Thread by @petrosoniak

People ask me how is the emergency department these days, is there much #COVID19 anymore?

My observations below in a short🧵

TL/DR = the healthcare system is a disaster and it will be years before it improves...so buckle up.

1/

The short answer in my experience/observation is, no we're not overwhelmed with #covid19 patients requiring ICU level care in the hospitals.

But...that oversimplifies the current state. Let's look at it from the hospital, clinician and patient/family perspective...

2/

At the system level

Healthcare leadership, running large multi-million dollar organizations have spent the past 2.5yrs devoting most of their effort towards managing a crisis of epic proportions.

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The opportunity cost of spending this effort towards #covid19 means that everything (or nearly everything else) has been delayed, attention diverted or fallen off the priority list.

What does that mean? Well not only have regular operational efforts been paused...

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it means that nearly all #innovation has been put on hold too. At the beginning of the pandemic, there were lots of stories of rapid innovation but as everyone got worn down, that stopped.

Yes, we've still be doing some non-covid work for sure, but not like pre-pandemic.

5/

It just isn't possible because there's just one crisis after another that's clamouring for our attention (e.g. staffing, new waves).

Imagine you have an asthma attack while running a marathon...and you lost your puffers...that was our HC system pre-pandemic...

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Post pandemic...run that same marathon without puffers but you're carrying your friend on your back...its not going to be pretty..

The efficiency in the system has diminished substantially and there's simply no slack to tolerate the multiple levels of added friction.

7/

Every process that I encounter on a regular basis is harder to do now than pre-covid. By ALOT.

Combine that with a patient population who's tired, also burnout, stressed and in pain...its no wonder violence/verbal abuse among HCWs is on the rise

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At a clinician level, we've all heard about the staffing crisis that hospitals/clinics across the country are experiencing.

Nurses, physicians, clinical support staff, and pretty much all clinical team members are exhausted and leaving. To where? I'm honestly not sure.

9/

But I'll tell you where they aren't...doing the same clinical work they were doing pre-pandemic.

Every week there's news reports of EDs closing or at risk of closing.

I hear from patients every day that they're family doctor retired and they can't find a new one.

10/

We're basically watching a mass exodus from #healthcare. This should worry every single one of us.

I'm looking at all of you politicians...its time to devote more time/resources to fix a broken system than ever. If you thought #covid19 was a crisis...naw, we got it beat
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At patient level

This is an awful time. Wait lists are longer than I've ever seen. People have neglected their healthcare needs for 2.5yrs...or worse, the system has neglected it for them.

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The challenges to access care from primary care, to diagnostics to speciality care... straight up...is bananas.

Add on the numbers of HCWs leaving...and its no wonder waitlists are shifting from wks to months to years...

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I've seen patients waiting months to see specialists, years for MRIs

And on the regular, hours to days to even make it into a bed in the ED (if they ever do).

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This isn't a thread with answers. I'm reminded of this quote when I hear people pitch "a quick fix" for healthcare.

We would benefit however from going back to first principles, breaking it down into components and engaging end-users (clinicians & patients) in the process.

End