Cardiac Surgery
The transition from standard operative practice to complete shutdown of elective cases was immediate in mid-March. Operating room boards were wiped clean as hospital administration scrambled to devise a protocol for triaging which cases would be appropriate to continue as planned and which cases could be safely postponed, minimizing PPE use and maximize available resources. Daily updates were issued reporting number of COVID cases within the healthcare organization, county, and state. Initial projections for the LA county area impact provided an expected two week timeline to exceeding ICU bed and ventilator capacity. During this time, surgical cases were restricted to emergencies only. Aortic dissections and patients with severely symptomatic valve disease were among the only cardiac surgical cases to be performed. Over the following month, the number of COVID patients fell drastically short of predicted. Throughout the state, there was a 62% decline in ED visits in April and a 35% decline in total hospitalizations when compared to previous years. [7-8] Triaging protocols were developed to begin a controlled re-integration of services in the cardiac surgery unit while actively monitoring COVID patient volume, ICU bed capacity, and availability of PPE. In mid-April, surgery services were resumed with team-based decision making on which cases could safely continue to be postponed versus those that took priority to be managed as early as possible. Patients with symptomatic disease have been amenable to proceeding with surgery, however some with asymptomatic disease such as aortic aneurysm have shown hesitation in rescheduling their previously planned surgery. Some changes to the pre-operative process include COVID testing within 48 hours of surgery and the restriction of visitors within the hospital. IPads are used to facilitate patient communication with their family members during their hospital stay, and daily telephone updates to family members, and Facetime communication between the patients and respective family members became part of the new routine.