Scaling back non-essential care

In mid-March 2020, it was communicated to hospitals via the HTSC committee that all non-essential care had to be suspended. Particular attention had to be given to surgical interventions that had an impact on bed occupancy for the ‘Intensive Care’ function.

This decision was made for several reasons:

  • To relieve the intensive care units;
  • To free up health care providers to care specifically for COVID-19 patients;
  • To optimise the use of equipment;
  • To reduce the use of protective equipment which was scarce at the time.

Naturally, urgent and necessary care continued as before. In early May 2020, it was communicated that the restart of plannable, non-urgent care could be implemented in phases under strict conditions. Each hospital was required to maintain the capacity to treat patients from the first wave, and be ready to receive patients from the second wave. Furthermore, organisational measures were taken to avoid crowding, and ensure physical distancing between patients.

The following phases for restart were set out:

  • Restart of consultations, home hospitalisation activities and the activities of
    mobile teams
  • Restart of non-surgical day hospital activities (e.g. geriatrics, psychiatry)
  • Restart of surgical day hospital activities not using intensive care
  • Restart conventional hospitalisations not using intensive care
  • Restart activities using intensive care

In preparation for restarting care, the Federation of Belgian Professional Associations of Medical Specialists drew up a reference framework on the necessity and urgency of care that can serve as an orientation tool for doctors.

Find out more about this reference framework (Dutch/French only): www.vbs-gbs.org

As the second wave gained momentum (autumn 2020), these phases were suspended in reverse order, allowing all necessary and urgent care to continue as before. As such, efforts were made to allow non-essential care to continue as much as possible. It was also necessary to defer non-essential care during the third wave (Spring 2021). In this phase, hospital managers were asked to estimate which care could continue or not, depending on the specific situation.

As a result of the measures, in the first wave we observed a 94% reduction in surgical care classified as non-essential. We also observed that 57% of essential, surgical care continued compared to what would be expected. In the second wave, we saw a 66% reduction in non-essential surgical care and a 20% reduction in essential, surgical care. The reduction in essential, surgical care illustrates the impact of the COVID-19 pandemic as well as the reluctance of patients to request the necessary care.

 EVOLUTION OVER TIME OF THE NUMBER OF PROVIDED
NON-COVID HEALTHCARE SERVICES [1]

Learn more: www.riziv.fgov.be

OVERVIEW OF DISTRIBUTION PLAN MEASURES AND POSTPONEMENT OF NON-ESSENTIAL CARE AND CHANGE IN NUMBER OF COVID PATIENTS

 

[1]The black line shows an advanced estimate of the expected amount of care provided based on 2019 data. A classification was made according to surgical interventions regarded as non-essential, mixed and essential. The mixed category includes provided care which, depending on the context, could be either essential or non-essential.