Despite renewed calls to wear masks, many Australians are now working, shopping and socialising as if the pandemic had already been relegated to the history books.
COVID-19 is still a very present and unwelcome reality for Australia’s hospitals, though.
In a May 2022 piece entitled, ‘Cases are high and winter is coming. We need to stop ignoring COVID-19,’ two Australian academics sound the alarm:
‘The health care system right now is in crisis throughout the country with people dying waiting for ambulances, record levels of ambulance ramping (where patients wait with paramedics for medical attention), prolonged emergency stays for patients in overcrowded departments, and hospital staff shortages.
…With winter here, and more people gathering indoors as the weather turns cold, COVID-19 cases are again on the rise in tandem with influenza.’
Australia’s hospitals in 2022
Years of underfunding meant the hospital system was struggling to meet the needs of a growing, ageing and chronically ill population, even before COVID-19 further increased pressure.
The Australian Medical Association’s (AMA) public hospital report card for 2022 is sobering reading. During the 2020-21 reporting period, 1 in 3 patients waited longer than the clinically indicated 90 days for category 2 elective surgeries (including CABG and heart valve replacements), representing a performance decline of 17% since 2016-17.
The AMA observes that, ‘The decline is evident in almost all parameters of public hospital performance: emergency department activity, elective surgery activity and waiting lists to see specialists in the public hospital system.’
AMA president Dr Omar Khorshid states, “Ramping is rife and avoidable deaths are now an unacceptable reality. There are over 175 hospitals around the country that are showing one or more red indicators.”
This isn’t just a COVID-19 problem. And it isn’t new. The performance of our public hospitals has been declining for several years and, after years of continued neglect, they are now at breaking point [with some hospitals already cancelling elective surgeries].
Australian Medical Association
It certainly isn’t just a COVID-19 problem but COVID-19 does worsen it.
Relatively high rates of vaccination have meant that most COVID-19 patients experience mild illness and recover at home. But there are still many who become unwell enough to need hospital care. On 27 May 2022, for example, there were 2,863 people in hospital with COVID-19, including 99 in ICUs around Australia. By 2 August, those numbers had risen significantly with 4,999 COVID-19 patients in hospital and 178 in ICUs across the country. That’s nearly 5,000 beds that have had to be freed up for COVID-19 patients. It’s no wonder that some hospitals have made the difficult decision to suspend elective surgery yet again.
Redesigning the system
The AMA argues that, ‘We need appropriate funding to clear the backlog of elective surgeries, and to build enough capacity to meet the growing needs of the community.’
It’s a similar picture in the UK. Cherry Lee is a UK health leader who has led multiple teams through Urgent and Emergency Care (UEC) operations, within a large acute National Health Service (NHS) Trust and then as the Regional Head of UEC Operations. She observes that,
The infection prevention and control pathways, along with huge staffing resource challenges due to staff sickness and isolation processes, along with an overall deficit in clinical, care and social care workforce recruitment and retention, have led to the perfect storm for healthcare systems in terms of acute hospital capacity…
The challenges we face are profound and long term, thus require longer term, strategic and often radical solutions to reset the use of acute services to support the urgent and emergency care pathways, and redesign the elective and diagnostic pathways to create the ability to overcome the backlog.
Currently, healthcare is mostly designed around the hospital, which exerts a gravitational pull on patients. Whether it’s for emergency treatment, urgent care or elective surgery, patients are all sent to hospital.
Redesigning the healthcare system involves considering the different needs of those patient groups. In a reimagined system, acute hospitals would exist primarily to meet urgent and emergency care needs, including those of COVID-19 patients. Meanwhile, COVID-negative patients seeking many types of elective care would follow a different pathway, not to the hospital but to a separate facility geared to their needs.
As Lee argues,
In order to support any healthcare system’s approach to restoration and recovery of their elective pathways, alternative capacity options that support the safe isolation of these pathways from the challenged acute setting would provide an option for delivery of a proportion of elective and diagnostic services. Thus, reducing the demand overall on the acute capacity.
Diverting some elective patients into self-contained minor surgery units could help to free up the acute sector for more complex or unpredictable procedures. As Lee states, ‘This is not a unique nor new concept, yet in reality, it can be seen as challenging to deliver and requires buy-in from clinical leaders, senior healthcare and operational managers and patients alike.’
That buy-in has already begun. Part of the UK’s COVID-19 response involved creating ‘surgical hubs’ separate to mainstream hospitals where planned surgery could continue with minimal risk of COVID-19 infection there.
The Royal College of Surgeons in England strongly advocates for this model and research shows that many patients are in agreement – 58% said that, if they needed an operation, they would prefer to be treated in a surgical hub (defined as a hospital that is not treating COVID-19 patients) while 73% said they would be willing to travel to such a hub if it was not their nearest hospital.
The concept of surgical hubs can be found in the Victorian government’s COVID-19 recovery plan. Rapid access hubs are being established in metropolitan public hospitals, exclusively to perform specific surgeries such as hernia repairs, cataract surgeries and joint replacements in a system that allows operating rooms, equipment and staffing to be streamlined. While still part of an acute hospital, the rapid access hub focuses exclusively on elective surgeries.
The Victorian government is also transforming Frankston Private Hospital into a public surgery centre with the capacity to support up to 9,000 public patients per year once fully operational in 2023. With no emergency department diverting healthcare workers to more critical patients, this facility will be focused on COVID-19 catch-up care.
Mobile and modular supplementary infrastructure offers an attractive option to hospitals wishing to create additional capacity for elective surgery. Almost any surgery that does not require the use of heavy robotic equipment can be performed in such a facility, which can also feature a recovery ward next to the operating room. The possibilities and potential site locations are almost endless but, once agreed, the service can be delivered rapidly, enabling hospitals to begin addressing historic waiting lists and enhancing capacity.
Q-bital Healthcare Solutions is a global supplier of mobile, modular and mixed-modality healthcare facilities. Contact the Q-bital Australia team for more information.