COVID-19 fundamentally changed hospitalization: many people were deprived of access to treatment in their city | Lifetime

How patient flows are distributed

“Everything would be simple if all beds were only in Vilnius and Vilnius residents, and for residents of other cities – in their cities. But today, Santara clinics are occupied by more than 95 percent. Beds for patients with COVID-19 in the Vilnius City Clinical Hospital (VMKL) – also about 90%, and every day we have to be ready about 30-40 free beds. As we see a growing number of diseases and the forecasts do not provide Hoping that the situation will still stabilize, we are trying to gradually expand each unit and increase the number of beds, ”said Aušra Bilotienė Motiejūnienė, Director of Management of Clinicas Santara.

Santara Clinics coordinates COVID-19 patient flows throughout the Vilnius region. Therefore, all coronavirus infected patients who need hospital services first come here and then distribute; After conducting the necessary examinations and assessing the state of health, some stay in the Santara clinics, others are sent to VMKL, the third – to Ukmergė or Alytus.

“If the course of the disease is complicated or the patient has severe comorbidities, we try to keep those patients with them as they may need resuscitation assistance or high-flow oxygen therapy. When they arrive, they may still feel quite wrong, but the research figures are cause for concern. The opposite is also true. The patient’s condition is stabilizing, but it is not yet possible to discharge home. In this case, we have transferred several patients to the Hospital Ukmergė.

Yes, it is inconvenient for the patient and their relatives, but for us it is important to have beds for very difficult patients. When we had more beds available, we tried to keep every second moderate patient with us so as not to overload regional hospitals. Now the situation is different ”, explained the interlocutor.

The distance to the other hospital is also chosen according to the patient’s condition.

“If we see that oxygen is not necessary throughout the day or may not be necessary, the patient can be transported to Ukmergė or Alytus, that is, a little further away. We try to be closer to all the more complicated cases. For example, a person with COVID-19 is mildly ill, but is seriously ill due to his other comorbidities, although they are not currently aggravated. Then he is transferred to VMKL. If his condition worsens, he will be returned to Clinicas Santara.

The decision to stay or expel the patient is made by the infectologist who examined him. If necessary, use other specialists to evaluate the condition. Other support hospitals periodically consult with the Santara clinics remotely regarding changes in the patient’s condition. There are also guidelines prepared by infectologists for this purpose, ”said A.Bilotienė Motiejūnienė.

According to the interlocutor, an even bigger problem than the beds is the staff. For example, Švenčionys Hospital was ready to open for COVID-19 patients a week ago, but currently doctors cannot work, they are in self-isolation. VMKL intends to vacate another 30 beds on its own initiative, but again it takes time to gather and prepare staff for this. “We also review the departments: what can be reorganized if necessary. After all, no one knows what next Monday will be like,” said the representative of the Santara clinics.

Scheduled services at COVID-19 hospitals are shrinking

Unfortunately, the volume of scheduled services in hospitals treating COVID-19 patients is declining. And this is inevitable.

“If I live in, say, Ukmergė and only there I would like to receive planned help, it may not be possible at this time. The first step will be to assess whether the person can expect the planned help. If not, there are Vilnius, Kaunas and others. Smaller institutions around Utena. Even large hospitals, as well as Santara clinics, have to reduce the scope of scheduled services simply because we cannot provide free resuscitation beds and they are often needed daily or after surgery. For example, in Alytus orthopedic trauma services are not provided, then the leg in plaster is transported to Lazdijai or Varėna “, said the interlocutor.

If I live, say, in Ukmergė and would only like to receive planned help there, this may not be possible at the moment.

151 patients with COVID-19 were treated with VMKL on Monday, 6 of them in the Resuscitation and Intensive Care Unit, that is, all the resuscitation beds for these patients were filled. Therefore, if a patient’s condition worsens and requires intensive care, it will be necessary to refer them to another hospital that can provide this service. If the condition of a patient improves, they may be discharged for further treatment at home or, if they come from a nursing home or have another illness that needs to be treated in the hospital, the Santara clinics will be consulted where to transfer them .

According to the director of the Narimantas Markevičius hospital, moderate patients are treated at this hospital.

