Mass. again limits non-urgent procedures in hospitals as crowding continues

If you have surgery scheduled for anything that’s not urgent at a Massachusetts hospital, be prepared for a call that says it will be delayed.

The Baker administration is asking hospitals to reduce procedures for non-life-threatening conditions, like hip replacements, by 50%. The state requested a 30% cut last month but patients are still being treated in hallways because rooms are full.

State numbers show 500 fewer available hospital beds since the beginning of 2021 as nurses and other medical staff reduce their hours, take a leave, change jobs or retire early.

“The Commonwealth’s hospitals continue to face significant challenges due to staffing shortages,” said Health and Human Services Secretary Marylou Sudders in a statement. “Today’s actions will help alleviate pressures by providing hospitals with staffing flexibility in order to reopen inpatient capacity in licensed and alternate space not currently being utilized.”

That could mean beds in conference rooms, waiting areas or outpatient recovery spaces. The state is also relaxing mandatory nurse to patient staffing ratios in ICUs.

The change means hospital staff are combing through patient records, trying to decide who to keep on the schedule and who to take off.

“None of these surgeries we’re contemplating here are elective for these patients, they are all surgeries they absolutely have to have,” says Dr. Ron Walls, chief operating officer, Mass General Brigham.

Walls says patients have scheduled time off work or arranged for a relative to come and help with their recovery. Patients may be in significant pain, unable to walk or be waiting for surgery that will clarify a diagnosis. Walls says there will be many difficult conversations in the weeks ahead. Hospitals can’t tell patients when their surgery can be rescheduled.

“We’ll have to wait and see what plays out over time and how much we’re allowed to ramp back up, in order to find time to slot them back in,” Walls said.

The state’s hospital association worked with the Baker administration on the guidance, which takes effect on Dec. 15. The new surge in COVID-19 cases comes during a time of year when hospitalizations typically increase about 10%, according to the state.

Some hospitals, including UMass Memorial Health facilities, are going further than the state request and postponing all surgeries or procedures that require an overnight hospital stay. President and CEO Dr. Eric Dickson says his system is at 110% of capacity today and has very limited ability to accept emergency transfers from nearby smaller hospitals.

Dickson says when he hears people say they think the pandemic is over he wants to ask, “do you understand how bad it is in the hospitals?”

So far, colonoscopies and other same-day procedures are continuing, but Dickinson says he may need to reduce those visits as well, and transfer staff to help with inpatient care. Dickson says he realizes delays might lead to more serious health needs, similar to the pent-up demand that is helping drive overcrowding problems now.

“You’re just kicking the can down the line,” he says. "And some patients will require more care because it’s been delayed, not less.”

Tufts Medical Center is also stopping all non-emergency procedures. And starting Monday, Tufts will delay some outpatient procedures such as eye surgery and colonoscopies “if postponing allows us to increase our ability to take care of inpatient or emergency care by using space or staff differently,” wrote Diana Richardson, chief operating officer, in an email.

Richardson says Tufts is telling patients these procedures may resume in January, depending on the hospital’s inpatient demand.

Walls urges everyone to consider what they can do to reduce hospitalizations: wearing masks, getting their vaccinations and boosters and being cautious about crowds during the holidays.

“All of us have an individual responsibility to work together,” Walls says. “We promise we’ll do our part in the hospital system but we’re hoping others will do their parts too.”