With extensive testing showing very low COVID-19 infection rates and with many safety measures in place, Stanford Health Care providers are now performing almost all medical procedures, including surgeries, diagnostic imaging and routine screenings.
May 4, 2020 - By Mandy Erickson
After extensive COVID-19 testing and preparations to help ensure the safety of its health care workers and patients, Stanford Health Care has resumed surgeries, diagnostic tests and other procedures that were previously delayed. Nonemergency services had been suspended for seven weeks in response to the COVID-19 pandemic.
The move follows a decision to provide COVID-19 testing for all patient-facing workers. With safety a top priority, Stanford Medicine leaders began offering testing two weeks ago; since then, more than 11,000 of 14,000 employees have been tested and only about 0.3% of those without symptoms have tested positive. In addition, there have been no recorded transmissions of the coronavirus between patients and health care workers.
Given the very low infection rates, a strong supply of personal protective equipment, and the implementation of numerous safety measures, leaders said this is the right time to start treating patients who have been waiting for care.
“Stanford Medicine prepared for the worst, and now we’re ready to resume much of what was put on pause during this health crisis,” said David Entwistle, president and CEO of Stanford Health Care. “We have planned for this recovery and restoration, and I’m confident that we can hit the ground running.”
Entwistle said extensive planning was done to protect the safety of patients and health care workers, and he and other leaders urged those in the community not to delay necessary care.
“As part of our plan to recover, restore and reopen, we’ve had multiple teams working around the clock to define a path towards rapidly scaling and resuming patient care safely,” said Lloyd Minor, MD, dean of the School of Medicine. “I’m pleased that we’re in a position to fully serve our patient population again.”
‘A necessary pause’
Stanford Medicine halted nonemergency procedures on March 13 to prepare for a possible influx of COVID-19 patients. Stanford Hospital, Stanford Health Care – ValleyCare and Stanford Children’s Health have been treating COVID-19 patients and those with needs that could not wait more than 30 days. Stanford Health Care outpatient centers, including the Stanford Medicine Outpatient Center; Stanford Cancer Center South Bay; Byers Eye Institute; and Stanford Health Care, Emeryville, until now have been serving only patients with urgent needs.
While putting normal operations on hold, Stanford Health Care leaders established many new safety protocols, including the consistent use of masks and other personal protective equipment among health care workers, symptom screening of employees before building entry, and testing of certain patients prior to their hospital admission or procedures. Providers also made an important shift to virtual visits, which don’t involve physical contact between providers and patients. Entwistle said that 71% of all outpatient visits are now through telehealth.
‘Ready to resume’
When, as a result of the shelter-in-place and physical-distancing measures ordered by the county, the surge of patients didn’t arrive, leaders looked to the future. Last week, Stanford Health Care staff started rescheduling patient procedures, and this week procedure rooms will operate at about 50% to 60% capacity. Amy Semple, RN, administrative director of operations, said she expects to be back to 100% within about three weeks and noted that providers are now performing all procedures except for cosmetic ones.
“With all the cases that have been waiting, it shouldn’t take long before we’re back to normal,” she said.
Bill Maloney, MD, the Boswell Professor of Orthopaedic Surgery at the School of Medicine, said that about 1,200 orthopaedic patients have had their procedures put on hold since the pandemic began. Last week, staff starting calling them to reschedule their surgeries. About 85% of patients expressed a desire to come in soon, he said.
At his clinic at the outpatient center in Redwood City, which has been gearing up for a return to normal, his staff has organized the schedule so that patients will remain apart from one another. “Redwood City is beautifully designed,” he said. “It’s perfectly set up to encourage social distancing.”
Norman Rizk, MD, chief medical officer for Stanford Health Care, said that health care workers have enough protective equipment to ensure their safety and that of patients. Given that the infection rate of Stanford Health Care workers is very low — less than 1% — “we know that our personal protective equipment is working,” he said.
He added that the hospitals and clinics will continue to keep the new safety protocols in effect: Everyone inside a Stanford Health Care facility will still be required to wear a mask, visitors will not be allowed, all appointments that don’t require a physical exam will be conducted via video or telephone, and health care workers will have their symptoms checked daily.
In addition, all hospitalized COVID-19 patients at Stanford Health Care are sequestered in isolation units. Patients who have tested positive for COVID-19, or are suspected of having the virus, and are not hospitalized but need treatment can receive care at a separate facility at the Hoover Pavilion in Palo Alto.
‘Testing, testing, testing’
“We intend to create a sanctuary from the virus in our health care world,” Rizk said. And safety, he said, “starts with testing, testing, testing.”
All patients will have their symptoms checked when they arrive at a Stanford Health Care hospital or clinic. Most will also undergo swab testing for the coronavirus three days before scheduled procedures and will be asked to quarantine themselves during those three days. Initially, about 10% of patients — those scheduled for procedures that pose less infection risk, such as some imaging and injections — will not be tested, Semple said, though she added that these patients will soon be tested as well.
Stanford Medicine is in a unique position to offer such testing. It was among the first medical centers in the country to have an in-house diagnostic test, which was developed by Stanford pathologist Benjamin Pinsky, MD, and his collaborators early this year. Since March 4, Stanford’s Clinical Virology Lab has run more than 33,000 of these tests, both for Stanford patients and members of the community. Stanford Health Care also began offering a serology test, which detects antibodies against the novel coronavirus and was developed by Scott Boyd, MD, another Stanford pathologist, and his colleagues in March.
As Stanford Health Care providers test more than 1,000 community members a day, infectious disease specialists here will monitor the spread of the virus and adjust Stanford Medicine policies as necessary. Information on the testing can also help local officials make policy decisions.
A new initiative will also allow Stanford Medicine faculty to conduct diagnostic and antibody testing in a cohort of the San Francisco Bay Area population and its health care workers for several months. “We’re keeping track of what’s going on in the entire Bay Area, tracking infections, looking for hot spots and keeping information up to date with our public health officers,” said Yvonne Maldonado, MD, professor of pediatrics, infectious diseases, and epidemiology. “I’m very confident we will be able to keep the high level of safety and inform our community to help them do the same thing.”
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