Elective cases in the middle of a Warzone

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A hospitalist in Austin posted they are out of gowns and they are wearing ponchos. In my new locale people are posting on the local health department social media feed that covid is fake news, a liberal scam and masks are control devices.
I think we are actually back to the I hope we get by stage of healthcare.

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A hospitalist in Austin posted they are out of gowns and they are wearing ponchos. In my new locale people are posting on the local health department social media feed that covid is fake news, a liberal scam and masks are control devices.
I think we are actually back to the I hope we get by stage of healthcare.
Reusable ponchos? This is going to be happening everywhere. At my current place, they don't want you to go from room to room with the same gown which makes no sense since they all share the same illness. Just don't touch anything and change gloves and sanitize between each patient as I have done in multiple other hospitals. Otherwise things will run out.

We are running out of CVC kits, dressings, etc. It is crazy out there.
 
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No one is advocating for replacing critical care trained docs and nurses with OR folks. The question is when there is no locums/traveler pool to being you more people (because they are already working somewhere else that is getting slammed) is it better to just have the staff there take on ever increasing numbers of patients or at some point is another person, even not as well trained, better. You think that nurse currently taking care of 4 critical patients would rather take on a fifth patient than let someone from pacu do their best with him or her? How about the doc who has been working 15 hour days trying to round on all their patients, you think they would rather cover more patients than have an anesthesiologist do their best with a few or at least do some of the procedures so they can get through the day faster?

Untrue. In the spring in New York, they seriously considered it. They had people in the ORs on vents at Columbia and even trialed splitting the vents like how we do for mass casualty events. We had some icu talks and went on icu rounds to start to prepare for managing icu patients before they decided to use us to do procedures instead. They also pulled our vents from the outpatient centers and from the ORs. Instead of using the anesthesiologists to do the notes/orders/day to day management, they pulled a ton of medicine residents from outpatient and elective rotations along with outpatient physicians to take care of covid patients. There were also a ton of nurses from out of state, including nurse practitioners, to do the icu care.

For this current surge, I know of a facility on the west coast where they stopped all elective cases and pulled all the staff for covid duties. Circulators are taking care of covid patients on the floors.

Equipment was tight so we used the same stuff for weeks. I used the same n95 many times in a row and they kept them locked away. I was able to get 2 more and used them in a rotation. I still have the faceshield that was donated by someone in the community. Wiped it down every time I wore it and used it for months. The nurses were hanging up their isolation gowns in the rooms when they were done so they can reuse them. Pumps were kept outside and monitors visible so that they could minimize the time in the rooms.
 
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Untrue. In the spring in New York, they seriously considered it. They had people in the ORs on vents at Columbia and even trialed splitting the vents like how we do for mass casualty events. We had some icu talks and went on icu rounds to start to prepare for managing icu patients before they decided to use us to do procedures instead. They also pulled our vents from the outpatient centers and from the ORs. Instead of using the anesthesiologists to do the notes/orders/day to day management, they pulled a ton of medicine residents from outpatient and elective rotations along with outpatient physicians to take care of covid patients. There were also a ton of nurses from out of state, including nurse practitioners, to do the icu care.

For this current surge, I know of a facility on the west coast where they stopped all elective cases and pulled all the staff for covid duties. Circulators are taking care of covid patients on the floors.

Equipment was tight so we used the same stuff for weeks. I used the same n95 many times in a row and they kept them locked away. I was able to get 2 more and used them in a rotation. I still have the faceshield that was donated by someone in the community. Wiped it down every time I wore it and used it for months. The nurses were hanging up their isolation gowns in the rooms when they were done so they can reuse them. Pumps were kept outside and monitors visible so that they could minimize the time in the rooms.
I mean replacing as in let those docs and nurses go on vacation or just sit at home. Augmenting when there are insufficient resources is what I am advocating.
 
