As patients return, surgeons at CHRISTUS children's hospital learn to 'smize'

April – May, 2020

April 23, 2020

The Children's Hospital of San Antonio is among the CHRISTUS Health hospitals in Texas that resumed elective surgeries on Wednesday. The surgeries had been suspended since last month due to restrictions related to the COVID-19 pandemic.

Surgeries dropped by about 60% at The Children's Hospital of San Antonio since restrictions limiting procedures to emergency or lifesaving situations went into place last month amid the COVID-19 pandemic. On Wednesday, five days after the governor eased the restrictions, the hospital and others in Texas that are part of CHRISTUS Health resumed electives surgeries.


As the hospital welcomes more surgical patients back while its COVID-19 precautions such as universal masking remain in place, Dr. Ian Mitchell, chief of surgery, said he and the other surgeons at the children's hospital are relying on new tactics to put their young patients at ease, including smiling with their eyes above their masks.

"Even silly things like the surgeons learning to 'smize' is an important part of reassuring the kids and their families that this is a place that shouldn't be scary," he said.

Like their counterparts in Texas, CHRISTUS hospitals in Louisiana and Franciscan Missionaries of Our Lady Health System' Our Lady of the Lake Regional Medical Center in Baton Rouge and its affiliated hospitals will be resuming elective surgeries on Monday. The hospitals' resumption of those services comes as officials across the nation begin to pull back on some of the stringent measures enacted as the deadly and highly contagious virus began to spread through community transmission.


Dr. Sam Bagchi, executive vice president and chief clinical officer for CHRISTUS, said that some of the procedures deemed elective include surgery for heart disease, cancer, pain, vision problems and other serious and progressive conditions. "We are working to avoid a surge in illness and suffering as a result of deferred and delayed care," Bagchi said.

No easing of precautions
Bagchi stressed that even with the easing of surgery restrictions, CHRISTUS hospitals will not be ending the precautions put in place in response to the pandemic. Those include:

  • Limiting visitors to one per patient.
  • Screening all visitors, staff members and vendors who enter the facilities for signs of coronavirus infection.
  • Isolating COVID-19 patients to dedicated care units.
  • Comprehensive cleaning and sterilization.
  • Universal masking for everyone on the campuses.
  • Using telemedicine to communicate with COVID-19 patients, so their caregivers and support staff limit the number of times rooms are entered.

CHRISTUS is using social media and working with newspapers and TV stations to communicate that it is keeping these precautions in place and adding others to protect the public and staff as operations ramp up, Bagchi said. One of the additional measures is the use of antibody screenings for some patients to tell if they have already been exposed to the virus and have built up an immunity.

Caution rules at Our Lady of the Lake
Scott Wester, president and chief executive of Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, said his hospital will not be in a rush as it restarts elective surgeries on Monday.


"We're being very conservative and very methodical, so our load of surgical business next week will be less than what it would be typically just to ensure we have the right processes and the right procedures to ensure the safety of our teams and our patients," Wester said.

Dr. Catherine O'Neal, the medical center's chief medical officer and an infectious disease expert, said the revised processes for surgical patients include asking them to quarantine at home for 10 days prior to their procedures. A separate virus testing site is being set up for people undergoing high-risk procedures to keep them away from people who are symptomatic.

w200423_Moseley Jeff

Jeff Mosely, vice president of facilities for Our Lady of the Lake, said extra precautions are being taken to clean the rooms where COVID-19 patients are cared for. This includes doing "terminal cleanings," which means every surface including walls and ceilings are wiped down, and the use of high-intensity ultraviolet light technology to sterilize the patient and treatment rooms. Starting next week, he said, the hospital will add in the use of an electrostatic sprayer that releases a fog of disinfectant into the rooms.

Prioritizing patients
At The Children's Hospital of San Antonio, Mitchell estimated that it could take two months to catch up on the backlog of procedures. Hospital leaders are still deciding whether to extend hours or allow nonemergency surgeries on weekends.

To address the backlog, Mitchell said doctors are working as a team to determine which patients get into operating rooms first. "The message that the surgeons are giving and are getting is that we're going to go through our highest priority patients first," he said, "and that means that some people that need an operation, but can wait a little longer, they may have to wait a little longer still because we have to prioritize those that are medically urgent."

Mitchell said that while the hospital had continued to perform emergency and lifesaving surgeries, even those numbers fell. That drop prompted concerns that pandemic-related fears were keeping children from getting needed care.

So far, no patients with COVID-19 have required surgery. But Mitchell said accommodations are in place, including an isolation recovery room, and simulations have been run in preparation for surgeries on COVID-positive patients. He said the hospital plans to test surgery patients for the illness as part of the pre-surgery screenings.

w200423_Cris Daskevich

Chief Executive Cris Daskevich said that early in the pandemic it was taking the hospital days to get COVID-19 test results back. Thanks to a new vendor, the turnaround time has been reduced to as little as 90 minutes.

She said the hospital will continue its strict protocols for treatment of COVID-19 patients. That includes isolating them from other patients and having them cared for by designated staff.

Reassuring families
The executives at both hospitals said they have plenty of the masks, gowns, medications and other crucial supplies being used in the care of patients with COVID-19.

If needed, Daskevich said CHRISTUS has processes in place to shift those supplies among facilities. "We will not do anything to jeopardize having appropriate protective equipment or medications or supplies here or across our system as we do additional surgeries," she said.

Daskevich acknowledged that families might be worried about the risk of exposing their children to the virus by bringing them to a hospital. She said extraordinary steps are being taken to mitigate that risk, including the screening of everyone who enters the hospital, universal use of masks and stringent sterilization of surfaces and gear.

She invited any families who want assurances of the hospital's safety to reach out. "We want families to know we're with them, we're here for them," she said. "We've created the safest environment we possibly can."

Copyright © 2020 by the Catholic Health Association of the United States

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