Urgent action needed for regional hospitals

10 Sep 2021

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Transcript: AMA Council of Rural Doctors Chair, Dr Marco Giuseppin, ABC Southern Queensland Drive with Annie Gaffney, Thursday 9 September 2021

Subjects: Regional hospitals

ANNIE GAFFNEY:    Have you heard of a Code Yellow? It’s a term that’s used to describe an internal emergency at a hospital. It means the beds are full, elective surgery has to be cancelled, people needing treatment have to be sent to other facilities, and it’s been happening repeatedly at Hervey Bay Hospital.

Now, staff at Hervey Bay Hospital are the ones who have been making noise over this issue but the pressure faced there, surging population growth and the need to redirect health staff to roles such as COVID testing and vaccination are happening across regional South-East Queensland. Dr Marco Giuseppin is the Chair of the Australian Medical Association’s Council of Rural Doctors, he’s also a rural generalist and a flying doctor. Marco, great to have you with us. Are many other hospitals in South-East and Southern Queensland in the same boat as Hervey Bay at the moment?

MARCO GIUSEPPIN:  Thanks for having me. Look, we are seeing this issue around our regional hospitals. The factors that you’ve already identified, population changes and staff needing to be reallocated to other facilities and other tasks is a big contributor, but the other thing that we’ve seen – probably for the last decade or more – is just a systematic underinvestment in a lot of our regional hospital infrastructure. In Hervey Bay, you see an example of very hard-working doctors and nurses that have been repeatedly banging their head against the wall, asking for more resources and meeting silence.

ANNIE GAFFNEY:    How much pressure has the combination of huge population growth and things like COVID testing and vaccine distribution put on our regional health facilities? If you had to talk about, I guess, percentages of staff redirected, what would it be? Any idea?

MARCO GIUSEPPIN:  It’s really hard to put a number on and I think it’s probably a question for the individual hospitals. But, depending on the size of the town, you can see a significant percentage of the workforce that needs to be redirected to tasks such as COVID testing and vaccination. In the earlier remarks from the Hervey Bay Hospital, we heard a good example of that where we’ve had five Code Yellows in May escalating to 10 in August. That’s not a bad marker of how things are going in different regional hospitals. And we are seeing the rates of those internal emergency declarations increasing across the board.

ANNIE GAFFNEY:    While this is happening here, in New South Wales and Victoria health workers are saying they’re being overwhelmed by surging case numbers of COVID. We don’t have a COVID outbreak in Queensland right now but it seems like our health services are being overwhelmed anyway.

MARCO GIUSEPPIN:  Yeah, that’s the worrying thing and I think what we’re seeing here is an important question that we need to ask as we have a conversation about what we need to do as COVID inevitably approaches us, which is how do we actually prepare our hospital system? The AMA has called for all state premiers to release and perform modelling, and I know we’re all probably a little sick of modelling, but it’s important to understand the impact of those surges on our hospital capacity. As you’ve said, in our regional hospitals in particular, there are some that are very close to, if not already, at breaking point that are likely to face significant problems moving forward.

ANNIE GAFFNEY:    The State Government is really trying hard to keep the New South Wales outbreak from crossing the border but it feels like it will get in here sooner or later. What happens if we do have a surge of COVID emergencies on top of the pressures that we already have at our regional hospitals? What is the likely outcome?

MARCO GIUSEPPIN:  Look, I think there’s a few things that will happen. The first thing that we’re currently seeing is obviously staff that are potentially exposed have to furloughed or put off work for public health reasons, and we’re going to need a plan for dealing with that, especially in smaller communities where those workforces are quite small. We’re also going to have to look at how we modify our hospitals to treat COVID-19 patients. That includes things like ventilation, down to things like the types of staff we put in certain areas and the flow of patients through the hospital. Obviously, a surge in COVID-19 patients will affect patient throughput as well. And it’s also going to affect our ability to a degree to provide our usual care, things like cancer screening, surgery, and things like heart attacks, strokes and traumas – a lot of the stuff that we deal with on a day-to-day basis. So we’re potentially in for a significant strain, and ignoring the risk of that is something that we do at our own peril.

ANNIE GAFFNEY:    We’ve got the major hospitals, like Brisbane and Sunshine Coast and Gold Coast university hospitals, taking COVID patients at the moment, but if we do end up in a situation like New South Wales with more than 1,000 COVID cases a day, aren’t we going to have our regional hospitals, our smaller hospitals, deal with these cases anyway?

MARCO GIUSEPPIN:  Absolutely. It would be quite unrealistic in the long term to expect large numbers of cases to all move to the larger city hospitals, so our regional hospitals are going to need to be prepared and we’re going to need to look at how we manage these patients across the spectrum of their illness. We’re going to have to look at how we manage relatively mild cases, probably at home, through to those more severe cases that may require intensive care or ventilation in an intensive care setting. We really need to look at the entire spectrum of how we treat COVID and acknowledge that, as you’ve identified, there’s a very good chance, almost an inevitability, that it will cross the border into Queensland at some point. So the message is get vaccinated, and hopefully decrease the already significant strain on our regional facilities.

ANNIE GAFFNEY:    What would you like to see the Queensland Government do right now regarding this issue, Marco?

MARCO GIUSEPPIN:  We, as in the AMA, would like to see the Queensland Government commission modelling on our hospitals’ ability to cope with these outbreaks, and the other thing we really would like them to do is actually consult properly with their clinicians, so consult with clinicians in these regional and rural hospitals, identify where the gaps are, develop appropriate disaster plans, and have them ready to go, so that the system is able to cope when it’s under strain.

ANNIE GAFFNEY:    Dr Marco Giuseppin, thanks for your thoughts this afternoon.

9 September 2021

Published: 10 Sep 2021