Victorian hospitals make seismic changes to deal with tsunami of the unvaccinated



Orthopedic surgeons, consulting physicians, theater staff, neurologists and even psychiatrists are seconded to help in coronavirus wards and moved to other sections of hospitals to help with the COVID-19 response.

Several high-level health sources not authorized to speak publicly said there had been high-level discussions about the possibility of creating “streamlined” hospitals for emergency surgeries like ruptured aortas. , heart attacks, organ transplants and traumatic incidents, and how it could be done without compromising patient safety.

Large hospitals with pediatric units are also debating whether to shut down these wards and send all children to Royal Children’s Hospital or Monash Children’s Hospital.

“They are as busy, but not as busy as all adult hospitals,” a source said.

Private hospitals, including those run by Epworth Healthcare, now account for the lion’s share of emergency and trauma surgeries.

During this time, Sunday age may reveal that states have been asked to ensure they have plans ready to deploy volunteer nurses or other staff to Victoria, or any other jurisdiction that requests it, as part of an agreement long-standing response to emergencies through the National Standing Committee on Health Emergencies.

This week, Victorian Minister of Health Martin Foley announced that 1,000 healthcare workers living abroad, including Australians abroad, will be recruited and offered reduced relocation costs, in a attempt to ease the pressure on the hospital system, in addition to the 350 already recruited. And recently, dozens of nurses in Melbourne took refresher courses to prepare them for deployment to intensive care.

Victoria Hospital’s oversight body, Safer Care Victoria, has developed guidelines on staffing plans for health services, and the Victoria Department of Health has confirmed some hospitals will make changes to their “model of care”. For example, anesthetists might need to work with other intensive care physicians.

However, some senior doctors are concerned that while hospitals each have their own contingency plans to increase hospital capacity, the state response still lacks central coordination and there is growing concern that patient care may be overwhelming. compromise for non-COVID medical emergencies.

“It would be very helpful if everyone across the state had a cohesive and consistent plan of what they are going to do, rather than 81 different health departments operating on their own,” said the AMA president. Victoria, Roderick McRae.

The worst is yet to come. Saturday saw a dramatic increase in hospitalizations – an increase of more than 100 admissions in a single day. COVID-19 response commander Jeroen Weimar explained that the reported hospitalizations were the result of cases first detected 10 to 14 days ago.

Last year, medical staff specializing in COVID at Sunshine Hospital.Credit:Jason South

Earlier this month, triage tents began pitching outside major metropolitan hospitals in an attempt to reduce pressure on already strained emergency departments – including Sunshine and Footscray – with some nurses saying Sunday age this week it looked like they were preparing for a war. New COVID-19 services have been rolled out in hospitals in the western suburbs in recent days.

Western Health ICU director Craig French said entire families were scattered in beds at Sunshine and Footscray and all of the intensive care patients this week were younger than the 56-year-old doctor. None have been vaccinated.

“These people are incredibly sick and they need high levels of oxygen and usually invasive or non-invasive ventilator support,” Associate Professor French said.

The number of available intensive care beds in Victoria has increased by around 20% since the end of September to 484. At the same time, the number of COVID-19 patients requiring intensive care has almost quadrupled to 163.

Additional capacity had been found by canceling elective surgery, only those most in need of urgent treatment now have procedures to follow.

“The reality is that we have 700 occupied beds today with COVID patients. They are sick and need this treatment, and that means others have to postpone treatment where possible, ”Weimar said.

On Saturday, the Victorian opposition highlighted the case of Chase Arnesen, who said a planned surgery to remove a tumor affecting his hearing and balance had been canceled indefinitely. He is one of more than 66,000 Victorians waiting on the waiting list for elective surgery.

Opposition health spokesperson Georgie Crozier said the state government had “18 months to prepare our health system. [and] They did not do it “.

As Prime Minister Daniel Andrews and healthcare workers have often reiterated, it is not a lack of physical beds or ventilators that will be the challenge, but a limited number of staff, especially nurses. And those who work within the extended system have been warning about burnout for months.

“It’s really tough, the workload is tough, the PPE is sinking into your skin,” said Narkitaa Van Ekeren, head of the intensive care nursing unit at the Northern Hospital.

“Your skin is itchy and you end up with irritation. There is a feeling of thinking “when is this going to end?” But the staff are not giving up. They keep coming back every day and I’m really proud of it.

Unlike last year, when people with COVID-19 weren’t so sick, almost all of the patients admitted to the hospital’s intensive care unit have lung failure, and they come to intensive care extremely tired, sweaty. , their skin tinged with gray.

“They are breathing very hard, they cannot speak properly, they have difficulty breathing, it is like they have just run a marathon,” said Ms Van Ekeren.

“We see it on a huge level with Delta. It is quite shocking. The patients are also much younger. We have patients as young as 21 in intensive care.

There are worrying official predictions about the impact of the growing wave of COVID-19 patients, not just on those with the disease, but on all sick Victorians. A brief document released by the Victorian government when it announced its roadmap to exit the lockdown in September presents one of the most candid representations of what Victorians should expect as they begin to demand their freedoms.

Stage two of the five-stage plan was already triggered when COVID-19 hospitalizations reached 600 patients last week, leading to more canceled elective surgeries and a shift to new workforce models at some hospitals .

If the number of COVID patients increases by an additional 200 people, elective category 1 surgeries – supposed to be performed within 30 days – could be suspended.

If more than 2,500 COVID-19 patients are admitted to hospital – a scenario seen in 63% of roadmap simulations conducted by the Burnet Institute – hospitals can only treat the sickest patients.

This could see a double peak in demand around December, when COVID-19 cases are expected to be at their highest, but also when more patients start returning to hospital in greater numbers – the result of accidents car, sports or alcohol – as restrictions ease. .

“All of these unvaccinated people will start getting COVID-19, along with all the other things that happen when the community starts to open up, so I think our hospital systems are really bracing for a pretty overwhelming increase in referrals,” said emergency doctor Simon Judkins.

Ms Fitzpatrick said you would be hard pressed to find an area of ​​the state’s public hospitals that is not under extraordinary pressure.

“There isn’t a place where people don’t get run over. Emergency services are very difficult, COVID services are especially heavy, maternity services are stretched, it’s so widespread, ”she said. “If you’re not in a COVID zone, you are removed from your own zone to help and that leaves that zone short. “

She said healthcare workers went to extraordinary lengths to ensure those who died were comforted in their last moments or had a family member by their side.

“The length that people are going to get is incredible,” she said. “It’s amazing and it’s just a testament to the quality of the people who work in our health care system.

With Annika Smethurst

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