On May 16, Gov. Andrew Cuomo announced that hospitals in Suffolk County could begin performing elective surgeries again. These had been suspended in mid-March by executive order as hospitals responded to the wave of COVID-19 cases inundating hospitals.
On Thursday, The Times Review Media Group interviewed Andy Mitchell, the president and CEO of Peconic Bay Medical Center, a part of Northwell Health, on the resumption of these procedures. His answers have been edited for space and clarity.
TR: How does your hospital define elective surgery?
Mitchell: Elective surgery is surgery that is not urgent or emergent, meaning it can be put off for a period of time, but not if that means a significant health deficit for the patient. I can look at my own case. I had a hip replacement on Feb. 4. I had put it off for two years until it reached that point where it really impacted quality of life. I could have continued to put it off, and it would not have caused serious health consequences but it was uncomfortable. That is elective surgery.
TR: During the time of the executive order stopping these procedures, how did you handle such requests?
Mitchell: We were very careful. A gall bladder issue can be elective if it’s not inflamed. It could wait a while. Or it could be vital and emergent and needed to get done. There are, in other words, either by state regulations or the executive order, or what we receive from the American College of Surgeons, procedures to be followed.
Patients are listed from zero to four, four being vital and emergent. During the executive order we continued to do the fours. A hospital will sometimes do a three, but what we do is continuously monitor those parents to see if their conditions have changed.
For instance, a patient comes into the emergency room and has an appendicitis issue. Sometimes you can send them home, or, after examination, you can get them right into the emergency room. We set up a committee here at Northwell to subject these decisions to peer review.
The committee asks: if we don’t do the surgery, is this a life threatening situation or could it result in other serious health issues? So, we were doing some because they were urgent cases. Another example would be a fall that results in a fractured hip that had to be repaired, or another kind of trauma case.
TR: Why did the governor issue the executive order barring these elective surgeries?
Mitchell: The order in mid-March was for all elective surgery to cease. The intent was for a singular reason: the concern over rising COVID cases. This allowed the repurposing of surgical areas like pre-op and post-anesthesia units to additional ICU beds. It also allowed us to redeploy a good portion of our operating room teams to support the huge increase in COVID patients.
TR: As you made that transition, what worked well at PBMC as you dealt with that increase?
Mitchell: We were very successful early on with better oxygenation of our patients with what’s called proning. Proning is the positioning of a COVID patient from being on his or her back to their stomach. That has been shown to increase oxygen levels in our patients. We had a lot of success with that.
TR: How did proning come about?
Mitchell: Northwell had arranged before we saw the huge influx of COVID patients for our clinicians to conference with doctors in Wuhan, China, and we got a lot of very good information on what is successful and not successful. What came out early on was proning, the turning over of the patient, and that it prevented many patients from having to be put on a ventilator. When you are on your back, your weight presses on your heart and lungs.
TR: With the lifting of the executive order on elective surgeries, will you change your procedures at PBMC?
Mitchell: The order was lifted for Suffolk, and the next day for Nassau. It is still not lifted for New York City. This is a direct result of improvement of the decline in COVID cases and deaths.
So, in practice as we evaluate cases, we don’t have to go back to the committee. But we will still address the most urgent cases first. Our committee will still set priorities – call it a triage committee. As the weeks go on, we will get back to normal procedures where you can operate on certain days. But right now we are still making sure we are not letting someone who is serious for this kind of surgery fall through the cracks.
TR: This is obviously a sign that COVID cases have improved at PBMC.
Mitchell: Yes. Looking back, I can see we were agile in our responses. Northwell communicated best practices while the number of cases were rising sharply. We were an agile organization as the situation day to day was so fluid.
As of today [May 28], in our ICU we have two positive COVID cases, one to be ruled out, and one of the cases on a ventilator. Throughout the facility we have a total of 11 positives in the house and two rule outs.
Compared to the 120-plus range of a few weeks back, this is a huge, huge improvement.