Increasing Hospital Capacity

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

taken from http://crystalandskyler.blogspot.com/2010/09/these-are-all-machines-that-are.html

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.

This report https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0020/473330/ACI-ICU-Exit-Block-Guiding-Principles-Consultation-draft-January-2019.pdf

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

Image result for operating theatre

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

The time to plan for this is now.