How Covid-19 changed hospital healthcare

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The NHS has been at the centre of the UK’s battle with coronavirus. The taxpayer-funded health service has burnished its reputation, managing to find beds for everyone with the virus who needed hospital care. But it has done this only by moving quickly to change the way it worked. Some of those changes may last long after Covid-19 fades away.

There are lessons here for all businesses, not just health care. Although agility is not always the word that springs to mind when thinking about the NHS, at Gloucestershire, the local hospital staff reacted with speed and creativity when the biggest public health crisis in a century struck. Mark Pietroni is the medical director for the Gloucestershire NHS Foundation Trust.

Previously, I’ve worked overseas. I’ve worked in Bangladesh. I ran a cholera hospital. I’ve worked through many epidemics, and I knew how an epidemic feels, I knew the pace, I knew the rhythm. At the beginning it’s always the same. You have a very long period of calm and then you have a very short period of rapid acceleration of case numbers.

Hospitals are still quite hierarchical places and the idea that an orthopaedic consultant could be being told what to do by a medical senior house officer just, you wouldn’t imagine it pre-Covid. At the height of the first wave, we created what we called pods. So groups of doctors and nurses working on specific wards and we had wards for palliative care patients who were dying and we have specialist palliative care physicians and other physicians who are experiencing that.

But a lot of the orthopaedic surgeons who wouldn’t normally be involved in those kind of decisions were working on those wards. And if you’ve been a senior consultant and then you’re working in a very junior level, that experience is always something you’ll take away with you.

Rachael Kaminski, a respiratory consultant, is one of those who found herself at the heart of the response, directing far more senior colleagues.

I was a new consultant in 2018 and suddenly, a year and a half later, I had 12, 14 consultants under me sort of delegating tasks and trying to work our way through the research that was coming through. There was no hierarchy, there was no division. It was no longer your job title. It was your skill set that meant you did the role you did. So, if there wasn’t a need for an orthopaedic surgeon doing an operation they would come and help you and that might involve them rolling a patient, it might involve them doing observations on a patient. So, all the jobs merged.

This kind of imaginative thinking is not limited to the UK. American hospitals have also learnt the value of using staff in different and more flexible ways.

We have all new ways of collaborating. I’ve never seen the level of interest that I see now in creating new, interdisciplinary programmes where the orthopedists are asking to work with geriatricians, who are asking to work with community health workers, who are understanding the role that, actually, that a food pantry has in keeping their patients healthy.

So I think there’s a new appreciation of this complex, adaptive system that we have that creates health for our patients and a lot of interest in working together. People who never knew each other who are now saying maybe we could figure out how to work together.

But it is patients rather than staff who will truly benefit from the ideas generated under the high-pressure conditions of Covid-19.

Another one of the innovations that developed rapidly in the first Covid wave was something that we call the Covid Virtual Ward. And this meant that patients could be admitted by a GP who was worried about the patient or discharged from the hospital one or two days earlier or perhaps actually not be admitted at all and be discharged from the Emergency Department into the Virtual Ward. They were given a pulse oximeter so they could measure their own oxygen saturations at home and they were rung on a daily basis, usually by a general practitioner, to make sure they were OK.

If we can keep patients at home, monitor them safely, and give single organ support at home in the form of oxygen therapy, antibiotics, once daily reviews, getting our occupational therapists and physiotherapists to go in once a day and see some of these patients that maybe need a bit of recovery and reablement, I think it’s the only way the NHS is going to survive if we adapt. And I think Covid meant that we had to do lots of things very quickly and this will be a positive thing because this wasn’t a sustainable model.

In the picturesque forest of Dean, not far from Gloucester, Covid-19 patient Sarah Drake found her life was hugely improved by the new approach.

I was on the Covid Respiratory Ward because I was advised I was too ill to go to ICU. It was life-threatening if I went to ICU. I wouldn’t be coming home. So, I said then, please don’t take me to ICU. Throw everything at me. I will fight as hard as I can and I will prove to you buggers I can go home.

I probably pushed that I wanted to go home. Physio had to assess me to come home. It was a question of whether I was able to come home yet, but my feelings, because I’m a positive person, my feelings were that if I could get home and take it quietly I could improve, because sitting in a hospital bed, as lovely as everybody is and was, you’re better off at home.

People have to be confident, as well, that they’re being looked after and there is vulnerability and scariness in that, but medicine has changed, medicine moves forward.

As the NHS attempts to move beyond the pandemic, it is facing a different but equally daunting challenge, caring for huge numbers of people whose treatment was postponed during the crisis. Can it maintain the ferment of innovation that has helped it get through the health emergency? More than five million people in England now waiting for hospital treatment are hoping it can.

Two decrepit old buggers together, aren’t we?

Well, we’ll get there.

Yeah, we’ll get there.

We’ll get there.

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