Non-Covid patients may need to be sent home to avoid ‘catastrophe’ of Sydney hospitals buckling under surge, AMA warns

Patients in Sydney hospitals receiving lower levels of care will need to be moved into their homes and cared for primarily by GPs if the city’s hospitals are to stand any chance of coping with surging cases of Covid, the Australian Medical Association has warned.

AMA vice president Chris Moy, has accused the Berejiklian government and health authorities of being “flippant” in insisting the New South Wales health system can expand its intensive care capacity to 2,000 beds, warning that if it is able to source enough staff to care for that many patients, hospitals would be in a state of “catastrophe”.

For 2,000 ICU patients to be cared for, he warns not all staff would be sufficiently skilled and the hospital system wouldn’t have capacity “to treat anything else besides Covid in hospitals”.

Moy’s comments follow Guardian Australia revealing that overworked Sydney intensive care nurses are increasing sedative doses for some patients in order to manage their workload, claiming pressure from the Delta outbreak makes it impossible to monitor all of their patients in an ICU environment one nurse labelled a “hellhole”.

Given the NSW government anticipates a peak in Covid hospitalisations in October, Moy believes health leaders must start drawing up comprehensive plans to deliver hospital-style care so people with “less severe conditions”, including mild-forms of pneumonia and deep vein thrombosis, aren’t admitted to hospital. Less serious Covid patients would also receive at home care.

Instead of going to hospital, patients would receive in-home care from GPs, visiting nurses and specialists and have meals delivered. Blood pressure readers and other monitoring equipment would be installed in their homes so they could be taken to hospital if their condition escalates.

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While some hospitals already provide low level in-home care to patients, Moy believes this will have to be implemented on a mass scale across Sydney and spearheaded by local doctors, to free up hospital staff and to minimise Covid exposure risk for patients whose care is unrelated to the virus.

Moy believes GPs are the “missing link” in NSW’s Covid surge contingencies, and said that without them alleviating hospital workers, “I don’t know where staff to care for 2,000 ICU patients would come from”.

He also believes highly skilled nurses who have recently left ICUs to work in the state’s Covid vaccine clinics will need to be recalled to intensive care units if a surge in serious coronavirus hospitalisations eventuates.

On Monday, as a record 1,290 cases were announced, there were 840 Covid patients admitted to hospitals in NSW, with 137 in intensive care and 48 of those requiring ventilators. Of those in intensive care, 119 are unvaccinated, while 13 have had one dose. Guardian Australia understands the five double vaccinated people in ICU have underlying conditions.

A week earlier, there were 586 Covid cases in hospital, with 100 in ICU and 32 people on ventilators. At that time, there were about 845 ICU beds in NSW, with 667 occupied. About 17% were Covid patients, however doctors have warned Covid patients stay in ICUs for much longer.

Premier Gladys Berejiklian stressed that authorities are anticipating October to be the worst month for Covid hospitalisations, due to the lag effect on a recent surge in infections and an expected continuation of record daily cases.

“The health system is prepared, but will it stretch? Absolutely,” Berejiklian said, reiterating the government’s plan to expand its 500 bed ICU capacity to 2,000 is already underway.

Health minister Brad Hazzard, speaking about the plan to train up staff and redeploy them across the state’s health system, said they were “happy” to have the opportunity to be sent to work in intensive care units. Hazzard insisted the hospital system was not at its limit, saying “field hospitals would not be on the agenda at the present time”.

However Moy is critical of the NSW government’s messaging.

“I think there’s this assumption that the health system can absorb more patients. Everyone, including the premier [Berejiklian] is talking about ventilators and surge ICU capacity, but they’re being flippant. It’s just not about the number of ventilators for ICU beds, it’s about the staff,” Moy said.

“Morale in hospitals at the moment is very tense and the pressure is significant. And we may not even be at the worst of it right now,” Moy said, noting the expected October peak noted by the NSW government.

Regarding his view of how the system could staff 2,000 ICU beds, Moy believes the federal government would need to step up funding for staff. This would have to stretch into next year, as he believes so many people would be forced to neglect regular hospital care during the October Covid peak that there would be a rise in serious illness throughout 2022.

Most importantly, Moy believes the NSW government must plan ahead of the October peak, not only to mobilise GPs for more at-home care, but to reconsider how skilled nurses are spread across the system.

Moy wants specialised ICU staff to be recalled from vaccination clinics and special health accommodations that many have left for. Already, recently retired nurses have been brought back into the system, with plans to expand that intake to nurses who retired within the past 10 years being considered.

Moy remains sceptical of the state’s hospital capacity and planned ICU expansion to 2,000 beds.

“We’re talking about a catastrophe at that point.”