This morning. A patient, an elderly woman, who needs surgery on her uterus. Nothing life-threatening, no cancer, but major surgery. Dicky, admission planner at the St. Antonius Hospital in Nieuwegein, immediately dealt the blow, as she always does. “I’m sorry, I don’t have good news. We have to postpone your surgery.”
“That was painful,” Dicky says when she has a break. “Especially when I heard her husband in the background. His sister had died of cervical cancer. I would have loved to help that family out of the uncertainty. But I know: this woman can no longer be operated on this year.”
Not a second of silence
Dicky has been working in the admissions department of the hospital for 28 years: a room with bright green walls that resembles a call center. There is never a moment of silence, there are always employees on the phone. On the desks are Christmas trees decorated with lights.
Dicky is responsible for scheduling surgeries in the gynaecology, urology and vascular surgery departments. And since the corona pandemic, she and her colleagues have had another major task: canceling a large part of those patients. The recording schedulers have now also become bad news bearers.
Much more soothing
“We need to appease a lot more,” Dicky says, “explain a lot more.” For quite some time she has found it difficult to accept those increasingly long waiting lists, it is in her nature to get rid of them. She points to her screen with one of those lists. 711 waiting for you. “And there’s a story behind every name, huh.”
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Before the pandemic set in, the planners occasionally called off patients. “How it is now… We’ve never experienced this,” says Monique, who implants the plastic surgery. In the first wave, the planners mainly encountered anger: why is that operation not going ahead? Sometimes there was aggression, now mainly disappointment. Resignation. Also with the people who are canceled for the second or even third time. Monique: “Everyone is already taking this into account to some extent.”
In addition, fewer operations are already scheduled as standard because there must be room for the ever-increasing flow of Covid patients. As a result, fewer people have to be canceled lately. However, the waiting lists are getting longer and longer.
The big surgery puzzle
Such decisions are taken in the so-called Tactical Planning Consultation of the OR, where department heads, care managers and doctors come together. Since covid has arrived, the big surgery puzzle is being laid during this meeting.
Because before the pandemic, this consultation was a matter of getting together for half an hour once a week, now the consultation is necessary twice a week and sometimes lasts longer than an hour. And before the pandemic, operations were planned eight weeks in advance, now it is one week.
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There is also such a planning meeting today. We are talking about next week. In the conference room there are four department heads and doctors, they look at a large screen with eight colleagues and a large colored block diagram, showing all available operating rooms, operators, teams, specialties and the number of patients.
Each patient requiring surgery is discussed. Who gets to act first is determined on the basis of urgency. U1 means that a patient needs surgery within 24 hours, U2 within two weeks, U3 within six weeks. “We can always place the U1 and U2 patients,” says Marjolein, department head of admission planning.
“But those U3 patients, they are now the bottleneck. These patients more and more often end up in the emergency room if they are not helped. You don’t want that.”
Search for holes
It is looking for holes, looking for urgency. Concrete example: during the consultation it is discussed which patients are given priority: those in bariatrics (overweight patients) or gynaecology. The gynecological operations are more urgently needed, is the conclusion. So they take precedence. Nod in agreement. Regularly.
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“And that is why I am so proud of these people here, and certainly also of the planners”, says department head Marjolein. “A lot is not possible anymore, but we remain super creative to help as many patients as possible.”
Recently, for example, more and more minor operations have been performed without the patient occupying a bed and thus burdening nurses less. Think of broken wrists or breast-conserving operations for breast cancer. These fast track surgeries are performed on fit, young patients.
They enter a special room, get changed, go to the operating room, have surgery, are in the recovery room for a while, get a bathrobe and go back to the room they came in. If they feel good, they can be picked up.
So that’s how we’re going to do it
“In this way, dozens of patients per week can still be helped,” says Marjolein. Patients who otherwise, she emphasizes, would sometimes have had to wait quite a long time.
It is now 5.30 pm, the consultation is over, it is now dark outside. Marjolein closes with the words ‘and that’s how we’re going to do it’. Colleagues wave and the screen is clicked away. The puzzle for next week has been put together.
The situation of the patient mentioned above has been written down in such a way that it cannot be traced back.
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Read more?
This is the last episode of the four-part story series about stalled care in hospitals. You can find the first three episodes here:
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