11 red flag procedures delayed due to ‘unprecedented’ COVID-19 surge and A&E pressures

Senior clinicians yesterday said high community transmissions of the SARS-CoV-2 virus was placing ‘unprecedented pressure’ on the hospital system.

Dr Catherine McDonnell, Western Trust Medical Director, said: “We are concerned about the demand from COVID-19 patients and our response to that and the escalation of admissions and demand on intensive care.

“We are concerned about an unprecedented rise in referrals and patients presenting to ED departments.”

Dr. McDonnell said the Trust was also working hard to ensure elective services are maintained. But the health authority is constrained due to workforce issues. Many staff are off on annual leave. Other workers have been affected by COVID-19 directly, she said.

“They are people who live within the community. They are suffering from COVID as many people are and they are also social contacts which requires them to isolate so there are major demands in terms of ensuring we’ve got adequate workforce to meet what is coming across the door.”

Mark Gillespie, Assistant Director for Operations and Service Improvement at Altnagelvin outlined how on June 25 the Derry hospital went from having five in-patients with COVID to 40 on July 25. This continued to rise steeply throughout July and prompted service managers to initiate escalation plans.

“Currently at the Altnagelvin site we remain in high surge with 37 in-patients,” he said.

Mr. Gillespie said that during the winter surge Trust management debriefed with senior medical staff and estate staff to look at how high numbers could be managed in future. A £500,000 investment in space and isolation capacity is due for completion at the end of August with one eye on a potential further wave in the winter, he said. “With the completion of this work our intention would be that we will be able to maintain normal services and not impact on our ability to provide theatre sessions. And also from a staffing perspective it’s important to note that when we were designing the works staff rest facilities were high on the agenda.”

However, over the last several weeks Altnagelvin has been dealing not only with the COVID-19 surge but equally a big spike in A&E attendances.

“June and July have been challenging for the ED team and it’s important to note that across June-July we had a 10 per cent increase in attendances in the Altnagelvin A&E.

“I think it’s fair to say people have waited longer than we would have anticipated to be seen by doctors and to get access to an inpatient bed.

“It’s also important to point out that for the same period last year we actually got a 5% increase in admissions as well. So the increase in attendance and the increase in admissions has put further pressure on the system given the challenges we’ve been trying to manage through COVID.”

All these factors continue to stress the system while managers are protecting ten beds on a daily basis for clinically urgent and red flag cancer patients. Some red flag elective operations have had to be delayed, however.

“From July 13 to July 27 as a result of heightened pressures we have had to delay 39 procedures, primarily in the areas of orthopaedics and urology. Of those 39 patients, eleven were red flag patients, and just to update, four of those have since had their procedure, six of those have been booked and one remains outstanding, and a further one of the six has been rebooked from overnight as well. So we have one patient who is outstanding at this point and we are continuing to work hard with our booking teams and with our partners across the system to have that patient rebooked.”

According to the latest Department of Health figures six out of nine ICU beds at Altnagelvin were being used to treat COVID patients; two ICU beds were occupied by patients with other conditions and one bed was free. In terms of general occupancy 11.78% of beds at Altnagelvin were ‘COVID-19 occupied’, 77.64% were ‘other occupied’ and the hospital was operating at 9.67% over capacity; 10.57% were ‘awaiting admission.’

The Derry/Strabane seven day COVID-19 rate is still very high and yesterday rose to 527.5 cases per 100,000. The COVID positivity rate here has also risen to just under 25 %.

Dr. McDonnell acknowledged that while Trust management expected another wave was coming they did not expect it to come as hard and as fast as it did.

“We did expect another surge but I think there would be agreement that it came quicker than anticipated and the pattern is slightly different than previously but that’s largely because we are dealing with a different variant.

“This is as a consequence of the Delta variant and each variant has a nuance and presents itself slightly differently.”