Australia has an opportunity to learn from what is happening in Italy as that is likely to be us in one month. One hopes that the Government and health departments understand the impact of the disease on hospitals
Once the demand soars for hospital services, a number of things will need consideration.
can we keep corona and non-corona cases separate ?
how can we optimize the use of whatever resources we have here to manage the care of patients.
In Australia we have a private and public system and this means that taken as a whole, our system has much more excess capacity than a purely public system such as France or Italy. Negotiating fair terms with the owners of those facilities is best done before the crisis hits. The Covid-19 cases in Italy requiring hospitalization have generally needed high level care; many intensive care and have had long hospital stays
To properly understand hospitals, it is important to understand equipment and staffing. A typical surgical or medical ward looks like this
although this ward is empty, there is capability for some simple monitoring (such as pulse and oxygenation, maybe blood pressure) some oxygen supplementation and an infusion or two. A nurse may look after 4 patients
Contrast this with ICU
In this example there are syringe driver pumps, infusion lines, a ventilator, a dialysis machine and many monitors. A general ward cannot do the same function. ICU will have one to one nursing.
shows that NSW ICU occupancy is already at 90% in the winter months. Although cancelling all elective surgery would free up significant numbers of beds in ICU it would likely only increase availability by 20%. Around 40% of ICU admissions come post surgery but much of that surgery would be emergency
It may be possible to convert private hospital recovery
or operating theatres
into makeshift ICU or high dependency beds (as is being done in Italy) but this will require negotiation with private hospital operators and importantly will require large numbers of staff to be recruited / redeployed / upskilled
One of the ideas to address a likely forthcoming workforce crisis is that of getting retired doctors back to work. The Victorian manifestation of this idea is not novel. Boris Johnson floated the same idea in the UK
The State and Commonwealth Governments now have no easy way to contact let alone recruit these practitioners. The roadblocks to them working again include
No current registration and no easy and quick method to re-verify and re-credential original training
Current standards do not allow doctors out of practice for more than 12 months to practice without an approved plan http://cybersecurity.sarossy.com/medical-recency-of-practice-registration-standard/
Medical practitioners need by law to participate in Continuous Professional Development. These programs are administered by the relevant colleges. It is near certain that retired doctors would have allowed these memberships to lapse as membership is very expensive
Doctors who have retired and triggered the Run Off Cover indemnity scheme find it very costly and difficult to regain indemnity insurance
In short, although it is possible to re-recruit retired doctors to the workforce, it is something that requires careful thought and planning and involvement of many departments and organisations.
If it is a serious suggestion, the time to enact it is now.