On March 23, the Saskatchewan Health Authority (SHA) needed to pause non-urgent/elective surgeries, procedures and diagnostics in order to address the emerging COVID-19 pandemic care needs. Over the past several weeks, many of these services are now being re-offered.
“There are a lot of considerations to weigh when lifting restrictions,” said Corey Miller, vice president of Provincial Programs. These include establishing whether the transmission of the virus is controlled so that the service can safely resume, whether the system can quickly isolate and treat as well as contact trace for each COVID-19 case in the area, whether additional measures are in place to avoid contamination in care settings, if the risk of importing the virus has been minimized, and whether communities and businesses are prepared.
“The determining factor is safety,” said Miller. “We are reintroducing services in a gradual and thoughtful way that allows us to bring services back on line while implementing strategies to keep patients and providers safe.”
To enable the system to begin resuming services, numerous proactive measures and precautions have been implemented. These include, but are definitely not limited to, implementing staff, physician and visitor screening and masking processes; enhancing cleaning protocols; ensuring physical distancing measures are adhered to (while in SHA operated facilities); ensuring staff with COVID-19 symptoms are quickly identified and assisted to self-isolate; implementing restrictions of employees to single work sites or areas to reduce the risk of spread of the virus between facilities; redeploying staff to areas of highest need; ensuring that adequate mental health programs and supports are in place; and putting processes in place to safely enable family visitation and presence in SHA sites.
To further underline why service resumption takes time, Miller provided two examples – one in phlebotomy and one in medical imaging.
With the added complexity and steps required to do blood-draws safely as a result of COVID-19, it's taking more time for phlebotomists to do them.
“They have to use new protocols to ensure social distancing and support enhanced cleaning, resulting in tests and procedures taking longer.”
In medical imaging, we have introduced a six-foot separation barrier between patients in the waiting room, and examination rooms are thoroughly wiped down between patients. When patients require intubation, which can be the case when a patient needs to be sedated prior to an MRI, rooms need to be cleaned and left vacant for two hours post-procedure.
“Improved safety measures have resulted in a quality review of our throughput which will impact the pace at which we deliver care,” said Miller. “That’s one of the reasons we haven’t been able to return to 100 per cent.”
Since the SHA began implementing its resumption plan on May 18, more than 540 health services have restarted in all areas of the province and new services are added daily. As of July 13, the SHA is in Phase 3 of a four-phase plan. Surgical volumes have increased at each phase of service resumption. Phase 3 will further increase surgical volumes to between 75 and 85 per cent of pre-COVID levels, depending on the site. MRI and CT scan services have progressed over the previous phase to 90 per cent of pre-COVID volumes overall, with MRIs at 91 per cent and CTs at 93 per cent.
To help increase the number of people receiving services, Miller said the SHA is looking at ways to extend hours and has implemented virtual care options, where appropriate. More than 175,000 appointments have been delivered virtually.
“We’re learning as we go what the balance is between service resumption and COVID-19 readiness: How much we can turn on in the system now and what the impacts of COVID-19 are on the system throughout its spikes and peaks,” said Miller. “We’re monitoring a number of triggers and evaluating how well the system can be maintained and at the same time what COVID-19 might bring us.”
Environmental Services staff sanitize public touchpoints at Pasqua Hospital.