However, the hospital includes patients not only with COVID-19, but also with other chronic diseases: various pathologies of the kidneys, stone disease, lung, liver, heart, nephrology ailments, insufficiency, etc. In chronically ill patients, COVID-19 infection also contributes, often leading to a worsening of the overall illness and causing symptoms consistent with those of COVID-19. Therefore, patients must be treated not only for COVID-19, but also for the underlying disease, and their condition can worsen at any time, ”he said.

The situation is similar in another COVID-19 support institution: Ukmergė Hospital. According to Marija Švedienė, Deputy Chief Medical Officer of Ukmergė Hospital, 48 out of 58 beds are currently occupied, three patients are receiving resuscitation treatment.

“We receive patients from other institutions with referrals from the clinics of the main Santara institution. Some patients are referred directly from the Center for Infectious Diseases. Some come from other treatment facilities where COVID-19 outbreaks have been reported, but the facility does not have a separate unit to treat them. Others were treated in hospital for other illnesses, still in need of hospital treatment, but were also diagnosed with an asymptomatic form of the COVID-19 disease. If the case is asymptomatic, at the end of the 10-day period, the patient is sent to a home, social care institution, or other “clean” room for further treatment, depending on the situation. On the other hand, sometimes the condition of patients changes not by days, but by hours ”, assured the interlocutor.

Having become a support institution for COVID-19, Ukmergė Hospital, like all the others, also faced a shortage of staff: “Working with these patients is complex, intensive, requires a lot of care, so all resources are dedicated to it. Of course, we had to reduce the provision of scheduled services, and we do not provide some services at all at this time, referring patients to other treatment facilities that have agreed to help. We try to keep obstetrics, surgery and orthopedics as long as possible, but if we have to increase the number of beds even more, we will stop. At present, the number of planned surgeries has also had to be reduced. “

Challenges for ambulances

Zdislav Skvarciany, director of the Vilnius ambulance station, also said that if there is a suspicion that the patient may have COVID-19, they are transported to the Santara clinics, from where they can be transferred to other hospitals or to the home to receive Outpatient treatment.

“In the field of patient transport, we have the assistance of the transport company Vilnius Public Transport (VVT). They take home light patients who do not need hospital treatment, or transport patients to another hospital who do not need special equipment during the trip. They are also involved in taking people to mobile checkpoints, ”said the interlocutor.

According to him, the ambulance is dealing with the current situation so far, although there are problems.

“Sometimes it is not clear where to transport a patient. We have to explain to the dispatcher, but in the end we still get him somewhere. If we need very urgent help, no one is looking, there are places in the hospital or not, we are just transporting. We also know how hospitals specialize, where to transport due to surgery, and where to transport due to stroke or heart attack. If the hospital notifies the dispatch center in advance that any room is closed, we will not transport there. Sometimes when the hospital informs us that there are no places, we even call others who could accept. Therefore, it is very important that the centralized information system works well and it is not necessary to transfer the patient from one hospital to another, ”Z.Svarvarnyny considered.

The services of this service have had to be used repeatedly by the Vilnius Republican University Hospital, which is not a support institution for COVID-19, but receives these patients.

There were 21 patients with COVID-19 in a hospital without covid

“With the recent deterioration in the epidemiological situation, most personal health care facilities face challenges due to the sharp increase in patient flows with COVID-19. Unfortunately, there is no possibility to treat all COVID-19 patients in all hospitals, therefore in the Vilnius region there is a division of patients between so-called support hospitals, which are used to help clinics de Santara, who provide services and provide basic care to such patients.

Based on its specialization, the Vilnius Republican University Hospital is an emergency medical service serving the largest flow of patients seeking emergency care, and this remains an operational priority even in pandemic conditions. Currently there are hospitalized patients in the hospital diagnosed with SARS-CoV-2 coronavirus (today we have 21), but with the help of the main referral and allowing the patient’s health status, they will eventually be transferred to other treatment facilities in the region of Vilnius receiving COVID. -19 patients.

The main hospitals to which patients treated by us are transported are Vilnius City Clinical Hospital and Ukmergė Hospital. When making the decision to transfer a patient, their state of health is always taken into account, and it is ensured that the receiving medical institution has the necessary treatment and nursing staff and the necessary infrastructure. specialist Asta Bagdonavičienė.