Reusable ponchos? This is going to be happening everywhere. At my current place, they don't want you to go from room to room with the same gown which makes no sense since they all share the same illness. Just don't touch anything and change gloves and sanitize between each patient as I have done in multiple other hospitals. Otherwise things will run out.

We are running out of CVC kits, dressings, etc. It is crazy out there.

Thats crazy, and over here qt my hospital the OB residents and the horde of medical students in tow use a fresh N95 for each OR patient encounter even when the pts are COVID negative. Hundreds of N95 wasted every week just from them.. Ridiculous.
 
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Thats crazy, and over here qt my hospital the OB residents and the horde of medical students in tow use a fresh N95 for each OR patient encounter even when the pts are COVID negative. Hundreds of N95 wasted every week just from them.. Ridiculous.
They can't even keep them for a whole day? You guys must not be in a war zone yet. I have never been in a facility that gave you that many masks in one day. We had to sign out one every three days and swapped.
 
Thats crazy, and over here qt my hospital the OB residents and the horde of medical students in tow use a fresh N95 for each OR patient encounter even when the pts are COVID negative. Hundreds of N95 wasted every week just from them.. Ridiculous.
Jeez. My hospital only recently allowed us to get a new n95 each day (though I scored some of the comfy duck bill kind and have been reusing them until I can't breath well enough anymore rather than use the current version they have in plentiful supply that threatens to erode my nose within an hour or so of use).
 
Untrue. In the spring in New York, they seriously considered it. They had people in the ORs on vents at Columbia and even trialed splitting the vents like how we do for mass casualty events. We had some icu talks and went on icu rounds to start to prepare for managing icu patients before they decided to use us to do procedures instead. They also pulled our vents from the outpatient centers and from the ORs. Instead of using the anesthesiologists to do the notes/orders/day to day management, they pulled a ton of medicine residents from outpatient and elective rotations along with outpatient physicians to take care of covid patients. There were also a ton of nurses from out of state, including nurse practitioners, to do the icu care.

For this current surge, I know of a facility on the west coast where they stopped all elective cases and pulled all the staff for covid duties. Circulators are taking care of covid patients on the floors.

Equipment was tight so we used the same stuff for weeks. I used the same n95 many times in a row and they kept them locked away. I was able to get 2 more and used them in a rotation. I still have the faceshield that was donated by someone in the community. Wiped it down every time I wore it and used it for months. The nurses were hanging up their isolation gowns in the rooms when they were done so they can reuse them. Pumps were kept outside and monitors visible so that they could minimize the time in the rooms.

The hospitals that are rationing protective equipment and skimping on personnel are probably (at least in some cases) the same nonprofits that are raking in that Covid money. Gotta make sure that the profits that they are "not" making are still around for the executive's deferred compensation.



 
They can't even keep them for a whole day? You guys must not be in a war zone yet. I have never been in a facility that gave you that many masks in one day. We had to sign out one every three days and swapped.

We (anesthesiologists) are rationing our use just in case supplies run low. I pick up an N95 each day,, and i keep the ones I use. Wr have plenty right now but who knows what the next few months will look. But watching some of these other specialties waste n95 and ppe like it is nothing makes me cringe. This was brought up to the OB leadership already but they continue to do this.
 
The hospitals that are rationing protective equipment and skimping on personnel are probably (at least in some cases) the same nonprofits that are raking in that Covid money. Gotta make sure that the profits that they are "not" making are still around for the executive's deferred compensation.



Great article. American greed at its finest. Cleveland Clinic needing money? I thought they had a VIP suites where Shiekhs stayed in penthouses and paid for everything in gold bars.
 
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We (anesthesiologists) are rationing our use just in case supplies run low. I pick up an N95 each day,, and i keep the ones I use. Wr have plenty right now but who knows what the next few months will look. But watching some of these other specialties waste n95 and ppe like it is nothing makes me cringe. This was brought up to the OB leadership already but they continue to do this.
Ours are still locked up which prevents waste
 
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We (anesthesiologists) are rationing our use just in case supplies run low. I pick up an N95 each day,, and i keep the ones I use. Wr have plenty right now but who knows what the next few months will look. But watching some of these other specialties waste n95 and ppe like it is nothing makes me cringe. This was brought up to the OB leadership already but they continue to do this.

