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Due to the coronavirus epidemic, patients faced severe limitations in the functioning of health care facilities. Outpatient clinics and specialist clinics have switched to telemedicine, while hospitals have suspended patients for scheduled surgeries. What if surgery is still necessary? In what situations must it take place? We ask doctor Paweł Wisz from Szpital na Klinach about it.
In the Krakow Hospital in Klinach, within a week of the first case of coronavirus infection in Poland admissions of patients were reduced by about 50%, and in the following weeks by 70%. – we learn from the medical director, Józefy Job. Similar actions were taken in most of the institutions in the country, both operating in the public and private sectors. The NHF recommended the suspension of admissions for elective surgeries that potentially require blood transfusions. Doctors decide which treatments can be postponed. Each such decision requires an assessment of the individual situation of a given patient.
– In this case, we cannot give a universal prescription or procedure, because a lot depends on individual circumstances. But we were not left to ourselves. Hospitals and medics are helped by, among others, scientific societies that issue recommendations to help you navigate in this new and difficult situation – said the medical director of the Krakow hospital in an interview with Medonet.
The cancellation of most planned treatments is the result of many factors:
– There are shortages in blood banks, so you have to make decisions about who we can operate at a given moment and whose operation we can postpone. Patients with less urgent procedures try to postpone them until the epidemic ends. Another thing is the need to minimize the risk so that the patient’s stay in the hospital after the surgery is not associated with a threat. Each surgical procedure affects the body’s immunity. In addition, it should be remembered that the activities of all hospitals have been reduced, because the forces are focused mainly on fighting the epidemic. You have to think about the availability of operating theaters, and then recovery rooms or even places in the hospital – explains Dr. Paweł Wisz, a surgeon specializing in urology.
– But of course there are oncological patients after accidents, i.e. acute cases. In people with cancer, postponing surgery could make further treatment difficult or impossible. When dealing with an oncological patient, its general condition and, of course, the severity of the disease must be taken into account. Sometimes these decisions are very difficult. We do not know how long the epidemic will last, and therefore also when the surgery would have to be postponed.
– When it comes to urology, we immediately operate on e.g. bleeding tumors of the lower or upper urinary tract. There are also emergencies such as a kidney blocked due to urolithiasis – here you need to act immediately, because failure to react may result in sepsis and death of the patient. Whenever possible, use minimally invasive, laparoscopic and robotic methods that burden the patient to a lesser extent. If we are talking about typically planned surgeries, performed, for example, due to benign prostatic hyperplasia or phimosis, this type of surgery can certainly be postponed – adds the specialist.
Sterile tools and sanitary rigor are not everything
In a hospital, strict safety rules apply all the time, but in an epidemic situation, following the existing patterns is not enough. Additional restrictions have been introduced. Each employee has a measured temperature before entering. It is the same with patients. In addition, it is carried out both among employees and among patients epidemiological interview. You must complete the questionnaire and then sign it. The questionnaire includes questions about whether the patient / employee has had contact with an infected person, has been in quarantine, or has had symptoms such as coughing or elevated temperature in the last 14 days.
– If we have a suspicion that the patient is infected with the coronavirus, the first thing to do is to assess whether surgery is necessary. If it is not a life-saving operation, it should be postponed, and if it is, it must of course be performed, but in a center that has access to a wide range of specialists, it includes ICU in its structures – explains Dr. Paweł Wisz.
Even if the history does not indicate that the patient has probably had an infection, you should not lose your vigilance:
– There is always a risk. We can minimize them, but we cannot rule it out, says Dr. Wisz.
- Also read: What does intensive care work look like? Nurse Weronika Nawara tells the story
Healthcare after the pandemic – the siege of hospitals is inevitable
When asked when hospitals will be able to safely lift restrictions, even epidemiologists do not know the answer. We do not have the peak of the epidemic yet, we do not know what the downward trend in cases will look like. It is only certain that after the coronavirus force test, health care facilities will experience a real siege. The influx of patients whose treatments have been postponed at this point is inevitable.
– Treatments that could not be carried out during the pandemic will require efficient implementation after its completion, and possibly even during it. Hospitals and medical facilities will have to face this challenge. Moreover, even before the outbreak of the epidemic, the entire medical system was under strong pressure from demographic changes and epidemics of civilization diseases, such as obesity, diabetes, cardiovascular diseases, oncological and mental diseases. The demand for medical services and the related costs grew rapidly, and the ability to fully satisfy them became more and more inadequate. Especially today, in the era of a spreading pandemic, it becomes clear that the medical sector will face challenges related to the transformation – says Józefa Job.
The editorial board recommends:
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- Where can you go to the dentist during the COVID-19 epidemic?
- Coronavirus and oncological treatment. What is the situation of oncology?
Have a question about the coronavirus? Send them to the following address: [email protected]. You will find a daily updated list of answers HERE: Coronavirus – frequently asked questions and answers.