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Victorian hospitals are bracing for a third wave of seriously ill coronavirus patients, with staff shortages, workforce burnout and overrun emergency departments fuelling a crisis across the public health system.
With the state recording 208 new coronavirus cases on Friday – and Premier Daniel Andrews warning that cases would continue to rise — senior doctors at Victoria’s hospitals are now reviewing their surge planning and reclaiming wards and other spaces for COVID beds.
Medical staff in the COVID-19 ward at the Austin Hospital in April.Credit:Justin McManus
There are 64 COVID-19 cases in hospital in Victoria, 16 of them in intensive care and 11 on ventilators.
A new “pandemic ward” opened at the Northern Hospital in Epping on Friday, with 28 negative-pressure beds, and the state government says it is prepared to open 4000 ICU and critical care beds, if needed.
The push to reinforce the health system comes amid revelations that hospitals have been so stretched that patients have died after waiting with paramedics at emergency departments for hospital treatment.
In one incident during last year’s second wave, a young mother died after reportedly spending more than an hour waiting at a Melbourne emergency department that was stretched to capacity. The Age confirmed the fatality this week.
The woman had been ferried by ambulance to the Werribee Mercy Hospital suffering from suspected postpartum haemorrhage, which involves excessive blood loss after childbirth. A Safer Care Victoria review found there were a number of significant factors that contributed to the death, on June 17 last year, including coronavirus-related protocols.
Australian Medical Association state president Roderick McRae said the Victorian health system had been “incredibly stressed for decades”.
“In a way we’ve got away with it, but COVID has ripped all of the clothes off, so it is standing there naked … it’s extremely likely we will fall short of what we wished we’d been able to provide.”
An Age analysis of performance data has revealed more patients are needing treatment than ever before, placing every part of the sector under strain, including ambulance response times, access to mental health services and hospital waiting lists.
But the crisis could be even worse than publicly reported, with the state’s Auditor-General revealing that the Andrews government cannot assure the community about the safety of its hospitals because of several gaps in the system.
In a damning report tabled this week, the Auditor-General found Victoria still does not have a “fully functioning” statewide incident management system to record adverse events, and found that at least 39 examples of “sentinel events” – hospital incidents that are wholly preventable and result in serious harm or the death of patient – were recorded as “minor” or “routine.”
With lockdown restrictions set to ease gradually in coming months, Mr Andrews on Friday again urged Victorians to get vaccinated to help take the pressure off hospitals and their staff, and signalled that people could soon be banned from attending certain venues or events if they were not immunised. The government is also considering adding two more hospitals – Barwon and the Austin – to its stable of hospitals designated to treat COVID-19 patients.
“We’re going to see cases rise. The maths of this is undeniable. But we’ve got to slow the rate of increase,” Mr Andrews said. “Otherwise … the number of cases will overwhelm our health system.”
Intensive care units are readying for the possibility that the number of gravely ill patients needing life-saving care will be well in excess of the peak of Victoria’s second wave, when dozens of patients were in ICU.
“We’re certainly preparing, as we did last year, for it potentially being in the hundreds in intensive care over coming months,” said Stephen Warrillow, the director of intensive care at the Austin Hospital, adding that he was hopeful this scenario would not eventuate.
Ventilators, stored after the second wave or never used at all, are being located and checked. General COVID wards are being re-established. Conversations have started with anaesthetists and surgical nurses, who might be deployed to the COVID frontline if there is a reduction in elective surgery to bolster a hospital’s COVID capacity.
“Basically it feels very much like a rerun of last year,” said Associate Professor Warrillow.
In emergency departments, many staff are having to again wear gowns, goggles and gloves throughout their shifts as a precaution for surprise COVID presentations. Emergency physician Stephen Parnis said there was a feeling of trepidation among health workers, who like most Victorians had been unable to properly recharge their batteries following a string of lockdowns.
Emergency doctor Stephen Parnis says numbers are going to get worse.Credit:Eddie Jim
“We know that numbers are going to get worse. We just don’t know how long [it will last] and how bad it will get,” Dr Parnis said.
The AMA’s Dr McRae said nurses and other public hospital staff were already having holiday leave cancelled and working double shifts. He said while they had the capacity to reduce demand through cancelling some elective surgery, there were things that couldn’t and wouldn’t stop – including increasing mental health presentations.
He said it’s now likely there will be deaths because overstretched staff will be unable to adequately treat people. In the worst-case scenario where there were tens of thousands of cases, he said it was inevitable that there would be thousands in hospital.
The warnings came as national cabinet met on Friday to discuss the expected influx of COVID-19 patients, which has also been a concern for other states.
In NSW, where around 950 coronavirus patients are currently in hospital and a further 150 are in intensive care, non-urgent elective surgery has been paused across Greater Sydney.
The same policy has been applied in Western Australia – despite the state being largely COVID-free for months – and South Australia. Victoria has no such restrictions, but hospitals have occasionally been forced to reschedule elective surgeries due to staff shortages.
“Our hospitals have been preparing for pandemic since last year, creating extra capacity and ensuring we have enough beds, equipment, PPE and staff to manage any surge in patients, while maintaining other services,” a Health Department spokesman said.
Emergency medicine physician and Victoria’s AMA vice-president Sarah Whitelaw called for state and federal leaders to work together to overhaul hospital funding, with more money pumped into the system for improvements.
“Australians, when waiting with a sick child or family member, don’t care what level of bureaucracy is responsible – they care that there are enough doctors, nurses and beds to give them the emergency care they need at the time the need it,” she said. “Right now, many can’t even get in the door.”
With Paul Sakkal and Clay Lucas
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