Lock em away. Make them sign them out. I don't routinely use an n95 in the OR unless it's a covid patient. Those idiots are what's wrong with America. The sheer wastefulness of our society will be our downfall.
 
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good discussion.

in the American health care system, forcing a stop to elective surgeries endangers ruining the hospitals without significant government aid. While upsetting, it’s the truth.

I think the hosptial needs to do something for staffing though if it’s really 1:4 for nurses in the ICU.

I can’t wrap my head around why the government isn’t bailing out hospitals.
 
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I can’t wrap my head around why the government isn’t bailing out hospitals.
It is. But the wealthy giant hospital systems that are swimming in money are gobbling up all the money since the government doesn't audit its financials. Just gives them money if they "qualify" for relief. Read the article linked above. Apparently FEMA money is an unlimited, bottomless pit of money of which I don't buy. There has got to be a limit on the money.
 
Our private hospitals got so much more money than the public hospitals that actually need it.
 
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I don't think anyone is saying we couldn't "get by" but I would argue outcomes would be worse than an ICU trained physician running the unit. It's not just tubing people and placing lines. Plus it's not just "keeping people alive" but also having the awareness of when someone is NOT going to live and being able to determine when doing to much is doing to much. There's a reason they do that fellowship and have a board certification.
I’ll disagree with this. I’ve spent a lot of time in the Covid ICU as a resident last year, people just riding the vent for weeks. Fluid balance, vasopressors, sedation, a bunch of Covid treatments that don’t work, paralyze and prone if hypoxia is severe enough. Very boring as a resident, and very sad because there’s nothing really to do to help them.

I don’t buy that your really gonna see any outcome difference with an anesthesiologist or any other physician Esther than an intensivist. I’ll bet there’s an outcome difference from the quality of ICU nurse staffing the unit. Simple things probably make a difference more than anything, good pulmonary toilet, keep the patient clean and free of pressure ulcers.
 
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I’ll disagree with this. I’ve spent a lot of time in the Covid ICU as a resident last year, people just riding the vent for weeks. Fluid balance, vasopressors, sedation, a bunch of Covid treatments that don’t work, paralyze and prone if hypoxia is severe enough. Very boring as a resident, and very sad because there’s nothing really to do to help them.

I don’t buy that your really gonna see any outcome difference with an anesthesiologist or any other physician Esther than an intensivist. I’ll bet there’s an outcome difference from the quality of ICU nurse staffing the unit. Simple things probably make a difference more than anything, good pulmonary toilet, keep the patient clean and free of pressure ulcers.

You’re a lot closer to your resident ICU rotations and studying ICU concepts for your boards than the average anesthesiologist.
 
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You’re a lot closer to your resident ICU rotations and studying ICU concepts for your boards than the average anesthesiologist.

Most of us only go to the ICU to pick up a patient, drop off a patient, or do an occasional procedure. We also like it that way.
 
The hospital is staffed mostly by travel nurses. And they aren’t enough.

Interestingly, this seems to be common amongst academic shops. The entire travel nursing industry really, really needs to be blown up. I have no clue how to end it, but all it does is drive up cost of care dramatically.

Further - why can’t your shop hire perms? Bad culture? Burnout?

Untrue. In the spring in New York, they seriously considered it. They had people in the ORs on vents at Columbia and even trialed splitting the vents like how we do for mass casualty events. We had some icu talks and went on icu rounds to start to prepare for managing icu patients before they decided to use us to do procedures instead. They also pulled our vents from the outpatient centers and from the ORs. Instead of using the anesthesiologists to do the notes/orders/day to day management, they pulled a ton of medicine residents from outpatient and elective rotations along with outpatient physicians to take care of covid patients. There were also a ton of nurses from out of state, including nurse practitioners, to do the icu care.

