The Australian Society of Anaesthetists (ASA) welcomes the increase in permitted elective surgery activity in private hospitals in Victoria announced today and looks forward to resumption of 100% activity across the whole state as soon as possible.
Great news for patients
Victorian Committee of Management Chair Dr Michelle Horne commented that patient wellbeing and access to care has been significantly compromised by the broad restrictions on elective surgery imposed on the 14th of October.
In what has been a difficult time for the Victorian healthcare system, patients and staff, elective surgery in private hospitals has been restricted to 50% of usual activity levels: meaning many patients have not been able to access needed procedures at this time.
Anaesthetists have been proud to support the healthcare system at a time of need in expanded roles. These have included: working outside the operating theatre environment in intensive care units in public and private hospitals to support the needs of our sickest patients; standing up temporary intensive care units in operating theatre recovery rooms; intubating patients in coronavirus wards, emergency departments and intensive care and caring for thousands of patients in community COVID-19 positive pathways especially in the north and west of Melbourne.
Restrictions on elective surgery in private hospitals which have been imposed at this time have applied across the board, including stand alone day centres. Many feel this has been a more heavy handed approach than necessary in order to preserve capacity for assisting public hospitals. In addition much of the transfer of care of patients from public hospitals to private to access some elective surgery has been done without adequate consultation with clinicians at the coal face and without adequate planning for quality and safety regarding that care.
“Throughout this latest wave and surgical restrictions there has been underutilised capacity in both the public and private sector, especially in day surgery and Tier Two hospitals” Dr Horne stated. “Many of these centres could have been treating patients safely without compromising access to ICU beds for COVID19 patients if a more nuanced approach had been taken”.
Dr Horne pointed out that ongoing restrictions cause patients to question the value proposition of private health insurance. “Unable to access care, the healthiest patients may choose to reduce their cover potentially creating an upwards price pressure on remaining patients’ premiums” Dr Horne stated. “The already stretched public sector may see more emergency department presentations when the usual referral patterns are not available due to restrictions”.
“Many patients have missed out on care and on much needed procedures. For example those needing cataract surgery and those with crippling arthritis and other chronic conditions manifesting as severe pain and limiting participation in essential daily activities. Elective surgery is sometimes seen as discretionary. However patients present for surgical treatment to maintain their autonomy and independence at home” Dr Horne said. “In addition, there are many elective procedures that lead to an early detection of cancer that have been delayed which will inevitably lead to a delayed diagnosis”.
The ASA is heartened that the department of health has indicated an imminent return to 100% of elective capacity across the Victorian system.
“The ASA calls for closer consultation with clinicians (working across both the public and private healthcare systems) when planning ongoing interventions and looks forward to collaborating with the government more closely going forward to implement support that is effective, evidence based and promotes patient wellbeing”.