Health services to come back in phases

The resumption of regular health care services in Saskatchewan will take place during several phases to ensure patient and staff safety and to maintain system readiness to respond to COVID-19 infections.

The Saskatchewan Health Authority (SHA) announced details about the phased resumption of health care services during a media briefing, May 5.

SHA CEO Scott Livingstone said the plan was created in partnership with the Ministry of Health, physician leaders, as well as patient and family advisors.

“This is a gradual, phased in plan that will allow for the resumption of health services in both urban and rural communities across the province,” he noted. “The primary consideration in this process will be patient and staff safety.”

The SHA had to implement health service changes and reductions when it started with the execution of the provincial COVID-19 readiness plan in March. Public health measures slowed down the spread of COVID-19, which will allow the SHA to gradually resume services.

Livingstone emphasized the service resumption plan will be implemented in a flexible manner and it will be adjusted to local conditions.

“It will not be a one size fits all approach,” he said. “It's more of a framework. It will be mindful of the different dynamics in the province, including accounting for the outbreaks that may slow the service resumption in certain areas of Saskatchewan.”

At the same time, he felt it is necessary for the SHA to move forward with the process to resume health services.

“The reality is we need to start to resume some services where we can,” he said. “While there are risks to resuming services, there are also risks if we don't. When people don't get everyday health care, their conditions can escalate. That is why we need a plan in place to ensure people get the care that they need.”

SHA Physician Executive for Integrated Urban Health Dr. Rashaad Hansia provided details about the service resumption plan, of which the initial phase will start May 19.

“The focus of the resumption plan is to work on expanding everyday health services,” he said. “Those are the services that keep Saskatchewan residents healthy and allow them to stay healthy. These are the services that we aim to provide as close to where people live as possible.”

He added that the provision of these services might not be provided in exactly the same manner as before the start of the COVID-19 pandemic.

“During the course of this pandemic we've encountered and implemented many new ways of working, such as virtual care as well as online groups, and these are initiatives that we absolutely need to continue going forward as they remain central to the way services will be delivered,” he said.

The SHA will continue to monitor the situation with regard to COVID-19 infection and spread, because that will determine their ability to implement each phase of the service resumption plan.

Other factors that will be considered are the availability of an adequate supply of personal protective equipment and the measures that will be required to ensure a safe flow of patients and health care providers through different facilities.

“We want to acknowledge that there will be variations in how this service resumption plan is executed and implemented across the province, and this is important to recognize and to know, because different communities will be experiencing different parts of the pandemic and different numbers of COVID related infections as well as potential outbreaks at different points in time,” he said.

The different health care services and programs are interdependent and it will therefore require extensive planning to resume services. Staff have been redeployed during the implementation of the COVID-19 readiness plan, for example to do testing. Functions such as laboratory medicine and pharmacy can only resume once staff return to their previous roles, but it must be done in a manner that will maintain COVID-19 readiness and activities such as testing.

There will be a gradual increase in the number of in-person appointments, but these will only be done where necessary or appropriate, and where it is safe to do so.

There will be staggered appointments to limit the number of patients in facilities or program areas at any one time, which will help to reduce the risk of COVID-19 exposure or transmission.

Dr. Hansia said it was a deliberate decision to only indicate a starting date for the first phase of the four-phase service resumption. The timing of the other phases will only be determined after careful consideration of the situation.

Phase one will start on May 19 with the resumption of some everyday services and the expansion of surgeries and diagnostic imaging. Surgeries will be expanded from emergency and three-week urgent cases to those booked as six-week urgent cases.

The surgical service expansion will occur at a ratio of 75 per cent day surgeries to 25 per cent inpatient surgeries.

“That is deliberate in order to minimize the foot traffic and the number of people in the facilities at any given point in time,” he said.

Interdisciplinary teams will continue to assess all waiting patients to ensure that surgeries and diagnostics are performed in a timely manner. Health care teams will start to contact patients on wait lists and there is no need for people to phone their providers or their physicians for this information.

There will be more primary care clinics during phase one, but wherever possible there will be virtual care appointments and priority will be given to in-person visits for those living with chronic diseases.

Various mental health and addiction services will resume during phase one, including the option of in-person appointments where needed. Therapeutic and day programming activities for groups of less than 10 people will be allowed, and regular hours for harm reduction programs will resume.

Various other services will start again during phase one, including routine immunizations, home care, maternal and child services, kidney health, public health inspections, and rehabilitation and therapy programs.

Service resumption during phase two will include the start of SHA-operated specialty clinics, but wherever possible this will take place through virtual care appointments.

Service delivery in various specialty areas will also start during the second phase of this plan, including electrophysiology, outpatient heart monitoring, respiratory services, tuberculosis clinic and treatments, eye centre testing, dermatology clinics, cast clinics, and increased fetal testing at high risk antenatal clinics.

The additional expansion of everyday health services will continue during phase three. This will include services for chronic disease management, wellness programs, stroke prevention, opioid agonist therapy, ongoing re-introduction of mental health and addiction services, and specialized services for clients with developmental disabilities, autism and brain injuries.

Full resumption of services will take place in phase four, when long-waiting elective surgeries and previously postponed surgeries will resume. Hip and knee outpatient clinics will re-open in this final phase.

Dr. Hansia emphasized the full resumption of services will be a “new normal” with new and different ways of working and delivering services.

“We will be carefully evaluating the situation in each part of the province and making decisions on whether the expansion of services should continue or should be moved backward at any given point in time,” he said about their approach to continue with each phase of the process.

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