Palo Alto Medical Foundation, Kaiser Permanente and Stanford Health Care are canceling routine and "nonessential" procedures, including elective surgeries, to protect workers and make them available to care for coronavirus patients as the need arises. The medical centers are also offering alternative options for patients to receive care, such as car clinics and virtual visits.
Sutter Health, which includes the Palo Alto Medical Foundation, on Tuesday began postponing elective procedures such as mammograms, minor surgeries and vaccinations that can be safely rescheduled at its hospitals. "This decision was made to help preserve capacity to address critical needs as they arise," the health care company said in a statement.
Sutter Health began calling patients in the last couple of days and sending emails to cancel services such as routine testing and vaccination clinics, Dr. Rob Nordgren, area CEO of Palo Alto Medical Foundation and Sutter Health Peninsula Region, said by phone on Wednesday.
"We're trying to keep patients as safe as possible, and keep staff and clinicians healthy, and we are efficiently using resources like gowns, gloves and masks," he said.
The clinics are better able to manage safety-equipment resources by cutting back on the nonessential visits. People will receive diagnostic procedures and treatments in person for chronic and suspected conditions such as cancers, he said.
Sutter is triaging patients through a variety of means before sending them to see a clinician, including through video, virtual visits and online assessment programs to actively reduce the need to come through the facilities, he said. Most patients are able to stay at home and do self-care without on-site examinations, he said.
For more serious respiratory infections, Sutter is holding "car clinics" that launched last week. Patients who are members of Palo Alto Medical Foundation and Sutter Health are referred by a clinician for an exam while sitting in their vehicle. He stressed that these clinics are not open to without a doctor's referral or to non-Sutter patients.
There are several car clinics across Sutter's network with clinicians and staff set up in a tent with exam room equipment from 8 a.m. to 5 p.m. They come out in protective gear to examine the patient in the vehicle or on a chair outside of the car, where they perform assessments such as listening to their lungs and taking temperatures. A portable X-ray machine is also on site to check for potential lung infections.
The patient is then given instructions for the next steps in their care, including if they need hospitalization.
The clinic service has ramped this week. Between 150 and 200 patients with respiratory issues per day have received care at their Palo Alto and San Carlos sites combined, Nordgren said. There have been a few hospitalizations as a result of the exams, but that is typical, he said.
Nordgren said that staffing levels are currently adequate at PAMF. When a staff member comes into contact with a patient who tests positive for COVID-19, the staff member stays home until they have tested negative for the virus.
The shelter in place has affected other staff members, however, who have kids and have found their child care has been canceled.
"We are closely monitoring staff and making sure we have adequate staff, but it is certainly a concern if the virus spreads more," he said.
Some doctors who normally work in urgent care are being shifted to the respiratory clinic. Staff who are now much less busy in other departments because of the nonessential appointment cancellations are also being used to help as needed.
Kaiser Permanente has also canceled elective surgeries and procedures, the medical organization said Tuesday in a statement.
"The health and safety of our members, patients, employees and communities remains our priority. In alignment with recommendations from the Centers for Disease Control and Prevention (CDC) and the American College of Surgeons, Kaiser Permanente physicians are reviewing all elective procedures scheduled for this month to determine those that can be safely postponed,” the company said. Kaiser staff is contacting patients to discuss options for rescheduling appointments and to answer questions.
"We understand that this is an inconvenience, but for Kaiser Permanente and other health care providers this is a necessary step to slow the spread of COVID-19 and ensure that we continue to have the resources, capacity, and staff available to care for our members and the communities we serve.
"We are taking action to help slow the spread of COVID-19 in our communities while continuing to provide high-quality, safe care for our members. We are following the guidance of public health authorities for the safe isolation, testing, and treatment of patients suspected or confirmed to have the COVID-19 virus. While our medical centers are open and operating and are safe places to be, we are helping to support social distancing, crowd avoidance, and other techniques that help to prevent and slow the dissemination of COVID-19," the organization said.
Kaiser is offering members the option of video or telephone visits, where physicians provide guidance and make recommendations for next steps, including if an in-person visit is needed or recommended. Kaiser is also encouraging patients to use its mail-order pharmacy service to help members avoid unnecessary outings.
Stanford Health Care said in a statement that it is also limiting nonessential services.
"Stanford Medicine's operations, including Stanford Health Care, Stanford Children's Health, SHC-ValleyCare, University Health Alliance, and Packard Children's Health will remain open and available to patients. Essential therapeutic support for our patients, where cessation of the treatment could negatively impact patient outcomes, will continue with in-person visits," Stanford spokeswoman Lisa Kim wrote in a statement on behalf of the medical center.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and Almanac here.