UPDATE (Friday, May 1 at 7:36 a.m. PT) — Oregon Gov. Kate Brown announced April 23 the framework for reopening medical and dental offices to elective and non-emergency procedures as soon as May 1. Hospital systems in Oregon say they're preparing to meet those guidelines and to start accepting more patients again.
Brown’s priorities for reopening medical offices include minimizing the risk of coronavirus transmission, maintaining hospital capacity for an increase of coronavirus cases, minimizing health emergencies presenting at emergency departments, reducing the financial impacts to the state’s health system, avoiding any further delays in Oregon health care and supporting the health care workforce in resuming its activities.
In order to address those priorities, Brown is requiring medical and dental offices to have enough personal protective equipment, such as gloves, masks and gowns, to last for two weeks without the need for “emergency PPE-conserving measures.”
All medical and dental offices must also follow “strict infection control policies as recommended by [the U.S. Centers For Disease Control],” the governor’s framework reads.
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Providence Health & Services in Oregon said it will not begin performing elective and non-emergency procedures until Monday, May 4, to make sure it is adequately prepared to meet the governor’s guidelines.
Providence Oregon’s chief executive, Lisa Vance, said in a statement that Providence is working to have 30 days' worth of PPE on hand — more than the governor’s recommendation of two weeks.
“We will develop a standardized process of use that must be followed,” Vance said in a statement in regards to PPE.
Vance said Providence is also working on having “adequate testing” for both current COVID-19 patients “as well as testing for patients before surgery.” It’s also working to have enough beds for coronavirus patients as well as surgery and other patients.
Vance said as of last week, Providence’s operating room use stood at 25% of its capacity. She said the health care network intends to ramp that use up to 50% in May and “increase that over time as conditions allow.”
"This will be a process,” Vance said in her statement.
Kaiser Permanente in Portland said it is also planning on “increasing patient care in the next few weeks.”
Kaiser said it will continue to monitor limited supplies of PPE and will remain prepared for an unexpected surge of COVID-19 patients. It said it will also maintain social distancing standards which will limit how many patients will be allowed into facilities.
“Initially, we cannot expand to more than 50% of pre-COVID volume,” Kaiser said in a statement. “Increasing beyond 50% will depend upon personal protective equipment supplies and testing capacity.”
Kaiser said its physicians have been following up with patients whose procedures have been delayed and that it will be treating patients who are most in need of medical care first.
“As we work toward resuming elective surgeries and procedures, we are re-assessing and re-triaging patients to prioritize among those whose procedures have been delayed,” Kaiser said.
Brown said in her framework that once non-emergency and elective procedures resume, medical and dental offices will need to reassess their plans every two weeks — including plans to maintain social distancing, plans to reduce or stop non-emergency procedures if a surge of coronavirus cases occurs and plans to prioritize patient procedures based on urgency.
Medical and dental offices should also be screening all patients for coronavirus risk factors and symptoms before delivering care, Brown said, and patients with coronavirus symptoms should not undergo any sort of non-emergent or elective procedures.
The Oregon Health Authority, or OHA, published its own guidance for health care providers Thursday which complements the governor's framework.
“This will be an ongoing process and outreach effort,” the Oregon COVID-19 Joint Information Center said on behalf of OHA.
An aerial photograph shows the Oregon Health & Science University campus in Southwest Portland, Ore.
Aaron Bieleck / OHSU
Oregon Health & Science University in Portland said it will also begin scheduling nonurgent procedures in the coming weeks.
“The process of resuming procedures will be gradual to ensure we have adequate protective equipment to take care of more patients with COVID-19 and to maintain safe physical distancing throughout the care process,” OHSU said in a statement.
The hospital said priority would be given to patients whose status may have changed since nonurgent procedures stopped March 18.
For St. Charles Health System in Bend, the hospital system said it does not have a particular date for when it will begin to ramp up elective surgeries.
The hospital system said surgeries that fell within the exemptions of the governor’s executive order have still been performed.
“We’re performing up to 25 surgeries every day that span a variety of disease states, but that have the common caveat that a delay in performing them would cause significant harm to the patient,” the hospital said in a statement.