A hospital divided and united

Alyssa Thompson Head of Department Medical

Alyssa Thompson Physician Head of Department

The magnitude of change at Gisborne Hospital last month was unparalleled for staff and patients, says a senior doctor who helped with the hospital’s response to COVID-19.

“If you ask any clinician in the world, they will say that this was a pivotal moment in medicine,” says physician head of department Dr Alyssa Thompson.

“This pandemic and the response here and around the world will change how care is delivered in the future - be it in the way we build hospitals or the way we work with patients.”

From late March, Gisborne Hospital was divided into green and red zones to help ensure the safety of patients and staff by reducing the risk of transmission of COVID-19. The move called for a rapid redesign of treatment spaces and staff rosters as well as decisions on what equipment to prioritise for each area.

“We had to look at absolutely every component of health care a patient would physically come into contact with,” says Dr Thompson.

The simplest description is that one hospital became two – the green zone for regular patients and the red zone for patients with suspected or confirmed COVID-19.

“We were tasked with ensuring that patients could be treated and protected whichever pathway they were on. At that time we didn’t know how many people we were going to get. How do you prepare for that scenario against an unseen enemy that could be everywhere or nowhere?”

Dr Thompson says in the lead up to, and during this time, she and the other department heads were watching their international colleagues cope with the horrific spread of COVID-19.

Those department heads and other key specialists formed a COVID-19 Response Group which met over the Zoom platform. From here they formed the plan to reconfigure the hospital.

Everywhere in the hospital, from the entranceway to the intensive care unit, from maternity to theatre, extensive changes were made.

Treatment spaces were redesigned to host one type of patient or another. For example negative pressure areas were allocated only for people with or suspected of COVID-19; the intensive care unit was separated in two; and regular wards were prepped to receive patients requiring intensive care.

At the same time staff were re-allocated to areas of need, and equipment including anything from beds, monitors, pumps, and ventilators were also moved to relevant areas of need. Next to the regular Gisborne Hospital theatre, the endoscopy suite was renovated so it could be used for operations on people who might have COVID-19.

When planning for the human flow of patients through the hospital during this time, Dr Thompson said it was essential to think about the space between patients, corridors and facilities -- and to erect barriers between them.

“There were countless other logistical considerations built into the design, from deliveries and patient transfers to storage and ventilation.”

The changes were so rapid that in some cases the policies that normally accompany a change to standard operating procedures were being written at the same time the physical changes were occurring.

Staff cooperation intensified to new levels during this time and the result will be enduring working relationships in the future, she adds.

The result of the accelerated plan meant within days of starting staff had transformed Gisborne Hospital to a safe place for staff and patients with any kind of illness.

As with any overhaul of a complex environment and processes, a huge range of staff were needed. Dr Thompson says she was merely a minor cog in the very human machine that created the change. From doctors to orderlies, health care assistants to nurses, catering staff to administrators - every member of the Hauora Tairāwhiti team was involved.

 “Each one of us felt like we were one of the five million people in the Unite Against COVID plan. Like everyone else we felt we had a role to play.”

Hauora Tairāwhiti chief executive Jim Green says the scale and magnitude of Gisborne Hospital’s reconfiguration is probably incomparable to anything most staff will have ever seen while working in New Zealand.

“Hospital reconfigurations usually happen with a much longer lead in time, and without the impending threat of a virus sweeping through.”

“Our staff were tasked with establishing a hospital that could continue operating in this new world while continuing to do their jobs by caring for sick people and keeping patients and themselves safe.”

“I know I speak for everyone across the district when I say we are all truly grateful for the countless hours and considerations that went into reconfiguring the hospital so staff could keep people who may have had COVID-19 away from those who needed to seek medical treatment for other reasons. Thank you one and all”

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