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Massachusetts back to telling hospitals to reduce elective inpatient procedures

The state today ordered hospitals to dramatically reduce the number of elective procedures that would require patients to stay overnight or longer, not so much because of the rise in Covid-19 patients directly but because of hospital staffing shortages and because of the seasonal increase of people coming in with non-Covid-related conditions.

In its "guidance" to hospitals, the state Department of Health and Human Services says:

On a statewide basis, hospitals are currently operating at over 90% inpatient capacity even as many hospitals have reduced their non-essential non-urgent scheduled procedures and implemented organizational measures to expand hospital bed capacity; this is compounded by 500 fewer acute care inpatient beds available as compared to January 2021 as a result of unprecedented staffing shortages. Furthermore, historical trends indicate that hospitalization rates increase by over 10% from late November through January.

The guidance does not apply to specialty hospitals or hospitals that have a certain minimum of free beds. The state had told hospitals last month to cut back elective inpatient procedures by 33%.

DPH defines non-essential, non-urgent scheduled procedures as procedures that are scheduled in advance because the procedure is not a medical emergency and where delay will not result in adverse outcomes to the patient’s health.

This reduction does not apply to ambulatory services that are not likely to lead to inpatient admission and preventative services, pediatric care or immunizations, pregnancy terminations, and essential, urgent inpatient procedures that have a high risk or would lead to a significant worsening of the patient’s condition if deferred. Accordingly, such services and procedures should continue.

The state also gave hospitals more flexibility to assign ICU nurses to other units, especially if they can help reduce the need for hospitalization - for example, by work in the emergency room.

In addition to telling hospitals to curb certain elective procedures, the state is also giving them permission to use space not normally allowed for care for non-invasive outpatient procedures and to use "alternate licensed inpatient spaces" for patients requiring hospitalization. These spaces have to meet certain standards for spacing between beds and easy access to medicine, medical equipment and hand-washing sinks.

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This is where hospitals and doctors are supposed to be the cream of the crop. Two friends of mine had major surgery. On on a heart valve transplant and one a colon removal. Both were released in 2 days. Both ended back in emergency the 4th day. Is this the reduced level of ethics?

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What unethical things did your friends do?

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From an insider's view, alarms bells are ringing across the state and country, across divisions in hospitals. People who thrive on stress, such as healthcare workers, or associated IT workers like me...we can look completely fine until we're not fine.

--------------------Trigger warning on burnout / anxiety / depression------------------------------

The stress of the pandemic, now the latest variant, and running around to keep everything running in a second year of firsts has raised my stress level to levels where I required hospitalization. I had to be hospitalized at a place where I used to work. That in itself is stressful.

To answer your question though, this is not reduced ethics. Doctors, nurses, and everyone else working in a hospital can feel crippling anxiety just like anyone else, once the usual routines are out the window. And because we have no idea when things will be normal again. The issue is that we usually don't feel it, and now we are all reaching our breaking points. Apparently, the breaking point long term is around 2 years, especially around holidays.

And the hospitals, state, and CDC are aware, that the normal release valves of managers, HR, 24/7 employee assistance programs, etc, are barely catching the most seemingly functional of us, who have been keeping it together until we couldn't.

I think the more other people start recognizing that, the fewer of us that will end up in the ED.

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Is this the reduced level of ethics?

This is being driven by insurance companies. They are telling hospitals to discharge patients as soon as possible, so they can stop paying for the room. Hospitals are feeling the shortage of rooms, which makes them more willing to go along with the insurers.

In essence, it is an ethical failure. The kind you get when parasitic profit-driven entities are making decisions about peoples' medical treatment. We still need single payer.

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If you were the one paying the bill at the current costs of staying in an American hospital, wouldn’t you want the stay to be as short as necessary?

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If you were the one suffering a medical crisis, wouldn't you want the necessity of your staying in the hospital to be up to your doctors, not some rent seekers?

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But that assumes that the only decision maker on the hospital side is the physician attending to your medical needs. The insurance company isn't your friend but neither are some of the folks running the hospital you've sought medical treatment from.

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Nothing to do with covid, from which we've been independent for almost half a year now.

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I don't know what you're trying to say with "we've been independent," but "nothing to do with covid" is ... wrong. The reason there are staffing shortages is COVID, The reason ICUs are at over 90% is COVID.

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I'll also add this: Over 90-95% of the Covid-19 cases who end up in the hospitals, being intubated, and/or dying from Covid-19 itself are unvaccinated. It's absolutely and totally disgusting, and many health care professionals are running out of sympathy for these people.

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Insurance companies shouldn't pay for care of anyone unvaxed (unless legitimate medical reason), it's a "choice" right? Then it's the unvaxed choice to come down with Covid and pay for it themselves.

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If insurance companies shouldn't pay for medical care for unvaccinated COVID patients, can they also deny coverage for HIV treatment when a patient chose not to take PReP?

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You know who are bigger scumbags than anti-vaxxers?

Insurance companies.

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I don't think this is accurate. While the majority of hospitalizations in Mass are in not-fully vaccinated people (even though that's only 27% of the population), there are enough breakthrough cases involving hospitalization that the ratio isn't nearly 90-95% (10:1 or 20:1). Specifically, last week the state reported 273 new hospitalizations of fully-vaccinated people, and 857 total. (This week's numbers aren't out until tomorrow.) That's more like 2:1.

Don't get me wrong — people who are choosing not be be vaccinated are absolutely the biggest problem here (and overall using the same numbers from last week about 5× as likely to end up in the hospital), but... I don't think exaggerating helps.

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Or if you don't like the BioBot poop data, there's the hospital bed count. https://www.mass.gov/info-details/covid-19-respons...

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"Independent," meant "free."

You know how spammers and scammers and trolls from other countries send emails that read funny because the translation function chooses the wrong words from the thesaurus?


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explain a lot of weird posts around here. Good catch @Brent Jeffries.

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