Overwhelmed by latest surge, hospitals again delay elective surgeries

Hospitals across Indiana are once again delaying elective surgeries and procedures, and some warn they are operating near full capacity due to the latest COVID-19 surge.

Indiana University Health, the state’s largest hospital system, said it has delayed thousands of elective surgeries in recent weeks, although it is continuing to take urgent and emergency cases.

“People are in line to get surgery who can’t be operated on right now because of our COVID numbers, and our record-high census as well,” Dr. Paul Calkins, associate chief medical executive, said during a press briefing Thursday afternoon.

The latest surge of patients is beginning to overwhelm IU Health’s doctors, nurses and other members of the patient care team. On Thursday morning, the hospital system said it had enlisted the Indiana National Guard to help.

“Our people are incredibly tired,” Calkins said. “We were watching the numbers go down, and to have them turn back around and start going up again is just about the most disheartening thing I can imagine. People are really, really, really tired of this. You can only do this so long before it just becomes draining.”

The Indiana Hospital Association said hospitals across the state have been delaying nonurgent procedures for some time, but that has “increased significantly due to the surge,” spokeswoman Laura McCaffrey said.

She said all hospitals are prioritizing the most medically urgent procedures and are evaluating capacity daily, “and in some cases, even hour by hour.”

Dr. Christopher Weaver, IU Health’s chief clinical officer, said most of the COVID-19 patients are unvaccinated, although up to 20% are vaccinated, including some who are now in the intensive care unit.

“It’s really hard work, taking care of a whole lot of people right now,” Weaver said. “It’s a big emotional strain to take care of people who are really, really sick, many of whom are dying.”

Eskenazi Health said it is delaying elective procedures through mid-January, “so people can plan around it, rather than hearing about it week to week,” said Dr. David Crabb, chief medical officer.

He said the hospital, which has 327 beds, had 376 inpatients on Monday, about 50 of them with COVID-19. The hospital has created other temporary sites for patients while waiting for beds to open on the nursing floors, including in clinical areas and in the emergency room.

Franciscan Health said it has begun using a priority scoring system to determine which cases are safe to defer and which need to proceed as soon as possible.

“This approach allows us to match our caseload, both inpatients and outpatients, with available beds and staff on a daily basis,” Franciscan said in a statement on Thursday.

Since mid-November, the number of COVID hospitalizations at Franciscan’s main campus on the south side has increased nearly threefold from the low 20s to the mid-60s. The system’s Mooresville hospital has set new records in the past few days with more than 20 COVID inpatients, many of whom are critically ill.

Community Health Network said it is determining on a day-to-day basis whether it needs to reschedule elective surgeries to make sure all patients who need them have beds available to them. It did not say how many surgeries it has delayed.

“We monitor staffing and are working with staff to make sure they don’t face burnout,” the system said in a statement.

Reid Health, based in Richmond, said Wednesday it has paused all elective inpatient surgeries and that it remains on “critical bed status.” It said all scheduled surgeries will be reviewed for urgency, and the surgeon’s office will reach out to those patients who need to be rescheduled.

A spokeswoman for Ascension St. Vincent said Thursday that none of its Indiana hospitals were delaying surgeries at present.

IU Health said its emergency rooms are backing up, as many of the 16 hospitals in its system are filling to capacity because there are no spare rooms or beds in the nursing units.

Hospital officials are trying to get people through the system and discharged to free up beds, Calkins said.

On Wednesday, the system was caring for more than 440 COVID-19 patients. Based on the rate that cases are climbing, it predicted it could have 575 COVID-19 patients by the end of the year. That would surpass the system’s census peak of 517 COVID patients on Dec. 14 of last year.

In the meantime, IU Health, like many other hospitals, is trying to cope with a severe nursing shortage, as nurses quit, retire or take new assignments. The system has spent millions of dollars hiring short-term “traveling nurses” to fill in but is concerned the latest surge will take its toll.

“One of the huge problems we’re concerned about is whether this is going to lead to more staff losses,” Calkins said, “because people just get to the end of their rope.”