For this current surge, I know of a facility on the west coast where they stopped all elective cases and pulled all the staff for covid duties. Circulators are taking care of covid patients on the floors.

Equipment was tight so we used the same stuff for weeks. I used the same n95 many times in a row and they kept them locked away. I was able to get 2 more and used them in a rotation. I still have the faceshield that was donated by someone in the community. Wiped it down every time I wore it and used it for months. The nurses were hanging up their isolation gowns in the rooms when they were done so they can reuse them. Pumps were kept outside and monitors visible so that they could minimize the time in the rooms.

This is all still very much common outside of high vent usage. Remember, in the earliest NYC days of the pandemic patients were intubated practically anytime they required more than 4L NC. That contributed to a ton of ventilator usage, and even then they never had to split vents. We should NEVER do that - go grab your crummy rehabbed vent from the plastic surgery office before you do that.
 
Interestingly, this seems to be common amongst academic shops. The entire travel nursing industry really, really needs to be blown up. I have no clue how to end it, but all it does is drive up cost of care dramatically.

Further - why can’t your shop hire perms? Bad culture? Burnout?



This is all still very much common outside of high vent usage. Remember, in the earliest NYC days of the pandemic patients were intubated practically anytime they required more than 4L NC. That contributed to a ton of ventilator usage, and even then they never had to split vents. We should NEVER do that - go grab your crummy rehabbed vent from the plastic surgery office before you do that.

I don't think that's true. There were some patients that we recommended holding off on intubation and going to high flow or bipap before intubation despite people being worried about spreading virus particles everywhere. There were plenty of patients in the obs rooms and ed or stepdown on a ton of nasal cannula that were being observed closely. We were also using decadron in the icu from the beginning.
 
Interestingly, this seems to be common amongst academic shops. The entire travel nursing industry really, really needs to be blown up. I have no clue how to end it, but all it does is drive up cost of care dramatically.

Further - why can’t your shop hire perms? Bad culture? Burnout?



This is all still very much common outside of high vent usage. Remember, in the earliest NYC days of the pandemic patients were intubated practically anytime they required more than 4L NC. That contributed to a ton of ventilator usage, and even then they never had to split vents. We should NEVER do that - go grab your crummy rehabbed vent from the plastic surgery office before you do that.
The traveling nursing industry needs to stay as is. The travel nurses are everywhere. Just like travel docs. The permanent nurses left because they were being overworked, underpaid and underappreciated. And I encourage the ones who’ve stayed to find greener pastures. Meaning more money because it’s crappy everywhere.
Some of these travel nurses have been doing this since NY. They are awesome. Some are clueless.
Traveling creates free market competition.
 
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My hospital lost $300M the first time, there won’t be a second until it’s overflowing, and even then they would only cancel elective cases that are planned admissions. I don’t think the governor has plans to mandate anything. You can’t have hospital systems collapse as well.
That's literally exactly the same thing we're doing, along with not meeting our profit goal for the first time.
 
Interestingly, this seems to be common amongst academic shops. The entire travel nursing industry really, really needs to be blown up. I have no clue how to end it, but all it does is drive up cost of care dramatically.

Further - why can’t your shop hire perms? Bad culture? Burnout?

4:1 ICU patient:RN ratios - nobody will put up with that for less than travel nurse wages

Travel nurses are fine to fill gaps in staffing, but any nursing manager that relies on them to staff their unit should probably be replaced.
 
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This country's priorities are ****ed up. Counting pennies over healthcare while spending hundreds of billions freely for defense projects.

The billions for defense projects enable the fed $ printers running.
 
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He is totally right. Our military supremacy is what keeps the hegemony going. People put assets in the dollar because they know that if you f with America you will get jacked up. We don't keep military bases running all over the world for free. Look at how we just took a crap on Saddam Hussein just to maintain the petrodollar. This allows for us to print money for free while maintaining the trust in the full faith and credit of the United States.
 
