Vital care on the move

How coronavirus forced surgeons to come together

THE strong partnership between Geelong hospital and its private counterparts was integral to pivoting when elective surgeries reduced early in the pandemic, research has found.

An article analysing the first elective surgery pause locally amid the coronavirus pandemic has detailed how “no other event in modern surgery has led to the need for such rapid, drastic changes in the delivery of a surgical service”.

The research, conducted by local surgeons and encompassing public patients, compared seven weeks of service delivery (March 30 to May 17) with the corresponding seven weeks in 2019.

The study found in Geelong there was a 45.9 per cent reduction in elective general surgery, excluding endoscopy, a 20.4 per cent drop in surgery wait list time for cancer patients, and a 13.9 per cent rise in emergency operations — but a safe and effective general surgery service during the early stages of the pandemic.

“There are some valuable lessons which could be adopted elsewhere in the event of a surge … of cases,” it said.

On March 20, Barwon Health surgical directors agreed to form a state of disaster surgical triage team, which met daily from March 24.

Most category two and all category three elective procedures — required within 90 days and one year respectively — were suspended from March 26 to April 27 statewide.

From March 30, all necessary public elective surgery that remained was moved to Geelong’s two private hospitals, St John of God Geelong Hospital and Epworth Geelong. The emergency surgical service was retained at Geelong hospital, and plans were in place to also move emergency surgery to the private sector, if the pandemic overwhelmed its capacity, the paper said.

“The key to being able to rapidly transfer our elective work to the private sector was Geelong’s unique pre-existing public-private relationship,” the paper said.

“This allowed rapid transfer of our units and a smooth transition to treat public patients in the private hospitals.”

During the period the research focused on, radical restructuring of outpatient clinic services led to a change from no scheduled telehealth consults in 2019 to 81.3 per cent of all general surgical outpatient consults being conducted via telehealth.

Royal Australasian College of Surgeons fellow and Geelong general surgery fellow, Dr Henry Drysdale, who led the research, said there had been “a lot” of benefits from telehealth, in particular for patients from far afield whose time it saved.

Surgeons Professor Glenn Guest, Professor David Watters and Dr Sonal Nagra supervised the research, which has been published in ANZ Journal of Surgery.

Professor Guest said surgeons were initially concerned by evidence from overseas that some lifesaving surgeries were not being performed as the health system dealt with COVID-19.

“We were pleased by shutting down elective surgery we could maintain emergency and essential surgery,” Professor Guest said.