Med center further limiting surgeries as COVID surges

Demand for inpatient beds and COVID-19 related impacts are forcing Nebraska Medicine to further limit the type of surgeries performed at Nebraska Medical Center.  

The census of patients with COVID-19 continues to increase, causing leaders to make additional modifications to the surgery schedule.

"We need to make changes to make sure we have beds for patients and access for patients needing time-sensitive, medically-necessary procedures," said Matt Pospisil, vice president of operations at Nebraska Medicine.  

To ensure Nebraska Medical Center is providing the safe and quality care that patients expect, effective Monday, Dec. 13, the following changes to the surgery schedule will be in effect:

  • Cases classified as D, E and some C will be reviewed and possibly cancelled at Hixson-Lied and C.L. Werner Hospital. (See case classification below.) 

  • The Pre-op and Post Anesthesia Care Unit areas of C.L. Werner Hospital will be used to hold surgery patients waiting for an inpatient bed.

  • To create access at other locations, OR capacity is expanding at Bellevue Medical Center and Fritch Surgery Center as resources allow.

  • Outpatient procedures (GI, IR, cath lab, EP Lab, pain) will continue as normal. Case classification should be reviewed for patients requiring an overnight or inpatient stay, and D and E cases should be removed from the schedule.

"We’re asking our surgeons to move appropriate D and E cases to Fritch Surgery Center, Village Pointe or Bellevue Medical Center as possible," Pospisil said.  

In late August, Nebraska Medical Center adjusted its surgery schedule to lift the pressure of inpatient teams.  

In the last several weeks, the number of patients admitted with COVID-19 has steadily increased and as of Monday stood at 79. 

"Another challenge is the average length of stay is up 10% compared to last year, while the acuity of our COVID-19 patients has increased, with a higher percentage requiring ICU level of care and ventilators," Pospisil said. 

Emergency room visits are up nearly 30% compared to last year, and more colleagues are off work due to exposure or infection of COVID-19.

"These are important steps to preserve access for all surgeons and their patients in the face of increasing demand for hospital beds at Nebraska Medical Center," Pospisil said. "It is difficult to anticipate what the next several weeks or months may bring. If demand for beds decreases, we will change our approach accordingly."

"Please encourage the people in your life who are not vaccinated to get vaccinated."

Case classification:

  • Class A – Life/limb at risk: should be done now.    

  • Class B – Time sensitive outcome necessitating procedure within 24 hours: short delays acceptable. 

  • Class C – Time sensitive outcome necessitating procedure within four weeks: scheduled at the discretion of the surgical/anesthesiology medical director. 

  • Class C1 – Time sensitive outcome necessitating procedure within one to two weeks. 

  • Class C2 – Time sensitive outcome necessitating procedure within two to four weeks. 

  • Class D – Can wait four to 12 weeks or longer without substantial change in outcome: reschedule at Nebraska Medicine for later date. 

  • Class E – Can wait greater than 12 weeks without substantial change in outcome: postpone and reassess in 12 weeks for rescheduling at Nebraska Medicine.  

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