Friday, 3 April 2020
DHB Hospital Services Activity Update 1 Dear GP and PHO Colleagues, We sincerely appreciate the patience and understanding you’ve extended to us over the last two weeks whilst we’ve been navigating and adapting to the significant changes required of our hospital and community health services. I recognise that there is uncertainty about which DHB-provided services are currently available. This email is our first communication aiming to bring as much clarity as we can in what is a volatile and changing situation. We will be aiming to communicate every week from after Easter to keep you up to date as things develop. For context, the factors which determine our ability to provide DHB clinical services include: • • •
The number of available staff (largely determined by isolation and quarantine criteria) Guidance on expectations from the Ministry of Health The impact of COVID-19 volumes on either individual hospitals or individual specialties
Inpatient surgical activity Our hospitals in Whakatane and Tauranga are currently operating at around 50% inpatient capacity and undertaking approximately 35% of our normal elective surgical volumes. This is consistent with most DHBs and is where the Ministry is expecting us to be at this COVID readiness stage. This allows us to ensure an optimal flow of acute surgery (ie minimising acute backlog) and be able to respond quickly when our COVID surge commences. This reduction in inpatients has resulted from implementing the Ministry’s expectation around elective surgery which is to undertake “Urgent and Non-deferrable” inpatients only. There is much discussion about the detail of this definition across the sector. The more patients we bring in for less urgent but important surgery, the more risk we expose our hospitals (and other patients) to. Therefore, our assessment of urgent suitability for surgery is being assessed on a case by case basis in consideration of the presenting problem, the likelihood of health status deterioration over the coming 12 weeks along with a degree of social situation consideration in some cases. Similar principles apply to colonoscopy procedures. We are working with Grace Private Hospital as a partner in our business continuity approach and intend to increase the number of patients receiving urgent and non-deferrable elective surgery through Grace over the coming weeks. However this also has to take into account the risk of a COVID positive (but asymptomatic) patient being admitted to Grace, subsequently diagnosed and resulting in the Grace team having to go into quarantine and being unavailable to us. The principles and considerations above apply to all specialties. Outpatients Most outpatient consultations are now being undertaken by telephone or video (Zoom being the preference). This has generally worked well with people being very understanding as we’ve worked our way through implementing the new approaches. Any feedback you have would be helpful to aid our learning and please feel free to email: ProviderServicesSupport@bopdhb.govt.nz
The Ministry’s expectation on outpatients is that these are minimised and over the last two weeks we have only been seeing Grade 1 urgent referrals. We appreciate that a number of new referrals have been returned to the GP to manage and that this is problematic for you and results in considerable uncertainty for patients. This issue is a current discussion with our Senior Medical Staff (today) and we agree with feedback that this is not the best approach. We aim to set out a proposed more suitable approach next week after wider internal discussion. Radiology Hospital based radiology referrals are being seen on the same basis as inpatient activity – ie Urgent and non-deferrable. After nearly two weeks we are recognising the need to be more explicit about what this means whilst ensuring that we remain within MOH guidance and consistent with our national DHB colleagues. The Intel Team in our Emergency Operations Centre has been working hard to develop new tools to provide daily and weekly service monitoring visibility. This functionality is expected over the coming week and will enable us to provide you with a more comprehensive picture of the current service levels after Easter weekend. Meanwhile, if you have any specific feedback or general questions (ie not about individual patients) please don’t hesitate to email us at: ProviderServicesSupport@bopdhb.govt.nz Best regards,
Pete Chandler | Chief Operating Officer Bay of Plenty DHB 027 807 1937
Healthy, thriving communities Kia momoho te hāpori ōranga
pete.chandler@bopdhb.govt.nz