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Healthcare crunch: From giving hospital staff breaks, to leaning on each other to deal with COVID-19 surge

Grappling with fatigue 20 months into the pandemic, hospital staff are finding ways to support each other – from food, to taking on new roles, to suggesting ideas for smoother workflow. Heart of the Matter talks to two senior doctors.

Healthcare crunch: From giving hospital staff breaks, to leaning on each other to deal with COVID-19 surge
A healthcare worker administers a swab test for COVID-19. (File photo: REUTERS/Edgar Su)

SINGAPORE: With the surge of hospital cases putting the strain on healthcare workers who are grappling with burnout and fatigue, ensuring that staff don’t buckle under the pressure is key.

At Sengkang General Hospital, where he is deputy chairman at the division of medicine and inpatient care, Dr Melvin Chua acknowledged the pace has been punishing and conditions “very intense” – with clinical staff having little time to catch their breath apart from sitting down for a sip of water or a quick meal break.

So, he does little things like cater lunches to make sure his staff have their regular breaks, he said on CNA’s Heart of the Matter podcast.

“We need to ensure that (our staff) are not breaking down because we need every hand on deck,” he said.

“We must, first and foremost, look after ourselves before we can adequately look after our patients.”

While asserting that “this is what we train for”, Dr Chua said that experienced doctors like him have been humbled by the pandemic, and are mindful about the challenges faced by the nurses and other junior colleagues not used to the intensity.

Some hospital workers in Singapore have shared about being pushed the limit in the long slog against the pandemic with no apparent end in sight.

Occupancy of COVID-19 isolation beds now stands at 85 per cent, up from 62 per cent in July; while the daily bed occupancy rate overall across the eight public hospitals in the week of Oct 3 to Oct 9 ranged from about 77 per cent to 93 per cent.

“We’ve been dealing with COVID-19 since 2020. So yes, it takes a toll, and (on) some more than others,” said Dr Stephanie Sutjipto, senior resident at the National Centre for Infectious Diseases (NCID).

“We’ve realised how COVID-19 is more a marathon than a sprint,” she added.

ON TAKING LEAVE

On the podcast addressing how hospitals are dealing with the unprecedented COVID-19 surge, the issue of leave arose. Healthcare workers earlier told CNA that applications for overseas travel have been suspended, and some are concerned that leave and days off could be cancelled, as happened in  the early part of the pandemic.

“We are not stopping leave at the moment,” Dr Chua clarified, even though he acknowledges that some personal plans have had to be “curtailed” given the challenging situation.

Dr Sutjipto said: “There are days when we have lighter surgeries, fewer numbers. And in those days, we encourage people who have been working over the weekend to take a day off, take a half day.”

So leave might have to be dynamic, and healthcare workers might not get the dates they want unless it is an emergency or an event like a wedding – but there is space for rest, the two doctors assured.

As for overseas travel, there are exceptions for individual circumstances, said Dr Sutjipto. She knows of staff, who have not seen their families for a while because of border closures, apply for leave successfully.

But this is a critical time, and hospital professionals understand such restrictions are temporary until things stabilise, she added.

THE UPSIDE: BREAKING DOWN SILOS

While the hours are intense and there’s pressure to keep up with changing protocols, both doctors say the healthcare fraternity is united by its strong sense of mission. And everyone pitches in to help.

“The sense of camaraderie on the ground is actually quite strong,’’ said Dr Sutjipto.

Pre-COVID, there was a clear segregation in how doctors and nurses worked, and different departments operated separately. During the pandemic, these hard distinctions melted away.

Dr Chua explained how colleagues from general surgery or orthopaedic departments have paused elective procedures and jumped in to run COVID-19 wards with the help of infectious disease buddies.

Whoever needed to change wound dressings for patients simply did it instead of waiting for a nurse. If there is a surge, others come in to cover without asking.

At Sengkang General Hospital.

There is a lot of handholding now too, Dr Sutjipto said. When hospital teams have weekly meetings on protocol changes, staff working in the COVID-19 wards are walked through the updates in detail and given guidance.

At NCID, staff have been surfacing ideas to improve ground operations during this recent surge in cases.

Going over and recording the health history of COVID-19 patients was a cumbersome task, until junior doctors suggested a streamlined template standardising questions. NCID management implemented it, Dr Sutjipto shared.

“(The) nursing (team) has also been amazing,” she added. They came up with a system to get as many details as possible from incoming COVID-19 patients over the phone, so that they can be attended to quickly once they arrive at the hospital.

The impact of such proactive moves – to create standard operating procedures that give certainty to workflows and cut down administrative work – cannot be underestimated.

“When you have 30, 40 admissions at night, it can be very messy and time-consuming,” she said.

‘WE ARE NOT PERFECT’

But even with simplified protocols and more community care and treatment facilities to ease the strain on hospitals, there are still gaps and more demands placed on staff.

“We are constantly pushing ourselves to the limit … we are always asked to do a little bit more,’’ said Dr Chua.

“Our guys, when they understand the situation we’re in, everyone will stretch a little bit more to try to help the patients we have.”

He added: “We are trying to prioritise as best as we can. We're not perfect in any way … We do make mistakes. The manpower is very stretched and we fall short, but we try our best for our patients.”

With home recovery now the default for most COVID-19 cases, and 3,700 more potential beds in treatment facilities being set up by end-October (for cases requiring observation but not hospitalisation), could this help ease the load on hospital staff?

Said Dr Sutjipto: “With fewer numbers at our hospitals, we actually have more time to attend to the sicker patients. So it's not just about the number, it's how many of these admissions are actually very sick and need urgent attention.’

Since Oct 7, the number of patients requiring oxygen supplementation or ICU care has hovered over the 300 mark, with 370 such cases as of Oct 15.

As for what keeps him up at night Dr Chua said it is worrying about how his patients are doing and how the staff are coping.

For Dr Sutjipto, it is whether “we have done enough for the patients that we see that day, whether we are doing the right thing, and if anything else can be done better”.

What they can lean on, they say, are their colleagues who have not only worked tirelessly in the trenches, but also supported each other through small gestures – like sending gifts and food.

Said Dr Sutjipto: “Something good (that came) out of this COVID-19 is seeing how people adapt, how they can shift and be readily deployed … how all departments come together.’’

Listen to CNA's full conversation with Dr Chua and Dr Sutjipto on the Heart of the Matter podcast:

Source: CNA/el

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