Will we go through a wave of deprogramming, as surgeons fear?

Hospital centers are forced to reorganize. second. In the face of the sudden rise in Covid-19 cases, the famous “white plans” have been reactivated. This system allows healthcare organizations to immediately mobilize additional resources in the event of an exceptional patient flow. Epidemiological pressure is mounting in hospitals facing the fifth wave: 2,901 patients in critical care Friday and soon “4,000 on recess,” according to the government.

To make room for patients, it is often surgeries that toast, a phenomenon exacerbated by birthdays and staff shortages. For its part, the main union of liberal surgeons fears the massive de-programming of operations and asks that “the management not make these decisions alone.” On the ground, hospitals are trying to avoid bleeding.

François-René Prouveau, President of the Conference of Chairs of Medical Committees of CHU Institutions, told L’Express: “On average, the deprogramming rate is between 20 and 30% at the end of the year.” The number of closed operating rooms varies from one institution to another according to the local health situation. As part of the activation of the white plan, reducing operating activity in principle makes it possible to avoid stressing the intensive care sectors with patients without Covid-19 disease. “We are doing everything we can to avoid deprogramming,” said L’Express Pierre Thépot, general manager of the Littoral Atlantique Hospital Group. In Rochefort and La Rochelle hospitals, Level 2 of the White Plan has been activated to counteract the significant increase in Covid cases in the department. In order to free up resources and add beds to accommodate patients, the operating room program is scaled back at least until the end of the year.

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“In the La Rochelle construction, we have two combined rooms closed for two weeks out of a total of 11 rooms. During the next two weeks, two or three additional rooms will also be closed in connection with the holiday period,” explains Pierre Thibaut. In other words, 30% of the blocks will be closed during the holidays. With regard to Rochefort Hospital, the observation is similar: three operating rooms out of eight will open during the end of the year. “It is above all related to staffing and absenteeism issues. We did not deprogram the operations, but we had to freeze drivers outside of emergencies very early,” the hospital director continues. He believes a recovery should occur in early January “depending on the wave”. For now, it’s hard to know if more deprogramming will take place in the coming weeks. The beginning of the school year will see two uncertainties: what will be the impact of the Christmas holidays on the vaccinated population and how will the Omicron variant spread?

period of “less activity”

“We need staff who specialize in intensive care or intensive care, which is why the operating sectors are the first to be denied their staff,” explains François-René Prouveaut, who also has an education cover at CHU from Lille. However, there are some red lines: “CHUs are trying not to touch cardiac surgery and neurosurgery.” The urgency of the operations is also evaluated according to various criteria: the length of the consultation, the pathology, the patient’s ability to wait … “If it is a hip surgery, then this is different from stomach cancer. In the latter case, we did not postpone the operation until six months later.” The period is special, too. With the Christmas holidays, staff are less present and some patients don’t want to have surgery. “Every year, starting on December 21, we enter a period of ‘less activity’.

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But that doesn’t stop some caregivers from worrying. Says Professor Benjamin Davido, infectious disease specialist and medical director and reviewer for Covid-19 at the Garches of Public Hospitals Auxiliary Hospital in Paris (AP-HP). Especially since postponing operations may have consequences. Avenir Spé-Le Bloc’s union co-chairman Philip Cook, AFP reports, is paying a “cry of alarm for patient care” for fear of the impact of deprogramming that will not be visible. the year. “The situation is likely to be catastrophic in January,” he said. In such a context, orders from some regional health agencies (ARS) that set specific targets for deprogramming, such as in Auvergne-Rhône-Alpes or in Pays de la Loire, are not well received by practitioners. The same anomalies that occurred during the first wave of ‘Spring 2020,’ estimates Dr. Cuq.

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Another union of liberal doctors, CSMF, had already asked the executive last week to “reverse the deprogramming mechanism and impose the principle of joint decision between the doctors involved and the health authorities”. Moreover, the effectiveness of such an organization is in doubt by some specialists. “Despite the white plan, there are no working music chairs. The staff is already busy with other tasks,” regrets Professor Benjamin Davido. In other words: Closing blocks is not necessarily a guarantee of employee savings to care for Covid-19 patients. Especially after five waves after the outbreak of the epidemic, the crew is exhausted. “We are aware that anesthesiology nurses do not always have the desire or skills to do intensive resuscitation in the short or medium term,” concludes the professor, adding that staff members are “tired of playing the mouth” and are also afraid of losing their “special skills.”

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