Are hospitals full? Why do we wait so long?

Given the increase in infection rate it is anticipated that the hospitals will experience pressure with Covid-19 admissions.

Dr Charl van Loggerenberg, GM: Emergency Medicine, Life Healthcare spoke to the Herald about the procedure that is followed during Temporary Capacity Divert, and how the public can assist.

Temporary capacity divert

The bed capacity across all our hospitals is fluid and is being reassessed frequently.

Given the increase in infection rate, it is anticipated that the hospitals will experience pressure with Covid-19 admissions. All Life Healthcare hospitals have a doctor Covid-19 Committee that works closely with hospital management in the daily and ongoing clinical decisions affecting patients, staff and doctors to ensure that the situation is managed optimally. There are daily operational briefings and live data to keep all management teams appraised of facility status.

Life Healthcare hospitals across the country are collaborating to ensure best practice and shared learnings. A capacity forum has been formed to deal with capacity considerations, including equipment and our Covid-19 task team is continuously assessing the situation and making sure that our facilities and employees across the country have all the required resources to treat patients who are affected by the virus, and those who are not.

It is important to explain that determining capacity at hospitals is based on several factors, not only patient numbers. It is standard practice in all hospitals, outside of the Covid-19 crisis, to place certain areas of care under Temporary capacity divert (TCD).

It is standard practice in all government and private hospitals to place certain areas under TCD. It is the process of advising Emergency Medical Services (EMS) or ambulatory service of the best possible options for patients. This is specific to when the level of acuity (severity of illness) of a patient cannot be met at the immediate time, for example when a specific specialist is not immediately available to attend to the medical emergency. TCD relates to the patient’s needs, and not only to the number of patients or beds available.

TCD does not mean that there are no beds available at the hospital, but rather that the immediate care needed is not immediately available. The same applies to the current Covid-19 situation. It is also important to note that TCDs are constantly in flux and can change at any point within a 24-hour period.

What procedure is followed during TCD?

Should a patient arrive at the emergency unit during a TCD, the patient will be triaged.

Triage is a process that involves the clinical assessment of a patient’s condition to determine the severity. Patients who present serious or life-threatening illnesses or injuries will be stabilised and transferred to a facility that can provide the best care required for the patient’s condition. Patients who present mild illnesses or injuries will be referred to an alternative facility for treatment and admission.

What affects waiting times at the emergency unit?

As noted above, given the increase in the infection rate, it is anticipated that the hospitals will experience pressure with Covid-19 admissions.

Longer waiting periods are generally experienced during peak times. Waiting time is also determined by the priority colour assigned through the triage process. Due to the level of urgency identified, some patients may be assisted before others as waiting periods are based on an immediate and clinical patient need. During a patient’s visit to the emergency unit, the doctor conducts a thorough assessment which may include requesting additional investigations such as X-rays or laboratory tests.

Only after having received these test results the doctor can recommend the best treatment plan for the patient. Depending on the patient’s diagnosis, the patient is either admitted to or discharged from the emergency unit. Should a patient require admission to hospital, medical aid authorisation is requested. After confirmation is received from the medical aid, the patient is moved from the emergency unit to a ward. When ward patients are discharged transportation is not always readily available which may lead to longer waiting periods as the patients remain in the ward until they are able to go home.

Another factor that can influence the waiting time is that rooms in the emergency units are disinfected. Before an emergency unit patient can be admitted in a room where another patient was cared for, Life Healthcare’s stringent infection prevention protocol is followed and the room is cleaned and disinfected prior to the waiting patient’s admission.

How can the public assist?

The Covid-19 pandemic is having an unparalleled impact on our way of life but social distancing and lockdown should not prevent anyone from seeking medical attention even if unrelated to Covid-19. Although emergency unit employees and doctors do their utmost to assist all patients as soon as possible, understanding the protocols and processes will assist the public with regards to expectations when visiting an emergency unit and create understanding regarding waiting periods.

The community is urged to phone the emergency unit before arrival where possible, particularly if you are experiencing any Covid-19 symptoms. This will ensure that staff can prepare for your arrival to get you screened and treat you for your medical condition as quickly and safely as possible.

It is absolutely essential that everyone takes measures advised by government to protect themselves and others from being infected by the virus. We appeal to your newspaper to assist the community you serve with extensive knowledge on Covid-19, how it spreads and how infection can be prevented.

That information is available on the Department of Health website at and the NICD website.