Amid new COVID surge, hospitals rethink testing, visitation policies, elective procedures

Grand Rapids-based Spectrum Health, along with some other health systems in Michigan, is ramping up COVID-19 testing of patients coming into the system and discussing delaying some elective procedures to conserve personal protective equipment and staff.

As the new surge of COVID-19 strikes Michigan with double-digit increases in cases and deaths the past several weeks, hospitals in Wisconsin, New Mexico, Colorado, Utah, Tennessee and Texas have already triggered changes in how they handle elective surgeries, testing and visitations.

Darryl Elmouchi, M.D., president of Spectrum Health West, told Crain's on Friday that Spectrum hospitals have begun testing all patients going into the emergency department and those who need to be admitted to the hospital, regardless of symptoms, because its COVID-19 positivity rate has exceeded 6 percent for patients.

Across Spectrum's 15 hospitals, 9 percent of tests are positive, up from 3 percent earlier this month, he said.

"There's enough community spread that we would want to test our inpatient adult inpatients to confirm they didn't have COVID," Elmouchi said. "It's mostly done to protect the patient visitors and staff."

Discharged patients who are headed to a congregate living situation also will be tested and those who have scheduled procedures are tested up to 96 hours prior to the procedure, Elmouchi said.

Friday morning, Spectrum Health reported having 167 patients with confirmed cases of COVID-19 and another 11 suspected, triple the number three weeks ago and breaking all previous system records. Spectrum also reported 62 of its employees have COVID-19, up from 29 earlier this week, with a total of 105 screened that are considered "not OK."

"Most employees are getting it in the community," Elmouchi said. "Almost none from patient to staff . ... and none from staff to patients because of our (personal protective equipment) rules."

While metro Detroit's positivity test rate was above 20 percent in April, Elmouchi said testing then was limited to mostly symptomatic people.

"We were only testing 200 to 250 people a day, and now we are testing 4,000," he said.

But Elmouchi acknowledged that Spectrum has discussed internally a plan to delay certain elective procedures, including cosmetic breast surgery, if COVID-19 hospitalizations increase too much and impacts staffing.

"The good piece of news is we have no significant concerns with PPE. Our supply chain has done a great job in securing adequate PPE," he said. "From a staffing standpoint, that is my biggest concern. ... What we're really trying to avoid is what happened in the first go-round, where we shut down everything other than COVID."

Elmouchi said surgeons have volunteered to delay certain procedures if the situation warrants it. He said already the hospital has shifted surgeries to different days and from inpatient to outpatient locations.

"To be honest with you, there is absolutely a chance you could be talking to me a week from today and I'll say we have canceled all of our breast implants for the next two weeks so we can have more staff to do" other surgeries, Elmouchi said. "It's a fluid situation."

Hospitalizations for COVID-positive patients rose to 1,398 on Oct. 29, a 41 percent increase from a week ago.

A 13-county region in West Michigan around Grand Rapids had 254 COVID-19 patients in its hospitals this past week, more than the 238 COVID patients in hospitals in Wayne, Washtenaw and Monroe counties, state data show.

Spectrum also is reducing the numbers of visitors to its hospitals and outpatient sites by limiting adult patients to one adult family member or guest per patient. Labor and delivery obstetrics patients are allowed two adult visitors. COVID-19 patients are not allowed in-person visitors, a policy that harkens back to April when Gov. Gretchen Whitmer ordered a lockdown and partial halt on elective surgeries. Spectrum said it will work with patients and families to coordinate virtual visits.

Crain's asked several other health systems in Michigan about whether they plan or are considering changing testing protocols or reducing volume of elective procedures because of the growing pandemic.

Most systems say they either leave testing decisions to physician discretion or follow Centers for Disease Control and Prevention recommendations for hospitals and outpatient centers. But this leaves patients confused.

Doug Jones, general manager of Metro Airport Truck in Taylor, said his mother was treated and admitted on different days by doctors at Michigan Medicine, St. Joseph Mercy Ann Arbor and Beaumont Hospital, Dearborn for a non-coronavirus symptom.

Jones' mother was tested for COVID-19 (negative) at Michigan Medicine and St. Joe's but not at Beaumont Dearborn.Nick Gilpin, D.O., Beaumont's director of infection prevention, said Beaumont Health doesn't test all patients entering emergency departments or hospitals. It leaves those decisions to the physician's discretion, he said.

Gilpin said the majority of pre-op and labor-and-delivery patients are tested and most patients who present with any symptoms consistent with COVID-19 are offered testing.

On delaying elective procedures, Gilpin said Beaumont has considered the possibility. He said Beaumont has sufficient PPE, along with hospital beds and staff.

With more than 1,300 hospitalized COVID-19 patients during a single day in early April, Southfield-based Beaumont Health treated more patients for the coronavirus than any other health system. On Friday, it had 210 coronavirus-positive patients in its hospitals, up from 96 on Oct. 1.

"This year, we have learned quite a bit about COVID-19. We do not see the need for patients to delay non-COVID-19 care at this time," Gilpin said in an email. "We have taken numerous precautions to provide a safe environment. Eliminating non-essential surgeries again would be unlikely at this point."

Mary Masson, a spokesperson with Michigan Medicine, said the Ann Arbor-based health care organization has not canceled any elective surgeries. "We are constantly monitoring and planning for patient surges and we could make changes in the future," Masson said.

At Detroit Medical Center, doctors order COVID-19 tests on all patients who meet the appropriate criteria as designated by the CDC.

"This includes testing all symptomatic patients being admitted for hospitalization, all pregnant women admitted for delivery, all babies born to mothers who are COVID-positive and those patients undergoing aerosol-generating procedures," DMC spokesman Brian Taylor said.

Livonia-based Trinity Health Michigan also has designed its COVID-19 screening process based on guidance from the CDC, MDHHS and local health departments, spokesperson Laura Blodgett said.

"Patients who present to the emergency room at one of our facilities are tested for COVID-19 if they are symptomatic, fall into a high risk category, or if they are going to be admitted or observed for any reason," Blodgett said. "Patients having a scheduled invasive procedure are tested for COVID-19 three days before their scheduled procedure."

Trinity hasn't made a decision on postponing elective procedures. Blodgett said the system believes it has sufficient PPE and staff resources, especially because it can tap into resources provided by the health system's 92 hospitals.

At Ascension Michigan, a 12-hospital system based in Warren, spokesperson Chris Gleason said the Catholic system is following CDC guidelines for the time being.

Gleason said Ascension hospitals also has a surge plan that allows it to quickly adapt to patient needs and health care demands by grouping patients and creating additional intensive care space for COVID-19 patients.

"We need everyone to take this seriously and do what they can to slow the spread," Gleason said.

Henry Ford Health System, a six-hospital system based in Detroit, also said doctors evaluate patients and test them if necessary. Surgery patients are tested or if a patient is to be admitted, even if asymptomatic, spokesman John Gillespie said.

"All obstetric patients will be asked COVID screening questions upon arrival to labor and delivery unit" and all emergency departments, Gillespie said.

"If screened positive, the patient should be tested for COVID-19 regardless of whether she is admitted or placed in observation," he said.

Gillespie said Henry Ford hasn't decided yet to postpone elective surgeries. He said the system has a 100-day supply of PPE.

"Henry Ford has had a formal systemwide group in place since midsummer to leverage everything we learned during the first surge to guide our operational decisions in the event of a second surge," he said. "This includes provisions to deploy our resources so that we may continue to meet the health care needs of the community while also caring for ambulatory and hospitalized COVID-19 patients."