SUDBURY - Health Sciences North is set to begin the process of clearing a queue of thousands of scheduled surgeries that were postponed due to COVID-19.
Dr. Penny Sutcliffe, medical officer of health at Public Health Sudbury & Districts over the weekend, confirmed over the weekend that the required criteria were met in the community for the hospital to resume elective surgeries and non-urgent procedures.
In mid-March, Ontario hospitals were directed by the Minister of Health to cease non-urgent elective surgeries and procedures. In the months that have passed since that direction was given, HSN postponed more than 4,400 non-urgent scheduled surgeries and minor procedures.
During that period, more than 1,000 emergency surgeries and necessary procedures were performed.
The re-introduction of clinical services at the hospital will be a gradual one, HSN president and CEO Dominic Giroux told Sudbury.com today, with the first phase of the recovery plan focusing on the reintroduction of surgical and cardiac procedures and tests where patients generally require 48 hours to recover in hospital.
This will include up to about 200 surgical cases per week, or 60 per cent of the hospital's normal activity.
"In the last month at HSN each department has been developing recovery plans for the eventuality that we would receive the green light to resume clinical services," said Giroux.
"On May 7, the province issued a framework to enable hospitals to begin the planning for the reintroduction of clinical services and there were a number of parameters that had to be met in order for hospitals to be given the green light."
Health Sciences North has set a benchmark of getting back to 60 per cent of normal activity in surgical and cardio-diagnostic during phase one of their recovery. Currently, the hospital is operating in the 17- to 28-per-cent range, depending on the unit.
Phase two will focus on some surgeries where patients require more than two days recovery in the hospital, with the hope that this phase will get underway in early July. During the third phase, HSN will increase to 75 per cent of normal case activity.
"Phase four, which we contemplate in the fall is to bring us to 100-per-cent normal activity for the surgical and cardio-diagnostic program," said Giroux.
"For the other clinical services such as diabetes, mental health and addiction services we will first want to monitor the situation in the first week in June with the surgical and cardio-diagnostic program because we need to closely monitor physical distancing, the use of PPE, the availability of drugs, the availability of staffing and so forth. After that each department would initiate phase one of their respective recovery plan."
On the matter of staffing, the hospital was fortunate not to be overwhelmed by COVID-19 and was able to redeploy 300 employees, and they will be gradually reintegrated into their normal positions at the hospital as they move through their recovery phases.
Prioritizing patients who have had surgeries cancelled will be determined by the medical leadership in each hospital unit, with considerations made to severity of the situation.
"You can appreciate that many activities that were considered to be non-urgent in mid-March have become urgent, and that's why since mid-March we have performed about 1,000 surgeries and procedures," said Giroux.
"There are a number of ethical principles that each unit is considering -- the severity of the situation -- but what we're beginning with in phase one in the cases of surgical and cardio-diagnostics, is cases where the hospitalization required is fewer than two days."
The hospital boss says that despite not performing elective and non-urgent surgeries for more than two months, capacity at the hospital is still rather high.
"We find ourselves today at 91 per cent occupancy," said Giroux. "We're not in a situation where we can start admitting a high number of patients, so that's why we're starting with phase one, with procedures that will require less than two days (recovery in hospital)."
Health Sciences North will also have to keep the possibility of a spike in COVID-19 cases close in their minds moving forward and will need to be able to readily access 10 per cent of their beds.
"The expectation of the province is not to revert back to hallway medicine, so in the case of today's occupancy that gives us the flexibility of about 41 beds. We're have 430 admitted patients and our conventional bed capacity is 471," said Giroux.
"Furthermore, the expectation as a region is to be able to make readily available 10 per cent of the beds in the region, so that represents about 300 beds. Right now in Northern Ontario hospitals, the average occupancy is about 76 per cent and there are 587 beds available in Northern Ontario."
Health Sciences North will be continuing its partnership with St. Joseph's Health Centre, NEOMO Primary Health Clinic and Ontario Health which has opened up bed spaces at the Clarion Hotel in order to free up space at the hospital.
"This partnership will continue until at least June 30 and we are making a request to the province to sustain that operation beyond that date," said Giroux.
The hospital will be contacting patients directly in order to reschedule their procedures and are asking patients and the public not to call the hospital or their surgeon's office to inquire when they will be rescheduled.
"There's no doubt it will take several months, more specifically of the appointments that were postponed since mid-March we've had about 2,000 surgeries, 1,400 endoscopies and about 1,000 minor procedures," said Giroux.
"What we have observed though is since mid-March we've seen a reduction in referrals from surgeons and medical staff in the community because they themselves were seeing fewer patients because of the pandemic."
The recovery plan will be monitored on an ongoing basis, especially in the event of a sudden surge in COVID-19 cases in the community.
"I think as a community we should be proud that there are no unresolved cases of COVID-19 in our public health area, at Health Sciences North we have no admitted patients with COVID-19," said Giroux.
"Thanks to the exceptional work of frontline staff at Health Sciences North we've had zero transmission among our healthcare workers and now we are among the first hospitals in the province that is in a position to resume clinical services. At the same, I need to manage expectations and it will be a gradual reintroduction and we are not immune to a second wave of cases and that's why each recovery plan in each department has ramped down provisions should the situation change."
