Local hospital systems are resuming nonemergency surgeries, which had been postponed since March 22 to prepare for an influx of people with COVID-19.


On April 17, Gov. Greg Abbott loosened surgery restrictions in Texas and as of Thursday, will allow nonemergency surgeries. Hospitals must reserve at least 25% of their capacity for treating people with COVID-19, and they cannot request any personal protective equipment from any public source "for the duration of the COVID-19 disaster."


St. David’s HealthCare locations will resume the nonemergency surgeries as early as Monday, according to a statement from the hospital, as will Ascension Seton hospitals. Baylor Scott & White Health began a few cases on Friday, with the majority starting on Monday.


Each hospital system has slightly different plans. Baylor Scott & White will assess each patient’s case independently and evaluate whether they need to be tested for COVID-19 and what safety measures are needed.


Ascension Seton plans to prioritize the most urgent surgeries first — those that cannot be further delayed and do not have an alternative for care.


Dr. J. Stuart Wolf Jr., co-chair of the Ascension Texas Surgery Network Clinical Care Council, says it is very much not business as usual. He gives an example of two patients who both need hip replacement surgery. The one who can manage by taking some ibuprofen will wait to have surgery. The one who is wheelchair-bound and at risk for blood clots will be prioritized.


By phasing in surgeries, Ascension Seton’s physician leadership is considering, "what is the safest approach," said Andy Davis, president and CEO of Ascension Texas. "It’s not about the economical approach."


Ascension Seton hospital staff are watching their dashboard that includes hospital capacity and number of patients with COVID-19. Ascension Seton hospitals have averaged about 50% capacity, and the number of COVID-19 patients has been a single-digit percentage of all patients in their hospitals, Davis said.


The next two weeks will be critical for seeing what Ascension Seton hospitals’ capacity will be and whether staff can clear the urgent cases first and then start treating less urgent and more elective cases.


All scheduled surgery patients will be tested for COVID-19 at least 48 hours before planned surgeries and must have a negative result to undergo surgery. Patients are being asked to quarantine themselves away from other people in the time between the test and surgery.


Each Ascension Seton hospital will have a dedicated separate entrance for surgical patients.


Ascension Seton also is changing the way it handles COVID-19 patients. All its hospitals can test for the disease. Anyone who tests positive and requires admission will be transferred to either Seton Medical Center, which has its highest level of cardiac care including extracorporeal membrane oxygenation machines that are sometimes needed for COVID-19 patients, or Dell Seton Medical Center, which is the only Level 1 Trauma Center in Central Texas. Pediatric patients will remain at Dell Children’s Medical Center. Those two adult hospitals also have been where most of the COVID-19 patients are arriving.


By relegating COVID-19 patients to only two hospitals, Ascension Seton says it will be able to more safely care for those patients as well as more efficiently use its resources, including staff and personal protective equipment.


Staff have created a plan to safely transport COVID-19 patients between hospitals, down to details including which pathways they will travel inside hospitals.


Ascension Seton is recommending that patients come to an emergency room only for an emergency, including difficulty breathing with COVID-19. To get tested or for nonemergencies, they should call their primary doctor first.


All hospital systems are reminding the community to not avoid seeking care for other symptoms and illnesses because of COVID-19, but to call their doctors first.


Dell Seton and Seton Medical Center still will care for non-COVID-19 patients and perform surgeries, but some doctors might choose to have their surgery patients move to other hospitals that might have more capacity than the two adult hospitals treating COVID-19.


All the hospital systems have reduced the number of visitors in hospitals, allowing only one adult visitor for pediatric patients, women giving birth or postpartum, people receiving end-of-life care, people with disabilities and people requiring surgery. All other patients are not allowed visitors.


Hospitals also limited the number of people in their facilities by offering virtual appointments, for which the governor loosened restrictions during this time, and drive-thru testing and specimen collections before and after surgeries.


Visitors, patients and staff who come into the hospital systems’ facilities are being screened with questions about their travel in the last 14 days, and whether they have had a cough, fever or shortness of breath. Some locations are adding questions about diarrhea, and loss of taste and smell. They are also doing temperature checks.


Ascension Seton is requiring masks to be worn by everyone it its facilities.


Even since March 22, surgeries have been happening at all local hospitals for emergencies and even cancer biopsies when it was life-threatening.


"While we postponed many surgeries and procedures following the governor’s March executive orders, we also – in compliance with those orders – continued to safely treat thousands of patients with emergent conditions over the last few weeks. In fact, currently around 90% of our hospital inpatients are not COVID-19 patients," Baylor Scott & White Health said in a statement.


The governor’s elimination of elective surgeries on March 22 was done to ensure that hospitals had enough supplies of things such as ventilators and personal protective equipment.


Hospitals are continuing to monitor that situation.


"Our supply chain continually works with epidemiologists and data scientists to track usage and demand so we can allocate PPE appropriately and preserve adequate inventory," David Huffstutler, president and CEO of St. David’s HealthCare, said in a statement.