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That's literally exactly the same thing we're doing, along with not meeting our profit goal for the first time.

And providing care for patients who need their surgeries and procedures. "Elective" Surgery is a relative term. People need to get stuff done for their own health and pain reduction. These patients are coming into the hospital/healthcare in the middle of a pandemic to get their procedures done. They go through covid tests. They really want to have the cases done.

We are in a very high risk area and none of our facilities have had any infection spread within the facility. We are masked, patients are covid negative. Its possible and safe.
 
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Interestingly, this seems to be common amongst academic shops. The entire travel nursing industry really, really needs to be blown up. I have no clue how to end it, but all it does is drive up cost of care dramatically.

Further - why can’t your shop hire perms? Bad culture? Burnout?



This is all still very much common outside of high vent usage. Remember, in the earliest NYC days of the pandemic patients were intubated practically anytime they required more than 4L NC. That contributed to a ton of ventilator usage, and even then they never had to split vents. We should NEVER do that - go grab your crummy rehabbed vent from the plastic surgery office before you do that.

I often wondered why they wouldnt just pay some out of work person 15/hr to stand there in PPE and squeeze an ambu bag every 5 seconds.
 
And providing care for patients who need their surgeries and procedures. "Elective" Surgery is a relative term. People need to get stuff done for their own health and pain reduction. These patients are coming into the hospital/healthcare in the middle of a pandemic to get their procedures done. They go through covid tests. They really want to have the cases done.

We are in a very high risk area and none of our facilities have had any infection spread within the facility. We are masked, patients are covid negative. Its possible and safe.
It is relative in the sense that if something goes wrong during the surgery (which it always can) you want to know that patient has somewhere to go. If the ICU is running at capacity and the ER is boarding ICU patients then the elective surgery is, relatively, completely elective because now you are trying to have life/death compete with pain/suffering. As an ICU doc it infuriates me to see them bringing elective valves and CABG in to our overstuffed ICU while I have to go round in the ED on a patient I cant get proned because they dont know how/have the right bed for the second day in a row. Absolutely disgusting.
 
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I often wondered why they wouldnt just pay some out of work person 15/hr to stand there in PPE and squeeze an ambu bag every 5 seconds.
Back in the day when there weren't enough iron lungs to go around for polio patients, that's exactly what they did ... with medical students. Who presumably didn't collect $15/hour but rather paid tuition. :)


The 1952 Copenhagen poliomyelitis epidemic provided extraordinary challenges in applied physiology. Over 300 patients developed respiratory paralysis within a few weeks, and the ventilator facilities at the infectious disease hospital were completely overwhelmed. The heroic solution was to call upon 200 medical students to provide round-the-clock manual ventilation using a rubber bag attached to a tracheostomy tube. Some patients were ventilated in this way for several weeks.
 
It is relative in the sense that if something goes wrong during the surgery (which it always can) you want to know that patient has somewhere to go. If the ICU is running at capacity and the ER is boarding ICU patients then the elective surgery is, relatively, completely elective because now you are trying to have life/death compete with pain/suffering. As an ICU doc it infuriates me to see them bringing elective valves and CABG in to our overstuffed ICU while I have to go round in the ED on a patient I cant get proned because they dont know how/have the right bed for the second day in a row. Absolutely disgusting.

So you'd rather have them come in with fluid overload and stemis? I'm not sure what you're complaining about. Those OR cases pay your salary.
 
It is relative in the sense that if something goes wrong during the surgery (which it always can) you want to know that patient has somewhere to go. If the ICU is running at capacity and the ER is boarding ICU patients then the elective surgery is, relatively, completely elective because now you are trying to have life/death compete with pain/suffering. As an ICU doc it infuriates me to see them bringing elective valves and CABG in to our overstuffed ICU while I have to go round in the ED on a patient I cant get proned because they dont know how/have the right bed for the second day in a row. Absolutely disgusting.

