when local facilities will fully open for business.
“They may or may not decide to wait a little longer,” he said. “I’m keeping track of all the folks who do need to have interventions. So once we get the OK, we’ll be able to start making phone calls.”
Indeed, the Illinois Department of Public Health will require hospitals to meet a long list of requirements before resume procedures, including having enough capacity for beds, ICU units, and ventilators. Each facility is asked to convene a “Surgical Review Committee” to oversee how elective inpatient cases are prioritized.
“OSF HealthCare is working on a comprehensive pathway to safely reopen services,” the Peoria-based system said in a statement. “OSF is having planning discussions about its post-pandemic recovery plan, and will ensure those processes are activated at the appropriate time.”
Advocate's primary focus when reopening will be patient safety, said Colleen Kannaday, president of Advocate BroMenn in Normal and Advocate Eureka Hospital.
“We are excited to begin re-activation planning for some of our services as we know there are individuals in the community whose care has been delayed during this pandemic,” she said.
Advocate is continuing its no-visitor policy and requiring face coverings for everyone. It’s also rearranged seating areas and spaced out appointment times to reduce overall traffic.
“Chief medical officers across our system are exploring best practices for meeting the critical needs of patients while maintaining the highest level of safety,” Kannaday said. “We are fortunate in our community that we have had a relatively low instance of cases.”
Another precaution is testing.
All facilities must test each patient for COVID-19 within 72 hours of a scheduled procedure to ensure they don’t have it. After being tested, patients must then self-quarantine until the surgery. (Doctor’s offices say patients will be screened in other ways, but not necessarily tested for COVID-19, during regular visits or exams.)
RETURNING WORKFORCE
The return of elective procedures also brings a lot of people back to work. OSF and Advocate are two of Bloomington-Normal’s Top 10 largest employers. There are more than 9,200 people working in health care and social-assistance jobs, their paychecks putting them squarely in the middle class. Some were furloughed and filed for unemployment.
Dr. Chalian managed to avoid that for his 13 employees, as his practice shifted largely to telemedicine-only services in mid-March.
“They’re all family to me. A lot of them are single moms. And without this job, they would be unable to put on the food on the table, or it would be difficult. We didn’t release anybody. It didn’t even cross my mind,” Chalian said.
For health care workers with children who’ve been off, child care could be the next challenge. Schools and day cares are still closed. There are only around 10 emergency child care options available.
“They really can’t come back yet as a result of that,” said Dr. Brownstone with VisionPoint, which furloughed many employees but is now bringing just about everyone back.
VisionPoint’s technicians will spend next week training on cleaning procedures, so they’re ready to go the week of May 11.
“We’re doing everything we can to make sure this happens in as safe an environment as possible,” Brownstone said.
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