Which delayed care comes first?
In the first instance, this concerns ‘ICU-dependent critically plannable care’, such as colon cancer operations, cancer treatments with chemotherapy or immunotherapy and kidney transplants. If this type of care is delayed for more than six weeks, there is a significant risk of permanent damage to the patient’s health. It may even mean that the patient dies earlier.
In order to determine the order in which hospitals will scale down and resume their non-corona-related care, the Federation of Medical Specialists divided the various treatments in the autumn of 2020. about five classes. The care that is now being resumed is class 3. The first two classes concern care that must absolutely be carried out within one week, such as an imminent heart attack or cerebral haemorrhage. This care has never been scaled down in the Netherlands.
Class 4 consists of treatments in which delay leads to ‘some’ risk of permanent health damage: hip operations, inguinal hernia corrections and certain hernia treatments. Patients for this type of care will remain on the waiting list for the time being. Class 5 care, including sterilization and cosmetic operations, will also not be resumed yet.
How much care must be made up in total?
The number of catch-up operations at hospitals is according to the latest estimates by the Dutch Healthcare Authority (NZa) about 115 thousand higher than normal. For this estimate, the NZa looks at the number of patients on the waiting list at 57 hospitals. The regulator then extrapolates that number to the entire healthcare sector, and finally compares it with 2019, the last year before the corona crisis broke out.
Last summer, the NZa estimated that hospitals and clinics between 170 and 210 thousand operations had to catch up, about 12.5 percent of the number of operations they normally perform in a year. Based on those numbers calculated ABN Amro that catch-up care would cost the Netherlands more than 2.3 billion euros.
In the summer, part of the waiting lists could already be eliminated. Hospitals rented additional operating rooms or continued to operate for longer in the evenings. But in the autumn the so-called work stock increased again. Since October, production in all specialties has been below pre-pandemic levels.
Why can regular care be resumed?
The occupation of Dutch hospitals has been falling steadily since mid-December. That is why Minister Ernst Kuipers of Health thought the time was right on Friday evening to complete the so-called phase 2d, the last phase for what code black means in practice. withdraw.
Kuipers’ predecessor Hugo de Jonge had announced phase 2d at the end of November. At that time there were 2,070 patients in the nursing wards, and more than 528 in the intensive care units. Moreover, the peak was not yet in sight. At its peak, the number of patients in nursing wards and intensive care units approached 3,000.
In the meantime, the pressure on hospitals has eased somewhat. On Friday afternoon there were still 954 patients on the nursing wards, 334 on the ICs.
Has the pressure in healthcare now finally passed its peak?
Ina Kuper, who will act as acting chair of the National Acute Care Network (LNAZ) and the National Coordination Center for Patients Distribution (LCPS) after Ernst Kuipers left for the Binnenhof, dared to say whether code black has been definitively averted in hospitals. on the radio show Sven On 1 not to say. ‘But given the developments in the countries around us, it seems likely that we will not end up in such a scenario.’
Nevertheless, it remains important to keep a close eye on the hospital figures. The downward trend in the number of new hospital admissions seems to have slowed down in recent days. If the omikron wave actually causes a reversal, it will probably be visible first and mainly in the nursing wards. At the moment, the number of new admissions there is still decreasing, but a lot less quickly than last week.