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How Mission Health Decides To Test Surgery Patients For COVID-19

Courtesy of American Journal of Surgery
This is the algoritm that was tested in the American Journal of Surgery. Mission Health uses a similar algorithm.

Since March, more than 9,000 cases of COVID-19 have been confirmed in BPR’s Western North Carolina listening area.  Most of those cases end up at the region’s biggest hospital, Mission in Asheville.  Dr. William Hathaway is Chief Medical Officer there. He says the hospital has been following CDC guidelines around patient testing.

“One of the places where we were most concerned about testing has to do with pre-procedural testing. So when you come into the hospital, who can you test and who should you test?” asks Hathaway, who is also senior VP for the NC Division of HCA.

Hathaway is referring to testing patients who are at Mission Hospital for surgery unrelated to COVID-19. When a patient comes in, staff follow an algorithm to decide to test patients for COVID-19 before they go under the knife – unlike some other hospitals around the country that test every surgery patient.

This strategy is outlined in astudy published in the American Journal of Medicine that follows 5 HCA Healthcare divisions that use the algorithm vs. 10 HCA divisions that do universal testing for surgery patients. The study finds that the percent of positive COVID-19 tests is about the same. The study was conducted in May and published in July.  

“If you are having a skin biopsy or something else that is much more low risk then it far less relevant at that point and time. So that is when we don’t rely on testing to protect people. We rely on masking,” says Hathaway.

You can read more about HCA’s COVID-19 masking policy here.

Dr. David Weber is a physician and public health epidemiologist at UNC-Chapel Hill. Weber says that testing surgery patients for COVID-19 has become more important as physician’s have learned more about the disease and community spread has increased.

“If you have COVID – pre-symptomatic or asymptomatic – and you undergo surgery then you have higher risks from the surgery, complications and higher mortality,” says Weber, adding that his concern is for the patients.

Weber explains that UNC Hospitals test every patient pre-surgery for COVID-19, despite the fact that the asymptomatic positive rate is below 1 percent – just like what is seen at Mission. He says there is some merit to the algorithm method: 

“It is more efficient and less costly but it does mean that you will miss some people who don’t fit into that high risk group,” says Weber.  

The study of HCA’s algorithm showed that $15,000 was saved per COVID-19 positive by only testing high risk patients. For Weber that cost savings does not equal the potential for loss of life.

According to Mission Health, all of the COVID-19 tests done on patients -  including inpatient, ED, ambulatory and pre-surgery -  around 40 percent were for presurgical indications and 1.3 percent of these were positive.

Meanwhile, Hathaway says that he fears that COVID-19 concerns are deterring people from coming to the hospital. Mission Health has seen a “significant decline” in heart attack and stroke patients at the hospital. Hathaway wants to warn patients that an untreated incident like this can be very dangerous. 

Mission Health Nurses Complaint

Nurses at Mission Hospital put forward a complaint to OSHA in August that they are not notified of COVID-positive patients or co-workers. 

Mission Health Spokesperson Nancy Lindell shared this statement in response to the OSHA complaint:

“We’re proud of our response and the significant resources we’ve deployed to help protect our colleagues. Meanwhile, the NNU has chosen to use this pandemic as an opportunity to gain publicity by attacking hospitals across the country,” says Lindell in an email, referring to National Nurses United union.

Mission Health reports that about 1.5 percent of its staff has tested positive for COVID-19  as of September 11. Mission that most of those people are believed to have gotten the virus outside of work. Hathaway says that the ration of those testing positive from their work at the hospital is about 1 to 7.

Mission Nurses voted to unionize at the beginning of September. The vote was by a margin of more than 2-1.

Lilly Knoepp is Senior Regional Reporter for Blue Ridge Public Radio. She has served as BPR’s first fulltime reporter covering Western North Carolina since 2018. She is from Franklin, NC. She returns to WNC after serving as the assistant editor of Women@Forbes and digital producer of the Forbes podcast network. She holds a master’s degree in international journalism from the City University of New York and earned a double major from UNC-Chapel Hill in religious studies and political science.
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