COVID-19 - Specialist Services in Level 3 Here is a message from Pete Chandler, the Chief Operating Officer of the hospitals in Whakatane and Tauranga: Dear All, Please find below a summary DHB Provider Services Update for your information which I trust will be helpful, especially as we move from Level 4 to Level 3. If there are any areas not covered, or any further clarity that you need, please don’t hesitate to ask. Apologies that this is quite long but hopefully it covers most things that people are seeking clarity on. 1. Overview Much of the last week has involved embedding the interim service changes that have been made, along with detailed planning for the change to Level 3 next week. Our ‘Pandemic Dashboard’ is continuing to be developed and as I said previously we will make this available to GPs as soon as we have it; bringing this to a conclusion has been slightly delayed to due to number and complexity of national data requests. Visibility of the service status across our whole Bay of Plenty Health network is most definitely the aim although it will definitely be built up in layers over time. One of our challenges is that data collection in many areas is based on a monthly cycle, when what we need for this endeavour is daily/weekly data, and in some cases such as CBACs we need close to hourly data. That said, we’re hoping to see a first cut dashboard next week. From a COVID-19 perspective we are currently assessing Whakatane Hospital as in ‘Green” status and Tauranga in ‘Yellow”. This means that we deem the risk (to and from) patients in the East to be negligible at this time, whereas there is a degree of risk in Tauranga because of the mental health service situation. A key focus of our management of waiting lists relates to the (best possible) ongoing review and reprioritisation of patients across all services as needed. Therefore if you are aware of a patient’s condition deteriorating please do let us know straight away. Hospital occupancy has gradually increased over the last week or so as has ED activity, although both are approximately 25-30% below normal levels for the time of year. 2. Moving from Level 4 to Level 3 Moving to Level 3 on Tuesday does not represent a huge change, but it will increase the number and range of patients we can see/treat. We need to maintain physical distancing for staff and patients wherever we can and also need to work within the constraints of the staff we have available, given that some are required to be in isolation currently. In addition (and I know you will have the same) we have revised protocols and infection control requirements which make all interventions more complex and time consuming. (a) Surgery During the Level 4 phase acute and cancer surgery has been prioritised, with elective surgery limited to ‘urgent and non-deferrable’ categories which accounts for about 30% of our normal elective surgery activity. From next week we will be gradually expanding the criteria for most other specialties to include low anaesthetic risk (ASA Grade 1&2) patients under 70 years of age. This change will commence next week with further increases from the following week (4th May). Please be aware that we are selecting cases based on need, and not waiting time. Need includes consideration of equity, clinical urgency and social circumstances. We are seeking to avoid too many
cases (aside from urgent and acute) which require HDU/ICU care post-operatively for obvious reasons. (b) Outpatients Outpatient consultations will not change notably during Level 3 although there may be increases in some specialties. We will be continuing to see as many patients as possible via Telehealth options. In the first two weeks of April we saw 1200 patients, 75% of these through video or phone appointments. We appreciate that as GPs you’ve been doing similar and so we know that this is a significant change but are thrilled with the very positive feedback we’ve had from patients. We have been very clear with our teams that any patients who would normally be accepted as FSAs continue to be accepted and so if you believe there are any issues please let us know at providerservicessupport@bopdhb.govt.nz. Overall, if you would normally refer a patient based on the presenting condition then please continue to do so. (c) Oncology Our oncology services have continued to operate relatively close to normally because of the needs of this client group. (d) Cardiology Cardiology warrants a specific mention because nationally we are seeing a significant issue with acute cardiology needs seemingly reducing significantly, which of course cannot be the case. The cardiology team are working on scaling up workload from next week to close to normal levels but leaving more capacity for acute treatments which are expected to be seen. (e) Imaging/Radiology · · · · · · ·
Under Level 4 all imaging referrals have been actioned depending on priority/urgency as per clinical details and justification written by clinicians on the request form. Priority 1 (Urgent or High Suspicion of Cancer) and Priority 2 (semi-urgent) and Priority 4 (Planned) where imaging is required within 2 weeks have been performed. Other Priority 2 patients have been reassessed at weekly intervals. Priority 3 (non-urgent) and other Priority 4 (planned) have not been performed. Under Level 3 there will be an increased number of patients being imaged with staff maintaining safe distances and using PPE if necessary. Priority 1 and 2 & Priority 4 (Planned within timeframes) referrals will be actioned first with any other available appointments being given to Priority 3 (non-urgent) patients. Some ultrasound and CT referrals have been outsourced during L4 to private providers. The DHB will continue to outsource some ultrasound scanning to manage the backlog of patients waiting.
(f) Community Services Support Net continues to operate largely as normal, albeit with most staff working from home. Community Allied Health(east and west): Current work is 95% virtual either telehealth or zoom with clients. The focus has been on waitlists and contacting vulnerable patients. Urgent essential visits (preventing admission and acute deterioration) are still occuring, as are equipment delivery.(non-contact where possible) Child Development Services (Tga & Whk): Current work is virtual with clients on waitlist being contacted and current families also being contacted. This will not change in level 3. Families have particularly enjoyed the contact which is at a higher rate than usual. NB families are struggling with
the additional stress of having their development delayed child at home with often very challenging behaviour. District Nursing has been largely operating on a telehealth/home delivery basis. All referrals continue to be accepted and prioritised accordingly and the service will expand the number of direct care episodes next week in line with surgical activity volumes. Community dental services are not operating currently in accordance with national guidance however a daily emergency clinic is being provided (both at Whakatane and Tauranga). (g) Mental Health Inpatients Te Whare Maiangiangi, our Inpatient Unit, is currently closed to admissions until we are confident of having managed the Coronavirus risk (with one client and two staff infected). The clients who were in hospital as at last weekend are able to continue inpatient care if required, but with a small, limited team. Fortunately our inpatient activity has been low (this does of course cause some concern of its own) but this means we are able to cope with current volumes. If demand grows we will utilise Whakatane inpatient capacity first, and then reach out to Lakes and Waikato DHBs who are readying themselves to assist if required. Just finally, during this time of significant change we are having to work out how best provide as much care as we can whilst maintaining safety for all. Many innovations and sensible changes have resulted, which we are collating currently. This email opens the door to you as our GP partners to suggest other changes which may help in the current constrained environment, or be considered for our “Progressing Forward” strategy (we don’t want a Recovery Plan which returns us to a pre-COVID sub-optimal state!). Let’s leverage this time of whole system team working and re-thinking and change our future! With best regards, Pete Chandler | Chief Operating Officer