SOMERVILLE, NJ - A sense of normalcy has begun to return to Robert Wood Johnson University Hospital/Somerset, with the number of COVID-19 patients dropping considerably over the past few weeks as mirrored at hospitals throughout the state - enough so that Gov. Phil Murphy has given the go-ahead for hospitals to resume elective surgeries and invasive procedures beginning May 26.
"We're excited to get back to a semblance of what was normal," said Tony Cava, president and CEO of RWJUH/Somerset, who for the past three months has overseen an "all hands on deck" effort by the staff in the battle against the coronavirus.
The hospital's pre-admission staff is busy consulting patients and helping doctors schedule surgeries, according to Cava; some doctors have as many as 100 patients awaiting surgery, he said.
There had been a ban in effect on most surgical procedures since mid-March as hospitals were overwhelmed dealing with the volume of OVID-19 admissions, but that dynamic has now reversed, with the number of COVID-19 patients being discharged far outnumbering admissions, according to Cava.
Just one month ago, RWJUH/Somerset was operating four COVID-19 units, with its Intensive Care unit caring primarily for COVID-19 patients. Its first COVID-19 patient was admitted March 8.
Last week, the hospital was able to shut down a third COVID-19 unit; one remains to handle new admissions. The shifting dynamic has enabled the hospital to reclaim dozens of beds for other admissions - elective surgeries and invasive procedures.
"it's a big psychological boost each time we close a COVID unit, it shows the progress we've been making," Cava said.
The hospital has discharged over 500 COVID-19 patients who are now home or at rehabilitation centers recovering.
"Our team has done phenomenal work, they really have," Cava said.
"We're definitely on the downside of the curve for sure;," Cava added, noting that at the height of the pandemic 75 percent of the admissions were COVID-19 patients; that number is now under 30 percent, he said.
Shutting down the COVID-19 units and re-fitting the beds and rooms for other uses takes between 3 and 4 days, according to Cava.
"We do a thorough deep cleaning, strip it completely down, change the privacy curtains, and we open those units better than before, Spic'n'Span clean if you will; that's been done routinely during the course of this pandemic," Cava said.
Cava said the hospital is well-prepared for the changeover.
"We've been planning this unwinding process for several weeks now; once we hit that plateau, and we started seeing the numbers decrease we assembled a team to determine how we were going to re-open," he said.
The "re-opening" started over a week ago with the first phase, - a restart of higher level outpatient services and diagnostic imaging, and rehab.
Earlier this week, the hospital began time-sensitive surgeries that had been scheduled prior to the pandemic, and have been put off for 8-10 weeks.
Cava said the pre-admission staff is busy - "our preadmission testing staff has been talking to offices of all our surgeons."
Going forward, Cava said the hospital will continue to follow procedures implemented when the coronavirus first hit.
"We're going to continue doing what we've been doing - screen everyone who comes in to the hospital," Cava said. Temperature scans will be administered at the door for all who enter the lobby; masks will continue to be worn by staff, patients, and any family members who accompany the patient.
Pre-admission testing will also be administered. Patients will be asked to come in to the hospital 72 hours prior to a procedure, return home and self-quarantine, with results available in 24 hours, according to Cava.
Cava also said that people have been avoiding coming to the emergency room.
"We know for a fact people have put off coming to the emergency department during the pandemic; we want to ensure them it is absolutely safe to come into the emergency department, it's safer than going out for your groceries, and we've been doing this for nine weeks.".
Emergency Department patients will be screened at the door, and if they exhibit any signs of an influenza-like sickness, they will be segregated immediately,
"We're excited about reopening for elective surgery and welcoming our patients back to a very safe environment," Cava said.
Gov. Murphy signed Executive Order No. 145 last week, allowing elective surgeries and invasive procedures, both medical and dental, to resume on Tuesday, May 26.
“Hospitals and ambulatory surgery centers are encouraged to gradually resume full scope of services when possible and safe to do so consistent with the Department’s guidance,” said New Jersey Health Commissioner Judith Persichilli. “This is an important step forward for individuals who are battling an illness or are dealing with chronic pain as these surgeries are vital to their health and well-being.”
These are the guidelines issued with the executive order:
Facilities shall establish a prioritization policy for providing care and scheduling of these procedures. Scheduling must be coordinated to promote social distancing: minimize time in waiting areas, stage appointment hours and post signs at entrances in appropriate languages about symptoms and precautions.
Patients should be counseled to self-quarantine following testing until the day of surgery. Facilities must have a process to screen patients for COVID-19 symptoms prior to scheduled procedures.
Facilities resuming elective services are required to:
- Comply with state and CDC guidelines to protect against further spread of COVID-19
- Institute screening of staff for symptoms and have policies in place for removal of symptomatic employees
- Enforce social distancing requirements in work and common areas
- Require masks for patients, expect patients receiving services that would not allow for masking
- When possible non-COVID care zones should be used in facilities that serve both COVID-19 and non- COVID patients
- Have an established plan for cleaning and disinfection prior to using facilities to serve non-COVID patients
- Facilities providing COVID-19 care should continue to be prepared for potential surges
- Facilities should be prepared to modify resumptions of clinical services in conjunction with surge status and to re-purpose and redeploy staff to urgent care roles to the extent feasible
Ambulatory Surgical Centers should not perform procedures on COVID-19 positive patients.
Hospitals should have available - and staffed ICU, Critical Care and Medical Surgical beds.
They must have a sustained downward trajectory for 14-days, with each day’s data calculated using the average of the three most recent days
- Influenza-like illness or COVID-19 like illness
- COVID-19 Infection rates
- COVID-19 Hospitalizations
- COVID-19 Emergency room admissions
- COVID-19 ICU, Critical Care and Medical Surgical bed use
- Ventilator use
- Ventilatory availability
Facilities must also have a plan, consistent with CDC and Department recommendations, for patient and patient support person use of Personal Protective Equipment (PPE). They should implement PPE policies that account for: adequacy of available PPE, staff training on and optimized use of PPE and policies for the conservation of PPE.
Facilities must implement disinfection and cleaning protocols and cohort COVID-19 patients and non-COVID patients. No visitors should be allowed except for limited circumstances, which includes labor and delivery and pediatric patient surgery.