Hospitals rose to the pandemic challenge – what changes will stay?

This time last year, the nation’s hospitals braced for a potentially overwhelming crisis. We look back at their response to COVID-19 and which changes could be here to stay.

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A year ago, Australia’s public and private hospitals were preparing to pool their resources as the nation’s health system geared up to meet the expected COVID-19 challenge.

It was 31 March 2020 when Federal Health Minister Greg Hunt, in a joint statement with representatives of the private health sector and medical and nursing associations, announced that the partnership aimed “to ensure the full resources of our world class health system are ready and focused on treating patients as required, through the coronavirus pandemic”.

As part of the agreement, described by the minister as “an unprecedented move”, private hospitals guaranteed to make 30,000 of their hospital beds and 105,000 of their nurses and staff available to the government in response to COVID-19.

The partnership paid dividends. At the end of 2020, Australia’s largest private hospital operator, Ramsay Health Care, announced that, throughout the year, it had made available more than 30,000 additional staff and 9,000 hospital beds across the country. Ramsay had also performed 28,000 procedures on public patients across a range of specialities.

In a statement, Ramsay CEO Carmel Monaghan said the partnership demonstrated the benefits of Australia’s hybrid model of care, featuring a strong public health system supplemented by a strong private hospital sector.

“This hybrid system offers patients more choice in ordinary times and vital extra capacity to support public patients in extraordinary times,” she said. “It’s this hybrid model which, we believe, helps to make Australia’s hospital system one of the best in the world.”

Preparing for the worst

The partnership was just one element of the government’s strategy to prevent hospitals from being overwhelmed by a wave of seriously ill patients with COVID-19.

“There was also a strong and well-coordinated response in the Australian health system to prepare for the expected influx,” says Sof Andrikopoulos, CEO of the Australian Diabetes Society and co-author of The Australian response to the COVID-19 pandemic and diabetes – Lessons learned.

As part of the research, Andrikopoulos and his co-author list the measures Australian hospitals took in response to COVID-19, including expanding existing intensive care units (ICUs) and establishing new ones to create more beds. Separate ‘hot’ wards, ICU facilities and dedicated ‘fever’ clinics were also set up to protect patients not suspected of having COVID-19 from those who were. And, to keep hospital beds open, non-urgent surgery and procedures were suspended in public and private hospitals.

“We also saw screening techniques introduced to enable hospital workers who tested negative and had only mild symptoms to return to work in 24 hours,” Andrikopoulos says

The digital response

At the end of March 2020, the Federal Government increased Medicare-subsidised telehealth services to encourage non-face-to-face healthcare. And after Australia’s first ever e-prescription between doctor and pharmacist was dispensed in early May, the government fast-tracked digital healthcare’s rollout as part of the pandemic response.

Andrikopoulos, who is also an Honorary Associate Professor at the University of Melbourne’s Department of Medicine, also saw a big push towards remote monitoring during the pandemic.

“Many more people with diabetes were set up at home with equipment to monitor vital measurements like blood pressure, weight and blood glucose levels,” he says.

“These readings can then be relayed to a health professional for assessment, and the monitors can alert both patients and doctors any time there’s a reading outside the normal range. These kinds of technologies make life easier for patients by reducing the need for travel and waiting in busy outpatient facilities.

“I think diabetes is just one of many chronic conditions that can be managed remotely, particularly where there is a strong connection between health professional and patient.”

Where now for Australia?

Ultimately, Australia has been extremely fortunate compared with many other countries. In February this year it was reported we had no cases in ICU at all and, even in the intense period of lockdown, our numbers were significantly lower than others: by July 2020 Australia had recorded 214 COVID-19 ICU admissions compared to the UK’s 10,421.

As a result, many short-term emergency measures introduced in response to COVID-19 have been eased – though some of the accelerated digital developments are likely to endure.

“Having seen the benefits these technologies can bring to people living with chronic diseases during the pandemic I believe they have a strong future,” Andrikopoulos says.

NAB’s own research also suggests that patients appreciate having digital options.

“Even before COVID-19, NAB research found that convenience is far more important to patients than many practitioners recognise,” says Kate Galvin, Executive, NAB Health, referring to the 2019 NAB/Medfin Australian Consumer Health Survey.

“This doesn’t just apply to people with chronic illnesses but also parents with young children, anyone dependent on limited public transport and people who work long hours. Now that many have seen for themselves how much easier it is to receive care at home, I don’t think they’d want to lose that choice.”

 

A digital panacea? Time will tell  

One question an increase in digitally delivered healthcare poses is around workload. While in general technology is associated with reducing burdens, for hospitals this could be the opposite. “Telehealth consultations add an estimated 20 per cent to the administrative load on an outpatient system,” Andrikopoulos says.

As he explains, when seeing a patient in person it’s relatively simple to access the latest pathology tests and remote monitoring downloads as you talk. For a telehealth consultation, this needs to be done beforehand, requiring much more preparation.

“You also have to make the connection, ensure that the patient is in a suitably quiet place and that the technology is working,” Andrikopoulos says. “This all takes extra time.”

“So the question is, how will hospital business models adjust to these new demands? Hospitals need to find a way to absorb that 20 per cent increase in administration costs or reduce it to a more manageable level.”

Alison Verhoeven, CEO of the Australian Healthcare and Hospitals Association (AHHA), believes our nation’s experience in tackling the challenges of COVID-19 provides a catalyst for re-imagining healthcare.

“Not only do we have to be better prepared for future shocks such as climate-related emergencies and pandemics, but we also need a more modern, sustainable and resilient health system,” she said on the release of the AAHA paper, Australian healthcare after COVID-19: An opportunity to think differently. “Identifying what is no longer required will be just as important as determining what is.”

While the verdict may still be out on digital healthcare’s role in the long term, there’s no question it proved a valuable addition to Australia’s stellar response to the COVID-19 public health emergency. Add the broadly positive patient response to and acceptance of its introduction and it seems more likely than not that digital solutions are here to stay in some form or another.