Hospital platform in the Western Cape under severe pressure

Hospitals in the Western Cape are currently under severe pressure. This is as a result of the sharp increase in patients requiring to be admitted with severe COVID-19 as well as the increase in non-COVID-19 trauma cases.

The bed status:

The 231 adult ICU/high care beds across hospitals are currently fluctuating between 80-100% total capacity daily (technically full) which is placing enormous pressure on the capability of all facilities. An additional 136 dedicated adult ICU COVID beds were made available, bringing the combined ICU/high care beds to 367.

As at 18 December there were 2 032 total Covid-19 patients in hospital of which 287 were in ICU/high care. However, the additional capacity made available requires resources to directed away from other services, meaning less capability for a particular health service to be rendered.

In addition, the 4 443 acute beds (excluding Maternity, Paediatric, Neonatal, Psychiatry beds, Red Cross, Mowbray and the TB hospitals) across the province are also taking strain with Metro hospitals operating at 78% and Rural hospitals at 89%.

The various bed totals change daily and is monitored by the management teams at hospitals.

Clinical decision-making during peak of pandemic

The protracted pressure on scarce health resources may result in possible delayed admission to hospital or the possibility that certain service packages cannot be rendered. To assist the teams the Department has initiated ethics committees to support the clinical decision making. Both clinical decision making and access to certain care packages will, by necessity, be different to those experienced in normal day-to-day services – for both COVID-19 and non-COVID-19 patients.

These are unprecedented times globally and require us to take unprecedented actions to support the most vulnerable patients. Senior management fully supports clinicians in this very difficult time as their decisions are guided by equity, fairness, dignity, and engagement. To further support our teams and the demand for services, an additional 829 dedicated COVID beds have been made available.

Providing additional intermediate capacity to lessen pressure on acute hospitals

The existing 487 intermediate care beds, which are being provided by Brackengate, Sonstraal and Freesia ward (Lentegeur) are also seeing an increase in admissions. Brackengate is nearing capacity (total of 264 admissions on 17 December).

To support these facilities, were will be creating an additional 263 beds within Lentegeur and Tygerberg Hospital. We have already started exploring/implementing certain plans to further expand our capacity to deal with the increased demand for hospitalisation. Each option is guided by the availability of suitable infrastructure and staff resources.

Staffing resources:

As demands are placed on our staffing resources, we have put the following measures in place to ensure that our staffing needs can be met:

1. Additional agency staff
2. volunteers and bursary holders
3. Extra doctors
4. Redeployment of staff internal staff

Staff safety is given the highest priority during this high-pressure period. No effort is spared to ensure safety protocols are adhered to. We have also staggered leave arrangements to try to ensure that staff can have some rest and time with their families.

While we expand our bed capacity, we require the support of every citizen in the province to do their part by being safe.

• Always wear a mask when going out
• Avoid crowded places, confined spaces with poor ventilation and close contact
• Stay home if sick and arrange a test – isolate while you wait for your results
• Be careful about sharing your “air space” by avoiding crowds where you cannot keep 1.5m distance
• Having people over? Limit the size of your get-together (more people = more risk) and Keep them short (longer = more risk)

Please use this link to access video content of Dr Saadiq Kariem, DDG: Chief of Operations for Western Cape Government Health: https://filegooi.co.za/get2/92708d4db775a5087646c458912f5ad8/VID-20201220-WA0006.mp4