Vero Beach, Fla.-based Vero Orthopaedics & Neurology has restarted elective surgeries in accordance with Gov. Ron DeSantis' recent guidance and is expected to return to pre-pandemic patient volumes in the coming weeks.
Craig Popp, MD, a spine surgeon who has been with the group since 2017, spoke to Becker's Spine Review about increasing patient volumes at his practice and preparations for a potential second COVID-19 wave in the fall.
Question: How are you approaching the return to elective surgeries at Vero Orthopaedics & Neurology?
Dr. Craig Popp: We started off slow and steady to get the feel of how we're going to do things, such as our cleaning and intubation routines and ensuring patients receive appropriate COVID-19 testing. The first couple of weeks were a little slow, with some patients not wanting to come in for surgery and some physicians not having their patients ready to go. I've had a pretty steady flow of patients that required surgery or had increasing pain management needs, as well as a bunch of patients that were bordering on urgency. As soon as they were ready to go, they were first on the list to get done. We still have patients that require urgent care, so we have to make extra time, and the hospital is allowing weekend surgeries. At our ASC, we've increased surgical capacity, keeping both ORs open and having the staff available to do that.
Q: Has it been a challenge securing OR time in the hospital setting?
CP: The nice thing is we have surgeons who still have their block time. I've been very fortunate to be able to have extra time in the OR. Some physicians have not been ramping up as quickly, so there is extra time available. Over the next few weeks I think we'll see more of a crunch at the hospital for OR time. Currently, I don't have any weekend surgeries scheduled, but I'll be adjusting if necessary.
Q: What levels are both you and the practice operating at now?
CP: My capacity in the OR is 100 percent. Our surgeons playing catch-up are operating at 100 percent or more. The practice is pretty much at capacity in terms of surgeries, and the office is operating at about 80 percent. There are two things that play into that in our community — the "snow birds" heading up north affects that a little, and there are also some patients who are hesitant to have surgery at this time.
Q: How long do you think it will be before your practice returns to pre-pandemic patient volumes?
CP: That's going to be patient-driven. Patients are going to have to feel comfortable making an appointment and coming in. Some patients coming in have more serious conditions because they have delayed surgery for a while, so they're either in more pain or their condition has digressed. Some patients couldn't do their physical therapy, as that was also shut down. A lot of the patients coming in are a little further behind, but I think we'll be approaching pre-pandemic levels in the next couple of weeks.
Q: Are you seeing a lot of reluctance from patients to have their surgeries done due to COVID-19 concerns?
CP: Some patients are giving it a little bit more time. Some are trying to head back up north and delaying the surgery until they get back in the winter or fall, and I had some patients that were very hesitant about proceeding immediately before the pandemic. They're asking if they can be put on the schedule four or six weeks from now to see what direction the pandemic is going.
Q: How is your practice preparing for a potential second COVID-19 wave in the fall?
CP: We had a great game plan as a group to spread people out during the initial portion of the pandemic. We still had patients that needed their post-op visits, acute patients coming in from the ER and patients with pain-related issues that we needed to examine to see if there was anything more serious going on. We broke up into two teams because we didn't know what would happen if one of the physicians, medical assistants or administrative staff got sick. If a large number of us were sick, how would we be able to run the office and take care of patients?
So, we grouped into an A, B and C team and worked on alternating days. We conducted a terminal clean every evening, we didn't allow staff from one team to work with another team. Our team was kept separated, which enabled us to distance nicely. We didn't have any crowds in the waiting room or hallways. We also instituted a system with people's cellphones, where we would have patients wait in their car or outside the office and let them know when to come in via text. The group also installed plexiglass dividers for our reception area, checkout areas and anyone doing any scheduling. We check our staff for temperatures every morning. We're continuing to take these measures, and if a second wave comes along, we're going to implement the same safety protocols.
We might reopen for weekend hours, which we did when we had the three teams. We may even spread things out more by looking into the evening and spreading visits out more. We have our playbook ready, and if a second wave comes around, we're going to dive right back into that.
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