Dr Shrikant Peters, Medical Manager of Theatre Services, ICU and Anaesthetics at Groote Schuur Hospital, shares his experience during the coronavirus pandemic.
“There’s always a lot of planning to do day-to-day to make sure theatres run and you have enough ICU beds, but with the external crisis of Covid it’s gone to another level. We’ve had had to de-escalate theatres – we’ve had to pull staff members out, decrease the number of lists we’re running so that we can get staff into ICU. And then we had to scale up our ICU beds quite substantially, which we were able to do successfully but it’s not been easy.
I don’t think we’ll ever have enough ICU beds and so clinicians are always making very difficult decisions on the floor. But we’ve been reviewing the cases that we’ve received and yes, the country doesn’t have enough ICU beds for capacity so based on whether you’re a candidate or not then it will change whether you get an ICU bed.
If you think about it, our normal ICU beds are 25 and we’re now on about 63 ICU beds – which is double the amount available in Nelson Mandela Bay Metro! And that’s just ICU – if you add high flow beds we’re easily at 100 and that’s unheard of. I mean each bed you have to scramble – we’ve had Friday afternoons where we’ve had to scramble to take an empty six-bed unit and create an ICU so it’s syringe drivers, infusion pumps, beds, suction, and then the nursing staff and doctors.
What’s also been good is we’re running a lot of research. So we’re innovating on the fly. We’re adapting new treatments as evidence becomes available. It hasn’t been easy and the mortality rates are a lot higher than your typical ICU patients but the staff are bearing the brunt and they’re doing fantastic work. It’s just not easy working in these circumstances.
I think we’ve managed far better than some developed countries. And you can only really see that in hindsight. From a clinical perspective the dice is really loaded against you. When you get into ICU you’re already got a very poor prognosis. So for me every life saved in ICU is worth gold.
We’ve had to stretch our staff. We’ve pulled people out of anaesthetics to go to ICU. We’ve got the anaesthetic intubation team which is servicing the whole hospital and making sure that as people crash there’s someone there to safely intubate and transfer to ICU. They’ve had more than 300 intubations – which are high-risk procedures where you’re looking down someone’s throat who has coronavirus.
And then we’ve added some doctors to the ICU pool but each registrar at night is looking after 18 ICU patients, which is a lot. And the nurses who are used to seeing one-on-one patients are having to split themselves to three patients which is also very difficult because they have to mix drugs, they have to feed, they have to write up orders. It’s a lot of work.
In the last three months, we’ve been opening a unit every week and nurses just aren’t available – we’re making do with what we have. But I think the people who are doing the work are obviously passionate about their work and they’re aligned to the hospital’s vision of being proudly GSH.
What we’ve found is people are willing to put themselves at risk if you allow them to work within their scope of practice. And so it’s been about allowing creativity and innovation at the floor level and then being able to harness that to the best outcomes in the system.
It’s up and down. You get days where it feels like everything’s crashing. But you have to re-define what success looks like. Now success is just running the course, making sure that you are seeing patients and that you save the lives that you still can. There’s never been a better opportunity to say to ourselves, ‘What should our service look like?’ I think I have to look at the positives, otherwise I’ll go crazy.”
* The Heroes of Groote Schuur campaign on Facebook was started two years ago to highlight the many unsung heroes working within one of the country’s most esteemed public hospitals.
But these heroes also need the right equipment to deliver a high standard of care - which is why the hospital has launched its Bed Fundraising Appeal.
The hospital needs to replace 84 beds in its Intensive and High Care Units with electronic beds to allow for the optimum care of patients. The total cost for each bed and accompanying monitor is R105 000 – bringing the total refurbishment cost to R8 820 000.
HOW TO ASSIST:
Please consider a donation towards this cause — any amount will help. Visit https://www.gshfb.co.za/donate/ to donate.