Jacob Musselman and Maria Flora, Lebanon Reporter
Clint Jones, 46, of Lebanon, wants to work, but a shoulder injury is holding him back.
Jones is stuck between a rock and a hard place, like many Hoosier patients who need surgeries they can’t get as hospitals across the state cancel elective surgeries while they battle the largest COVID-19 surge since the pandemic’s beginning. Instead of undergoing shoulder surgery on Tuesday as scheduled, Jones sat at home, in pain and hoping for the surgery that will allow him to work again.
“I had my prescriptions for pain killer and nausea meds filled out, and then they called me up one day and said ‘We’ve gotta cancel,” Jones said.
Jones was scheduled to have bone spurs removed and perhaps a mu s c l e and tendon repaired at Witham Hospital in Lebanon. But Witham, overwhelmed with COVID - 19 cases, halted all elective surgeries last week. “The trifecta of reduced staff, reduced supplies, and an increased number of very sick COVID-positive inpatients, has created the maelstrom we are living in day-to-day,” Kelley Braverman, CEO of Witham Health Services in Lebanon, said Wednesday.
Boone County, and all of Indiana’s 92 counties, were in the Indiana State Department of Health’s red advisory zone this week as new coronavirus cases reached an all-time high.
Witham is a county hospital in central Boone County, north of Marion County. “Patients are known to our staff before they arrive,” Braverman said. “Many times our staff already have a relationship with the patient.
“It’s the guy who sold them groceries or a friend’s son, or a former babysitter. Not just someone lovely they get to meet for the first time when they come into the hospital.”
“The volume of the sick and those who have died has just become so sad,” Braverman continued.
ELECTIVE SURGERIES
Associate Chief Medical Executive Dr. Paul Calkins from IU Health Methodist Hospital in Indianapolis defines an elective surgery as one that can be postponed for some length of time, depending on circumstances, but not indefinitely. Calkins said there is a “judgment call” made in deciding if a surgery can be delayed.
“We are continuing to do surgeries that involve cancer, fractures, or active infections, as well as cases which will help speed discharge of patients from our hospitals,” Calkins said in an email. “Each of our hospitals has set up processes to understand what should be continued and what should not – using guidance that we have developed as a system.”
Witham re-evaluates the situation daily, monitoring trends in staffing, supplies and COVID-19 positivity rates to ensure a safe environment before reinstating elective surgeries, or expanding restricted visitor guidelines. And no one knows when that may be, Braverman said.
Jones said Witham told him it would be at least six weeks. His surgery can’t come soon enough, as he’s been in pain and out of work since injuring his shoulder doing yard work in early summer.
“It’s my right shoulder, and I’m right handed, so no matter what I do, it’s agitated,” he said.
Pain management is key, Jones added. “I have to wear a lidocaine patch, and that helps a little bit, but not with the bone spurs,” he said.
Calkins said each entity of the IU Health network came to the decision to halt elective surgeries independently. He said from there, IU Health sets criteria to determine if elective surgeries need to go forward.
In early fall, IU Health started to reschedule elective surgeries and other procedures due to the extremely high COVID-19 and non-COVID-19 hospital census, as well as staffing restraints, Calkins said. A hospital’s census is the total number of patients admitted to the facility in one day.
The cancellation of elective surgeries, at more than 200 IU Health locations statewide, are caused by a multitude of reasons. One main reason Calkins said is because of the “unprecedented” number of inpatients, both COVID-19 and non-COVID-19, resulting in delays to usual care because of the past 22 months of COVID-19 surges.
“Like other hospitals, IU Health is facing constraints with staffing. Today our staffing is affected by employees who are sick or in quarantine because of COVID-19, specifically surrounding Omicron,” Calkins explained. “The number of team members out during this particular surge is more than twice as many as we’ve ever seen before. In addition, our overall patient volumes are far higher than they have ever been historically, even considering the COVID-19 patients.”
Staffing shortages, bed shortages and other factors have pushed hospitals all around the state to their breaking points, with some even making public cries for help via social media.
STRATEGIES
The cries heard around the state also ring true in Boone County.
“We are doing everything we can to take care of everyone, but we need the community to do everything they can do, too,” Braverman said. “Please help us. Get vaccinated, wear a mask, socially distance, and wash your hands.”
“There’s just been a lot of death,” she said. “My heart is breaking for our staff.”
Vacancies, coupled with employees who are out ill, account for a 16% workforce reduction at Witham.
“Many of the employees who have left Witham did so due to exhaustion,” Braverman said. A handful said they may return at some point, “but right now the grief and the numerous deaths they have experienced are just to much.”
Halting elective surgeries frees surgical nurses and supporting staff for work in the emergency department and in other areas where COVID patients are cared for.
To mitigate the staffing shortage, Witham has moved to teams-based nursing, which pairs staff from diverse areas of the health system with nurses more experienced with in-patient care supervising the team. Witham is preparing to call in staff from outpatient areas into the hospital to ensure they can care for the increased volume of COVID-positive inpatients, Braverman said.
“This may impact some of our outpatient and in-person access, but strategically, we have options in many locations for the use of virtual visits,” Braverman said.
Calkins said IU Health also continues to leverage its resources to support patient care with resources from around the state as well. IU Health called members from Indiana’s National Guard, the Indiana Department of Health, as well as the Federal Emergency Management Agency (FEMA) for assistance with the higher patient count and lower staffing numbers.
“Our most severe constraint is related to the number of staff available to take care of patients, rather than the number of physical beds to put them in,” Calkins said. “In fact, IU Health has converted multiple areas to create additional space to care for patients.”
Calkins said the community can do a lot to help with the influx of patients.
“Masking, social distancing, and getting vaccinated are all effective ways to prevent COVID-19 transmission, as well as avoid hospitalization,” Calkins said. “Our message on this has not changed.
“We also request that patients not come to our emergency departments solely to seek COVID-19 testing,” Calkins added. “Emergency depar tment physicians throughout IU Health are caring for a large volume of patients, including those with urgent COVID-19 and other serious ailments, as well as trauma, cuts and broken bones. To preserve our staffing resources and reduce your exposure to illness, families with patients experiencing mild symptoms should utilize IU Health’s virtual visits app, or contact an urgent care clinic or community site to receive a COVID-19 test.”
Resources about COVID-19 testing and vaccinations may be found online at ourshot. in.gov.