Hospitals preparing to move to ‘code black’ - NEWS.com.au

Hospitals are preparing to move to a “code black” in NSW’s intensive care units if admissions rise above 900 patients.

Hospitals are preparing to move to a “code black” in NSW’s intensive care units if admissions rise above 900 patients and the “alternative arrangements” could include ventilating patients in operating theatres and requiring ICU nurses to supervise more than one patient.

The warning is contained in a pandemic plan based on modelling prepared by the Burnet Institute that predicts ICU admissions are expected to peak at nearly 1000 patients in October.

But NSW Health moved to reassure patients on Monday that even at this level anyone who requires ICU care will still be able to get it under the plan.

“At any given time in our hospital system, there would be around 400 people with non-Covid related issues in ICU,” NSW Premier Gladys Berejiklian said.

“And so our surge capacity including staff in our intensive care units is 1550. Just to give people that reassurance. We certainly don’t want to have to use of all those beds and staff because we know what pressure it will put on the system, but we want everybody to be reassured that the capacity is there.”

The traditional model in Australian ICUs is one nurse for every patient on a ventilator.

But the plan outlined by NSW Health notes that if patient numbers in ICU rise above 900, new strategies may need to be deployed including the use of private hospitals and “alternative workforce models e.g. higher number of patients per staff member”.

NSW Nurses and Midwives’ Association General Secretary Brett Holmes told news.com.au any move away from one nurse per patient in ICU was of cause for concern.

“We’re seeking further information around what the plan specifically means regarding numbers of patients nurses will be expected to care for, how the nursing teams will be configured, and where the 2000 upskilled nurses are,” he said.

“Will the wards or units they’re coming from be able to reduce services or is it a plan to work exhausted nurses harder?”

One option may include moving nurses currently working in mass vaccination clinics back into hospitals.

Up to 560 Covid-19 cases are expected to need intensive care treatment in hospital by mid-October. When non-Covid patients are also included, ICU demand is expected to peak at 947 patients.

“It is anticipated that between 2200 and 3900 people will require hospitalisation,” the document states.

“Achieving uniform vaccination in the LGAs of concern is critical as vaccination rather than reduced infection numbers will be the intervention that leads to a fall in hospitalisation.”

The pandemic plan outlined in the document released by Ms Berejiklian includes a traffic light system to explain the level of threat in ICUs.

There are currently 177 Covid patients in ICUs in NSW, including three children. Two of those children – a baby and a nine-year-old – are on ventilators.

But the total number of patients in ICU is generally around 400 – which suggests the overall number of ICU patients is now close to 600 patients.

Level 1: Code Yellow

Currently, the situation in NSW hospitals is described as a Code Yellow or Level 1. This is described at the point at which there is a “moderate impact on daily operations of ICU”.

According to the ‘Step Plan’ provided by NSW Health, ICUs are “approaching maximal operational capacity” right now.

This is defined as the point at which there are 579 to 790 patients in ICUs including both Covid patients and non-Covid admissions.

During this phase, care delivery for ICU2 patients may be moved to other hospitals after admission to manage the caseload.

It advises hospitals to commence the “transfer of critically ill patients to other facilities as appropriate”.

Level 2: Code Red

The next phase of pressure on ICUs is Level 2 or Code Red. This phase will be used to describe the point at which there is a “severe impact on daily operations of ICU”.

The “Red” phase of the ICU plan will commence when the number of patients in ICU reaches 791 patients. This is expected to be reached in coming weeks.

Overall demand for critical care is defined as “exceeding ICU operational capacity”.

Level 3: Code Black

When the overall number of patients hits 900 in ICU – including Covid and non-Covid patients – the plan will move to Level 3 or Code Black.

This final phase is marked by “overwhelming impact on usual daily operations of ICU”. At this stage, the demand for critical care services significantly exceeds organisation-wide capacity.

It notes that care delivery for ICU1 and ICU2 patients in alternative areas may be required including ventilating patients in operating theatres

This phase includes the use of private hospitals and alternative workforce models e.g. higher number of patients per staff member.

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2021-09-06 08:21:55Z
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