While I get the sentiment and frustration, I wouldn't have picked CABG/valve replacement as a hill to die on regarding "cases that should have stayed home."
 
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So you'd rather have them come in with fluid overload and stemis? I'm not sure what you're complaining about. Those OR cases pay your salary.
Ok, how about the spine fusion or TKR on the BMI of 45? We all know that’s gonna help them get on the treadmill and lose some weight to get to a healthy BMI. Because their bad knees and spines keep them from winning the 10km.
Yup, that will do it. That’s urgent.
 
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While I get the sentiment and frustration, I wouldn't have picked CABG/valve replacement as a hill to die on regarding "cases that should have stayed home."
Well there are some that will likely do fine waiting a month (which may be enough to be out of the crisis mode time or may not be depending on what else happens).
 
So you'd rather have them come in with fluid overload and stemis? I'm not sure what you're complaining about. Those OR cases pay your salary.
Im not talking about the cases coming in to the ER in failure, I am talking about the 3v disease found on a routine LHC in a guy who has symptoms but has never been hospitalized with good heart function.

Also I would stay away from the idea that another specialty subsidizes any other. The reimbursement system we live in is demented and it makes absolutely no sense that a hospital would lose money when it is full of sick people actually taking care of them. I can only imagine there will be some kind of reckoning down the line when we understand the fallout from all of this. Not to mention the cardiac surgeons might pay some of the ICU nurses but I have yet to see a dime from them.
 
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While I get the sentiment and frustration, I wouldn't have picked CABG/valve replacement as a hill to die on regarding "cases that should have stayed home."

We’ve had the same cabg booked and rescheduled for the past week because of no icu beds.
 
And providing care for patients who need their surgeries and procedures. "Elective" Surgery is a relative term. People need to get stuff done for their own health and pain reduction. These patients are coming into the hospital/healthcare in the middle of a pandemic to get their procedures done. They go through covid tests. They really want to have the cases done.

We are in a very high risk area and none of our facilities have had any infection spread within the facility. We are masked, patients are covid negative. Its possible and safe.

We’ve had several patients contract Covid in the hospital while recovering from their surgery as inpatients.
 
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We’ve had several patients contract Covid in the hospital while recovering from their surgery as inpatients.
Well whomever decides to have an elective surgery in the middle of the worst pandemic in our lifetimes ought to think about this.
Now those patients could die. Hope they weren’t the usual morbidly obese knee and spine cases.
 
Im not talking about the cases coming in to the ER in failure, I am talking about the 3v disease found on a routine LHC in a guy who has symptoms but has never been hospitalized with good heart function.

Also I would stay away from the idea that another specialty subsidizes any other. The reimbursement system we live in is demented and it makes absolutely no sense that a hospital would lose money when it is full of sick people actually taking care of them. I can only imagine there will be some kind of reckoning down the line when we understand the fallout from all of this. Not to mention the cardiac surgeons might pay some of the ICU nurses but I have yet to see a dime from them.
Maybe this will change reimbursements down there line. Who knows?
While I get that the ORs are what keeps hospitals in the black, I really can’t imagine that other departments don’t bill and collect enough to pay for themselves.
But that is the sentiment I get on this board as I have been told it repeatedly.

Let me ask a COO I know how this works at his hospital.
 
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So you'd rather have them come in with fluid overload and stemis? I'm not sure what you're complaining about. Those OR cases pay your salary.

We should probably separate the facility fee from the professional reimbursement when talking about how salaries are paid. If I submit a 99291 critical care H&P with 30 min of CC time on a patient with Medicare or BC/BS it might have a total unit reimbursement value of $200-$300 depending on the region (and that's before talking about CC procedures or time spent beyond 30 min). Multiply that by 15-20 pts per day and you can see how some of these facilities are able to pay outrageous CCM locums without necessarily subsidizing from other service lines.
 
