TO: Ballad Health team members
FROM: Ballad Health Corporate Emergency Operations Center (CEOC)
DATE: Aug. 24, 2021
TITLE: Ballad Health to pause all elective/non-emergency procedures
ACTION: Please share with all team members. This memo supersedes all prior memos on this subject. Note link to Elective Surgery Acuity Scale included within memo.
On Monday, Aug. 23, the census of patients being treated as inpatients at Ballad Health for COVID-19 reached 264, with seven of these being children at Niswonger Children’s Hospital. The volume trends are exceeding what had been modeled as a most hopeful scenario, with the census growing a surprising 20.5% just since Friday. Based on current modeling, it is now likely that, without any changes to the trends, Ballad Health could be serving as many as 400 COVID-19 patients within two weeks.
Ballad Health’s highest priority is to provide care that is safe for patients and for team members. Given the limitations on available staffing, it has been necessary to take initial steps to ensure the safest possible environment. Steps previously taken to limit overnight, non-emergent/elective surgical procedures have helped mitigate the impact on our capacity as volumes have shifted from surgical to COVID-19 and other urgent medical admissions. We are grateful for everyone’s ongoing cooperation and input. Unfortunately, as the volumes appear to be growing even more, the strain on the system is such that additional steps are important in order to safely optimize our capacity to absorb the anticipated volumes.
In an effort to prepare for a higher volume than originally anticipated as our “best case” scenario, we must now begin planning for a “worst case” scenario. As we continue to urge mitigation steps in the community, such as vaccinations and indoor masking, we must also take the unfortunate step of further limiting our services. To that end, effective Thursday, Aug. 26, all elective and non-emergent surgeries will be postponed, including already-scheduled procedures. This updates the Aug. 11 pause on all elective surgical cases requiring overnight patient stays at Ballad Health hospitals.
This is a necessary move to preserve much-needed space and staffing. Ballad Health is not furloughing team members, but rather, may ask that team members provide support in various areas throughout the facility in which they work. This will enable Ballad Health to prioritize the most critical and high acuity patients.
To determine which procedures are classified as non-emergent, Ballad Health will continue to follow the Elective Surgery Acuity Scale (ESAS), which was developed by St. Louis University and is recommended by the American College of Surgeons as hospitals and health systems respond to challenges posed by COVID-19.
As examples, postponed procedures will include low-acuity surgeries for healthy and unhealthy patients, including, but not limited to, hernia repair, cholecystectomy, cardiac and interventional radiology procedures, aesthetic and plastic surgeries, podiatric procedures, vasectomies, bariatrics, joint replacements, screening endoscopies and non-essential spine surgery.
The incident command (IC) of each hospital has been working in coordination with their respective chairs of the medical staff, surgery and anesthesiology to seek input and assistance as this decision is implemented. The Chairs will cascade the necessary information to their teams, and surgical offices will need to notify patients whose procedures are being postponed.
The Corporate Emergency Operations Center (CEOC) will reevaluate this decision on an ongoing basis, with the goal of returning to full service as soon as possible. This decision will rely upon information about the spread of the COVID-19 virus and projected volumes, patient demand for urgent and emergent services requiring medical or surgical admission, and available staffing.
Deferring procedures needed by patients is the last possible effort to ensure a safe environment for patients who have urgent or emergent medical or surgical needs. In making this decision, Ballad Health relied upon guidance from the American College of Surgeons, American Society of Anesthesiologists, Association of Perioperative Registered Nurses, and the American Hospital Association, all of whom issued a joint statement in November 2020 that stressed the importance of regional cooperation to address hospital capacity and patient needs, as well as case prioritization and scheduling.
CEOC will keep you informed as the situation evolves.
