Updating on hospital services from Pete Chandler, Chief Operating Officer at BOPDHB Dear general practice colleagues, In the light of the Prime Minister’s update on moving to Level 2 we are now working through the implications for the further expansion of our DHB provided care services. Meanwhile, I thought it would be helpful for you to see how hospital activity has tracked during the Level 4 and 3 periods of the last few weeks. Data from April, along with new reports we have been working on, is starting to come through and I’ve assembled a range of datasets below for your reference. Over coming weeks we will be working hard to try to understand important unmet need and prioritise meeting this in our Recovery approach. Our DHB provided services are operating at around 65-70% of normal activity in many areas now, although outpatients is still focussed on urgent and high priority referrals. We continue to put considerable effort into reviewing and re-prioritising patients where updated information changes their priority status. A key element which determines how much work each service can provide is the number of staff who are isolated because of age or underlying health conditions but we expect that at Level 2 most staff will be able to return to the clinical frontline. Currently approximately 8% of our workforce are in isolation at home for this reason. Work to identify the quantum of clinical service backlogs is progressing well and we have already identified ultrasound as specific area where we are going to need an outsourcing approach as we have a COVID related backlog of several hundred treatments. Discussions are underway with the private sector in relation to undertaking elective surgery to help with our backlog and a reminder that we are selecting cases based on need and benefit rather than waiting time at the moment. At this stage, some of the patient groups that we are most concerned about are: • • •
Maori who have been afraid to engage with the health system due to COVID risk and resulting deterioration in health status Cardiology patients – we have seen a drop in people presenting to ED with chest pain and can’t be sure whether there has been an actual reduction, or a reluctance to present Mental health inpatients – there may be various factors impacting on acutely unwell patients requiring inpatient care but until we understand this in more detail we have a concern about pressing unmet need
Further understanding about unseen/unmet need will undoubtedly develop as well delve into the data; as always, if you have any questions or require further information please don’t hesitate to email us at: ProviderServicesSupport@bopdhb.govt.nz Pete Chandler | Chief Operating Officer See the charts below for detail about how our hospitals are currently working
FSA outpatient referrals This graph shows the number of referrals we’ve received since March, how many we’ve accepted and how many we’ve seen (most by telehealth). In the first week approaching lockdown it was clear that an increased number were being returned not accepted, however we addressed this quickly with our teams.
Outpatient Appointments This chart shows outpatient appointments by month over the last couple of years and the rise of telehealth by phone (red) video (orange) compared to the normal volumes of face to face (beige).
ED Presentations Showing the impact of lockdown on the numbers of people presenting to Whakatane and Tauranga EDs.
Hospital Occupancy We would like to maintain occupancy at or below 85% at this stage – although seasonal peaks of medical illnesses will impact on this (eg today Whakatane Hospital is at close to 100% occupancy because of a weekend influx of medically unwell patients).
Surgical Activity The middle chart in the below shows surgical activity against normal patterns (note that the darker colour front shape peak is last week’s activity, with the subsequent drop-off relating to the number of patients booked so far for future weeks, rather than a planned reduction in activity. As of this week, over 80% of our theatre sessions on both sites are operating.