By Dr. Gajan Srikanthan, Director of Clinical Pathways

With coronavirus spreading and states ordering shutdowns, many hospitals went into crisis mode, putting a temporary stop to elective surgeries like hip replacements. Others that could be delayed without definite harm, such as treating certain types of cancer, were also postponed on a case-by-case basis.

As emergency rooms filled up with highly contagious patients, people became used to thinking of the hospital as one of the most dangerous places to go. After all, their new housebound existences were structured entirely around avoiding the need to go there.

Now that Covid-19 cases are declining in many places, and states are opening up for more business, patients are understandably skittish about coming back.

Medical providers are finding it a challenge to convince patients to return for elective surgeries, delayed interventions, and even necessary time-sensitive procedures to monitor chronic conditions. Even some patients with truly urgent conditions such as heart disease and stroke are wary of coming into the hospital, sometimes even delaying or forgoing lifesaving care.
Patients don’t feel safe in hospitals

The National Online Survey on Coronavirus, undertaken by Public Opinion Strategies and Jarrard, Inc., in April 2020, found that when asked to rate how safe they feel right now in healthcare facilities, 51% of respondents answered 5 out of 10 or lower. Even those who are involved in healthcare, such as healthcare workers and their family members, couldn’t bring themselves to score their feelings above a 6.

Among the 55% of survey respondents who postponed or canceled an elective procedure at the start of the pandemic, 35% did so because they didn’t feel safe entering a medical facility. Another 53% had their procedures canceled or postponed by providers, so it’s impossible to tell whether they would have done so themselves anyway at a later date.

When potential patients will be willing to return to the hospital is an open question. Those in households involved in healthcare are likely to return faster, though still 20% of them suspect it will take them at least seven months to feel comfortable again.

Of the 45% of respondents who haven’t had to delay or skip a medical procedure, 42% said they may not seek treatment for a future elective procedure due to feeling unsafe. The three things that would make most patients feel safer going to the hospital are (1) a drop in COVID-19 cases in the local area, (2) the restriction of COVID-19 treatment to separate facilities, and (3) their doctor reassuring them that it is safe.
The anxiety is real

Regardless of how safe hospitals actually are at this point, people’s anxiety over negative possibilities are a barrier to care. As states begin to open, 40% of Americans are worried about getting very ill or dying from COVID-19, and 62% are fretting about loved ones contracting it, according to a poll by the American Psychiatric Association. All this worry is having an impact: 36% say coronavirus is seriously affecting their mental health.

The fear of healthcare facilities is so strong that it’s even causing people to endanger their health by staying away. Afraid to come to the ER, people are dying far more frequently at home. Emergency medical services in Newark, New Jersey, pronounced people dead on the scene 239 times in April, four times as often as the previous year. ER visits at University of Rochester Medical Center in Rochester, New York, have dropped by 50%, with some heart failure patients only coming in when they can scarcely breathe.

With all this anxiety tipping over into potential self-harm, it’s important for providers to help patients take action to become informed about risk and shore up their emotional defenses as they contemplate returning to the hospital.

A recent study by researchers from the UK’s University of Oxford and Keele University tallied the most commonly cited evidence-based methods for reducing anxiety about coronavirus:

Healthcare providers can use these techniques to help reduce patients’ anxiety, but they will also need to convince them they will be safe when they do come into the hospital.

Patients need to know about all the practical steps providers have taken to make their sites safer, such as segregating COVID/non-COVID patients, new cleaning protocols, testing ALL patients prior to admission and virtual appointments where possible.

Patients also need to understand what they can do to minimize their own risk, for example self-isolation before their surgery, what to do if they develop flu-like symptoms and who to contact.

At times like these, patients need to feel engaged and informed.

This doesn’t necessarily need to mean an extra burden on staff to contact and reassure patients. Using “virtual” automated patient engagement technologies to communicate, instruct and assess patients is a smart play, as they have the triple advantage of:

Better ‘virtual’ care orchestration can help:

Getting patients to trust hospitals again will be an ongoing process for the foreseeable future, one that can be greatly helped by putting systems in place that help keep patients at home for as long as possible, reduce cancellations, minimize patients’ exposure, and smooth their medical experience.

The need for providers to implement these systems quickly is why we have put together the Virtual Care Playbook for Surgery a “back to surgery” proposition that shows providers how to improve care orchestration, safety, and patient confidence.