Many hospitals have had to delay elective procedures during the pandemic to make sure there are enough beds and providers available for the surge of COVID-19 patients. Staffing shortages and other administrative concerns can also lead to the delay of non-urgent care. But elective procedures tend to be some of the most lucrative and delaying them can lead to lost revenue.
The nurses at Brigham and Women’s Hospital in Boston, MA say the facility isn’t complying with state orders to delay elective procedures and are asking regulators to investigate. They say the hospital is scheduling non-essential procedures, like tummy tucks, ahead of more urgent procedures, such as those for broken bones and brain surgery.
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The complaint was filed on behalf of the Massachusetts Nurses Association, a union that represents 3,500 nurses at Brigham and Women’s. The union told the Department of Public Health that the OR remains as busy as ever, but administrators are prioritizing non-essential care, a clear violation of the state’s rules regarding elective procedures.
“We don’t see any action by the hospital at all to try to curb elective surgeries,” said Trish Powers, an OR nurse who chairs the union bargaining committee at the Brigham.
We feel extremely overwhelmed, not just the nurses, but physicians, technicians — everybody is so overwhelmed. We’re understaffed and have way too many patients,” she said.
Hospital officials say they are complying with state regulations regarding elective procedures, which went into effect on Nov 29.
The rule says hospitals need to reduce “non-essential, non-urgent scheduled procedures” by 30%. Gov. Baker asked facilities to cut those procedures down even further, by as much as 50% as long as they don’t harm patients. However, the rule only applies to surgeries that require patients to stay overnight in the hospital, not outpatient procedures where patients go home the same day.
Gov. Baker said the rule is designed to help facilities deal with a lack of staff as well as a surge in patients with all kinds of medical conditions, including COVID-19. As of last weekend, there were 1,355 patients hospitalized with COVID-19 in Massachusetts, up more than 200 patients in just a week.
Elective procedures aren’t always optional, but they are rarely time sensitive. Most elective procedures are scheduled several weeks or months in advance. They can include routine procedures for cancer patients and those with other serious conditions, as well as joint replacements and hernia repairs. In some cases, delaying these procedures can lead to pain and other health complications.
Hospitals generally have some leeway in deciding when to delay certain procedures.
Lori Schroth, a spokesperson for the hospital, said Brigham and Women’s is complying with the mandate and decides which procedures to postpone based on criteria developed by a group of experts, including doctors and nurses.
“We are carefully balancing against the need to avoid contributing to the wave of patients that we are now seeing who require more intense care as a result of previously deferred care,” said Schroth. “We are also closely monitoring our patient volume and making decisions on a day-to-day basis that ensure we are doing everything possible to meet the needs of our community.”
Dr. Ron Walls, chief operating officer at Mass General Brigham, which is a part of the same health network that includes Brigham and Women’s, said the hospital is currently delaying around 15 procedures a day to comply with the rule.
Surgeons say they are also changing inpatient procedures to outpatient procedures if the patient can go home safely the same day.
But Powers says the hospital needs to do more to lighten their load. She said the hospital is often so crowded after surgery that patients sometimes have to wait for a bed where they can recover.
“If you’re going to do elective surgery, you need to know the patient has a bed after surgery,” she said.
Officials at the Department of Health confirmed that they received the union’s complaint and are currently reviewing it.
Other hospitals are delaying more elective procedures that the mandate requires. For example, Tufts Medical Center reduced scheduled procedures by 70% this month and said it’s stopping all non-urgent procedures if they can be safely delayed.
“At this time, we are postponing cases through the end of the calendar year but will be carefully watching the situation and will adjust that date to earlier or later based on the inpatient demand,” said chief operating officer Diana Richardson.