Bed shortage forces surgery delays

  • Delays: twelve surgeries had to be postponed in March owing to the bed shortage at King Edward VII Memorial Hospital

 (Photograph by Akil Simmons)

Twelve surgeries had to be postponed in March owing to the bed shortage at King Edward VII Memorial Hospital.

The Bermuda Healthcare Advocacy Group expressed its dismay over the impact on patients, with one of its members claiming his own health problems deteriorated as a result of delayed surgery.

A Bermuda Hospitals Board spokesman said knee replacements, cosmetic breast surgery, skin grafting, hernia repairs, and a gall bladder removal were subject to waits last month.

“Out of 849 completed surgeries in March 2017, 12 surgeries did not take place on the day they were originally scheduled at King Edward VII Hospital — 1.4 per cent of the total number of surgeries in March — due to bed availability,” she said.

“Of those 12, six were hip replacements that were rescheduled and completed within the same week. Eighteen hip replacements surgeries took place in total in March.”

BHAG member Allan DeSilva told The Royal Gazette that his prostate surgery, postponed on December 8, took two months to proceed.

“Had this surgery gone off without a hitch, I would not be in the trouble that I am now,” Mr DeSilva said.

“I have to go overseas for my kidney stones. Hopefully that’s going to happen soon. If my prostate had been treated before Christmas, my kidney stones could have been resolved early. I’m not blaming my doctor for it. The blame has to go to the hospital.”

BHB announced in March that availability of beds stood at “crisis” level, with every space filled.

The spokeswoman said a bed capacity meeting was held each morning, with discharges and emergency admissions changing capacity each day.

“Surgery” is a broad term, covering procedures requiring anaesthetic, particularly operations in surgical suites. Procedures using local anaesthetic or stitching take place in outpatient offices and the Emergency Department — in hospital and in the community offices.

The procedures may be inpatient, requiring a stay in hospital afterwards, or outpatient, with patients leaves after going through post-anaesthetic care.

Elective or planned surgeries are not by their nature emergencies, but they can be critical to a patient, the spokeswoman explained.

“For that reason, we take the decision to reschedule any surgery very seriously and open special overflow beds to allow as many surgeries to take place on time as possible.

“For example, a hip replacement is not life-threatening, but we know there is a patient who is pain whose life is impacted by the delay.”

Rescheduled procedures are discussed with surgeons, whose advice enables BHB to “jointly prioritise surgeries based on clinical need first”.

“We work with patients a few days prior to surgery and discussion is held during their pre-admission testing and the day before surgery regarding the possibility of the need to reschedule their surgery,” she said.

“We understand their frustration, and we are always honest with our patients when it is a bed issue.”

Data provided for the fiscal year 2016/17 showed “patient no show” as the biggest cause of surgery delay, at 178 cases.

No shows cover scenarios such as “the patient cancelled, forgot to call, didn’t turn up, or went overseas”, the spokeswoman said.

The second-highest factor, at 110 cases, was patients deemed unfit for surgery, based on assessments by the surgeon, anaesthetist or patient themselves.

Reasons ranged from laboratory or X-ray results, to pregnancy or incomplete screening.

Third, at 89 cases, was cancellation due to the procedure being “too late to continue”.

Scenarios ranged from patients not being able to wait longer, or a lack of time to complete the surgery.

For 2016/17, 32 surgeries could not proceed on their scheduled day due to a lack of beds.

Asked for the figures for the first three months of 2017, a spokeswoman said that 20 had been cancelled because beds were not available, accounting for 0.8 per cent of the 2,273 total surgeries.

“In the period April 2016 to December 2016, only 18 surgeries (0.2 per cent of all surgeries) did not take place at their scheduled time due to bed availability. It’s worth noting that during this period, 7,211 surgeries were booked and 391 were cancelled.”

All hospital wards are being used to accommodate patients, with some adults placed in maternity or the children’s ward.

The Royal Gazette also requested specific locations where patients would be placed, in the event that they had to be moved to make room for acute patients.

While details were not forthcoming, the spokeswoman told us: “BHB will never turn away a patient or deny them treatment. The time in which patients are attended to in the Emergency Department depends on the acuity of their conditions.

“Those with the highest acuity are treated first. This has not changed.”

Pressed on the issue, she responded: “BHB’s mission is to provide the public with safe, high-quality care. This mandate remains in place despite the current shortage of beds. Each case is managed with careful consideration.

“On the wards, if patient transfers are necessary, they will take place.

“In the Emergency Department patients will always be seen in the order of the acuity of their condition.

“The more severe or acute their condition, the faster they will be seen by a physician.

“No matter what the injury is, the public can be assured every decision made will provide our patients the ability to undergo treatment, heal and recuperate, safely.”