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We’ve had several patients contract Covid in the hospital while recovering from their surgery as inpatients.
In what kind of timeframe? The ones I have seen have become symptomatic in a time frame that suggests that their negative test pre op might have been a false or they picked it up right after (they are tested 4 days preop and asked to stay home afterward but I doubt everyone complies). If it is later than a week postop then I would consider hospital acquisition more likely.
 
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In what kind of timeframe? The ones I have seen have become symptomatic in a time frame that suggests that their negative test pre op might have been a false or they picked it up right after (they are tested 4 days preop and asked to stay home afterward but I doubt everyone complies). If it is later than a week postop then I would consider hospital acquisition more likely.
Agreed on the false negatives. I have had a fair amount of people show positive symptoms/finally have a positive test pod 1-2, even in places where they require 2 negative tests for surgery like the NIH. Hell, one pt recently came in with a viral myocarditis with 2 negative tests and active respiratory symptoms with a positive contact in the household and finally had a positive test the day AFTER getting placed on ecmo.
 
In what kind of timeframe? The ones I have seen have become symptomatic in a time frame that suggests that their negative test pre op might have been a false or they picked it up right after (they are tested 4 days preop and asked to stay home afterward but I doubt everyone complies). If it is later than a week postop then I would consider hospital acquisition more likely.
I had one who was hospitalized for 2 weeks after a trauma, negative on admit then got hypoxic and had a positive 2w later. Maybe negative on admit and had just gotten it with 2w delay until sx, how can you know though?
 
Well whomever decides to have an elective surgery in the middle of the worst pandemic in our lifetimes ought to think about this.
Now those patients could die. Hope they weren’t the usual morbidly obese knee and spine cases.
With the amount of community transmission, is it really that much riskier coming into the hosptial. At least in the hosptial everyone is masked. Still many parts of the country where people aren’t wearing masks.
 
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Have people in the pain clinic that don’t want to come in for opioid script. Am I to believe they just never leave their house to buy groceries, shop, work, etc? But coming into the hospital for 30 mins for a quick office visit is too much?
 
My point, I don’t blame people for getting their surgeries done. Not like people are getting TKAs for fun. Maybe now is a good time for them to get it done, who knows what will happen in the future, maybe these people won’t have the same health insurrance many months down the road, maybe they’re afraid they’re surgery will get put off for years if they wait, etc.
 
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My point, I don’t blame people for getting their surgeries done. Not like people are getting TKAs for fun. Maybe now is a good time for them to get it done, who knows what will happen in the future, maybe these people won’t have the same health insurrance many months down the road, maybe they’re afraid they’re surgery will get put off for years if they wait, etc.
I guess I would ascribe to this idea if they also accepted that any life threatening complications resulting in a need for icu care would lead to them being brought to the er directly from the or and triaged behind the people who didn't choose to get sick instead of being guaranteed a spot in the ICU.
 
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I guess I would ascribe to this idea if they also accepted that any life threatening complications resulting in a need for icu care would lead to them being brought to the er directly from the or and triaged behind the people who didn't choose to get sick instead of being guaranteed a spot in the ICU.
This is what would happen for any outpatient surgery center cases I do that go bad. Has made me very selective about what cases I will do there.
 
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In what kind of timeframe? The ones I have seen have become symptomatic in a time frame that suggests that their negative test pre op might have been a false or they picked it up right after (they are tested 4 days preop and asked to stay home afterward but I doubt everyone complies). If it is later than a week postop then I would consider hospital acquisition more likely.

One was several days postop from valve repair. We are an older hospital with few private rooms. It was assumed he got it from his roommate who was initially Covid negative. The patient and his roommate were both initially negative. Then the roommate became positive and placed in isolation room. Then the postop heart became positive. Another was a trauma patient who was longtime icu player. He initially had several negative Covid tests, then positive 3 weeks into his hospital stay.

We’ve also had many who were initially negative and then become positive within the first few days of their admission. We assume those were community acquired, not hospital acquired.
 
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