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.