Hospitals with COVID undergo delayed surgery, warning of rationing

Kaiser Permanente is postponing non-urgent and elective surgeries and procedures throughout California as its hospitals – such as the health care system statewide – continue to reel from a massive onslaught of critically ill COVID-19 patients.

According to statements by the Healthcare Consortium, the halt will remain in effect during January 10 in Kaiser’s Southern California region and January 4 in Northern California.

In Southern California, Kaiser is also not scheduling any new elective surgeries through the end of January.

Low-pressure processes need to be pushed back, officials said on Monday, “to respond to current and forecasted growth in COVID-19 cases” and free staff to “focus on supporting COVID-19 care” . “

“Cancer-related surgeries will continue,” officials said in a statement, because “postponing surgery in any situation will negatively impact the patient’s medical condition, including pain.” “

“We understand and recognize the potential for patient concerns, but believe that these necessary steps will help us ensure that we can keep the capacity and staff available to provide high-quality care to our members , While also meeting and preparing for current needs. During this increase the number of COVID-19 patients is steadily increasing, “the Kaiser Permanente Southern California statement said.

The delay process is a tool healthcare providers have at their disposal to de-stress their systems.

The latest, sparse flow of COVID-19 is applying more pressure than ever before.

“Sixteen of our 36 hospitals are already above 100% in our ICU,” Kaiser Permanente President and Chief Executive Greg Adams said during a news conference last week. “We are struggling to add capacity for COVID patients as we speak.”

With some procedures discontinued, statewide hospitals have already been forced to take other steps to combat the crush of COVID-19 patients – such as keeping patients on ambulances for hours until space is available and some patients Transferring what would usually be ICUs to other areas of the hospital.

However, those measures can only go so far, and healthcare officials warn that capacity is limited not just by physical location but by a shortage of trained staff.

“As the number of hospital beds continues to decline, we won’t be able to keep the bus, if the COVID continues to rise,” Adams said.

Should the medical system become overwhelmed and overstretched, officials warn that there may not be enough staff or resources to provide critical care to all those who will greatly increase the likelihood of patients dying.

Under odd circumstances, hospitals may be forced to ration care – doctors no longer have to pull out all the stops to save lives and instead ensure where to most effectively use resources and equipment Do it

Huntington Hospital in Pasadena is now warning of that serious possibility in the information sheet for patients and their families.

Should the situation “reach a point where our hospital faces a shortage that will affect our ability to care for all patients,” officials wrote, then a clinical committee consisting of doctors, a community member, Includes a bio-physician, a spiritual care provider and other specialists “will review the case of all patients who are critically ill” and “make the necessary decisions about allocating limited medical resources based on the best medical information” And will use the same decision criteria that are being used on all patient cases nationally and throughout California. ”

Hospital officials said in a statement on Monday, “It prevents weak bedside staff from making any decisions about triangular care when they lack resources, and instead assigns them to a committee”. “Crucially, no person will make a careful decision, and the committee will not be given any information about the patient’s race, ethnicity, religion, citizenship, insurance or any other information related to the patient’s health.

“As always, we are committed to providing compassionate care for all and wholeheartedly thank our frontline healthcare workers, physicians and staff members,” the statement said.

The worst wave of the coronavirus epidemic is the walls of all corners of California.

As of Sunday, the most recent day for which complete data are available, 19,766 coronovirus-positive patients were hospitalized statewide – an all-time high and more than 45% two weeks earlier.

Of those patients, 4,228 were in intensive care, also a record.

In the face of an already unprecedented number of COVID-19 patients, health officials fear an increase in infections from Christmastime visits and ceremonies.

COVID-19 patients who are now in hospital show coronavirus cases diagnosed two weeks earlier. This means that hospitals are still expected to increase demand in the new year as the transition occurred in early December.

It will take weeks before Christmas to fully assess any outcome, but officials have warned that the health care system may not struggle with another boom that followed the thanksgiving.

Unfortunately, state officials said on Monday that they felt another holiday-fuel spike was likely on the horizon.

“We definitely speculate that a very difficult time is going to happen in our hospitals in mid-January, where cases really start to pile on top of each other from this week and next week – emergency rooms, our hospitals Ward and our influence ICU spaces, ”said Dr. Mark Galy, California Health and Human Services Secretary.

The state imposed strong attacks on businesses and activities earlier this month.

Although a wave of new coronovirus cases has continued since then, officials said the rate of that increase is closing in many areas, along with the number of new coronovirus-related hospitals.

“We are seeing now that most people in the state are experiencing a plateau of new hospital admissions … really starting to see that rate of growth, with one major exception – and that’s Southern California, “Reports of massive infection numbers continue in Los Angeles, Riverside and San Bernardino counties,” Gov. Gavin Newsom said on Monday.

La County, the nation’s most populous, is of particular concern. Hospitals there have already reported severely congested conditions, waiting patients in ambulances for hours and hiring doctors and nurses.

In light of the crisis, Newsom said the state is sending a new team, which will be sent “to LA County” to encourage load leveling and more coordination between hospitals. “

“Routine emergency room care is being slowed down,” Newsom said. “If you think it does not affect you, if you think you are immune to the effect of COVID in some way: it has a direct effect, and it is the transmission of this virus. There is an indirect effect, god no Do you have a stroke or heart attack, you have a car accident or you need other serious care. The impact of this virus, this epidemic, is being felt on the entire hospital system. “

At Los Angeles County-USC Medical Center, the position Chief Medical Officer Drs. According to Brad Spellberg, “mass crisis” reached mode on Sunday evening.

There was not an available bed for at least 30 patients who required intensive or intermediate level care, Spellberg said, and the hospital had to close its doors to all ambulance traffic for 12 hours.

Some patients, including some who were very ill and required intensive oxygenation, experienced waiting times of up to 18 hours.

“We were just completely overwhelmed,” Spellberg said, adding that the hospital is trying to work out a daily, hourly, simultaneous solution to get us through this crisis. “

Conditions at the hospital – one of the largest trauma centers in Western America – have been steadily deteriorating since Thanksgiving, with an average of 10 new COVID-19 patients arriving each day.

As of Monday, there were approximately 240 COVID-19 patients in all areas of the hospital, which, according to Spellberg, was almost double the previous increase in July.

And the expected “Christmas bump” hasn’t even begun.

“When you go to the ICU, and you see every bed occupied by a ventilated COVID patient, there are ducts in all the holes in their body, then you start to understand what we were dealing with 10 months ago. We are not dealing with them, ”Spellberg said.

Four of California’s five defined regions – Southern California, the Bay Area, the San Joaquin Valley and Greater Sacramento – are under a state-issued stay order and subject to restrictions such as reduced capacity in retail stores; The closure of some businesses, including hair salons, nail salons, card rooms, museums, zoos and aquariums; And the ban on most ceremonies, hotel tours and outdoor restaurant stays for dining.

A three-week lifetime is mandatory for orders that are placed in an area when the ICU availability of an area falls below 15%. Thereafter, depending on the expected hospital conditions of a region in the near future, they may be raised.

Southern California and the San Joaquin Valley performed their three-week minimum on Monday. However, as the two regions have reduced zero availability in their intensive care units for more than a week, officials have said they fully expect those orders to increase.

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