Thread by @YouAreLobbyLud

1/ HOSPITAL IN THE HOME (HITH) IN VICTORIA IS IN A STATE OF COLLAPSE

These are the messages to me this evening from a friend who works in the system. The words speak for themselves.

“HITH list unmanageable today, worst I’ve ever seen. This is it. Total collapse coming”

2/ “We aren’t coping, just doing the best we can, nothing else we can do but watch”

“the HITH list is overflowing, we are taking two days to get to priority 1s which are the immunocompromised. Regionally there is no access to Paxlovid in big centres or smaller regions”

3/ “Regionally there are major outbreaks everywhere, most regional HITH lists are managed by nurses with minimal medical input”

And no pharmacy support. Which means most of the regions don’t have access to Paxlovid in reality

“Emergency meetings today at Vic DoH”

4/ [Side note: @VictorianCHO reported today that he himself has COVID]

https://twitter.com/VictorianCHO/status/1524972453545791488

“Every HITH in vic currently overrun with huge lists, which means it’s harder and harder to get to the high priority ones quickly.”

5/ “Every second patient has chest pain and short of breath, which means it’s impossible to get to the actual patients who are having a heart attack or acute pneumonia”

6/ “Too many asthmatics with reactive airways answering “short of breath at rest” on the daily questionnaire, so they come up as “severe” on system, so hundreds of calls to these so called severe symptoms. Only a few are truly severe but they get lost in the flood."

7/ "This is what a system collapse is. It’s not being able to identify people who really need that call. As we are held up calling all of these patients. But people will report what they feel. It’s not their fault.“

8/ "Can they talk in sentences?
That’s the question that needs to be on the questionnaire but is missing.
Chest pain mild moderate and severe are the three options, half of the patients on my list today are currently sitting at moderate and severe"

9/ "None are having a heart attack, one may have pericarditis
How do I find that one?"

“In a surge, it’s the not sick ones who break the HITH system”

“It’s the numbers that kill the system. We need to reduce the total number of infections

10/ There is no other way to save this system”

11/ "Because what we call “mild” and “nothing to worry about” is chest pain they’ve never experienced and that will worry them for days, with the doctor on the phone reassuring them for 20 minutes that it’s not a heart attack and it’s not pneumonia.

12/ That takes my time away from me
That’s the time I don’t have for 40 patients a day to do that reassurance so they don’t call an ambulance and swamp the ED"

13/ "I pretty much hear someone say “elephant sitting on my chest” every day and “baseball bat to the back of my head” every few days.
you can't exclude PE, ami or subarachnoid over the phone. You can’t. It’s just a statistics game. Gamble"

14/ "The risk of missing a serious case always sits with the medic, so I’ve had to learn to sit with it."

15/ PERSPECTIVE BY ME, DR DAVID BERGER
I have been a doctor for 30 years, a qualified GP for 24 years. I have years of experience of out of hours telephone triage, which is effectively what this GP is doing, and I used to teach it to other GPs.

16/ This situation is very dangerous and is likely to lead to serious illness being missed due to the pressure on the system.

17/ This is catastrophic for the patient and also the clinician concerned: they are put in a position where they are being set up to fail and will carry the can for it. Cue career-ending, even life-ending, moral injury. I know - I have seen it.

18/ What is happening in Australia now is unsustainable. There is no option but to suppress transmission. You can ignore reality for only so long.

19/ These messages have been shared and anonymised by me with permission and when I said to the GP concerned "This is very shocking stuff. It will likely go viral and get picked up by the press.

20/ Take some time to make sure you really want me to share it" they came immediately back with:

"I think it’s good David, it’s the risk that people need to know about. When they get covid they will become a number. This is triage medicine, no other way to put it."