BHB urologist performs Bermuda’s first laparoscopic kidney removal

Dr Gordon Kooiman

28 February 2017: Hundreds of nephrectomies (removal of kidney) have been performed in Bermuda over the years, but the Bermuda Hospitals Board (BHB) can now report the first case of a patient having the procedure done laparoscopically.

Urologist , MBBS MSc FRCS(Urol), joined BHB last December. A specialist not only in urology but also laparoscopic surgery, he quickly received a referral from another local urologist.

Forty-three-year-old Elizabeth DeSilva said she wasn’t in pain, but when she learned that her left kidney “was completely filled up with large stones” her physician told her it would be best to have it removed. “He called me up and said I should get a second opinion from Dr Kooiman at the hospital,” said Mrs DeSilva. “[He] explained that if he did the surgery I would have a scar about 12 inches long but that Dr Kooiman might be able to do it where the scar would be much smaller.”

Mrs DeSilva said after meeting Dr Kooiman she and her husband opted for him to remove her kidney laparoscopically.

“He was a really wonderful doctor,” she said. “He made both my husband and I feel at ease with the surgery he was going to perform. He was really warm and friendly.”

Elizabeth DeSilva

A mother of three and grandmother of two, Mrs DeSilva said her entire family was concerned about her health. “And I was very nervous,” she added.

She had the nephrectomy on 15 December 2016.

“I was fine when I came out,” she said, “although I was sore. It took some time, but I eventually felt better.”

Dr Kooiman said: “Removing a kidney via the laparoscopic (keyhole or minimally invasive) approach is available in most urology centres worldwide. Three or four small 5-10mm wounds allow a camera and thin, long instruments to be used to free the kidney from the surrounding structures. The kidney is then removed by extending one of the small wounds. Because the main wound is smaller, laparoscopic nephrectomy is associated with less post-operative pain, quicker discharge from hospital and quicker return to work.”

In the case of Mrs DeSilva, she spent only four days recuperating in the Acute Care Wing compared with a likely stay of seven to 10 days if she had undergone open surgery.

If you would like more information on laparoscopic nephrectomy, contact Dr Kooiman’s office on 239-5908 or email Gordon.Kooiman@bhb.bm.

Update on bed capacity at the King Edward VII Memorial Hospital

22 February 2017: Bermuda Hospitals Board (BHB) today updates the community on bed capacity at the King Edward VII Memorial Hospital.

Bermuda is currently experiencing higher levels of flu and respiratory illness. This, along with an aging and increasingly chronically ill community, as well as difficulty discharging seniors due to the lack of community nursing home facilities, has caused a sustained surge in demand. This is being felt in the Emergency Department, and admissions have increased for Acute Care Wing and General Wing units, leading to the hospital being over capacity.

In just three days (Saturday 18 to Monday 20 February), there were 279 Emergency Department visits. It took an average of 3.13 hours for Emergency patients to be seen, treated and discharged over this period. Thirty eight (38) Emergency patients were admitted to an inpatient ward just over this three day period. The maximum number of beds in the Acute Care Wing is 90. The wait to be admitted to an inpatient bed was 4.83 hours on Saturday, but on Sunday and Monday it took over 15 hours.

Delays are occurring in Emergency as people wait to be assessed, because the department has been filled with admissions awaiting transfer to hospital ward beds. A Fast Track service is running in the Emergency Department to reduce waiting times for patients. Although the Lamb Foggo Urgent Care Centre (UCC) remains closed for refurbishments until 1 March 2017, UCC staff are working in the Emergency Department to help cope with demand.

To cope with demand for inpatient beds, wards in the General Wing are currently being used for acute admissions. Additional space is being sought within the hospital to cope with the high number of inpatients and some elective (ie non-emergency) surgeries may be postponed as available bed space is optimized, although outpatient surgery will continue as usual.

Chief of Emergency, Dr Edward Schultz, comments: “Our hospital staff are working round the clock across departments to care for the current levels of unwell people in Bermuda. We ask for the community’s understanding and patience if they come to Emergency. We are doing all we can to ensure everyone can access the services they need. This is not about misuse of Emergency services as individuals coming to us at the moment are very sick. However, people who can wait to see their GP should, and we are asking GPs to refer non-emergency cases who need access to specialists directly to the specialist – for example, surgical lancing of abscesses can go directly to a surgeon for an outpatient appointment. This will help us focus on the people who truly need Emergency services.”

Chief of Nursing, Judy Richardson, comments: “Although the situation has eased slightly today, we apologise for the inconvenience caused by delays for patients being admitted to wards and for patients waiting to be assessed in the Emergency Department. As the Island’s only hospital we do whatever is needed to cope to ensure those who are sick or injured get the care they need. While delays are being experienced and people may not find themselves on the usual wards for acute care, I would like to reassure the community that they will be cared for. The surge is most significant in our senior population and the lack of community home beds is making it increasingly difficult to discharge people when they no longer need acute care services to free up capacity. This increase in inpatient numbers has to be staffed and support services increased to ensure safe clinical care, a clean environment and additional patient meals. I would like to thank all of our staff across the board who are working tirelessly and determinedly to keep services available for all those in need.”

The public is asked to help hospital staff at this time of high capacity by using services appropriately and maintaining their health wherever possible:

• If you have a close relative at KEMH who is ready to be discharged, please work with the hospital teams to get them home without delay.
• If you have a minor illness or injury, book an appointment with your GP – you will avoid long waits. If you are in an Emergency situation, however, please do not hesitate in seeking care at the hospital.
• If you know which specialist you need and it is not an Emergency, make an appointment directly with the specialist (if you need a referral, see your GP).
• Manage any chronic conditions you might have – for example, make sure you take your hypertension or diabetes medication to avoid an emergency.
• Look after yourself: eat healthily, exercise and wash your hands regularly to try and avoid infections and optimize your wellbeing.
• Drive safely at all times – and don’t drink and drive! You can avoid an Emergency visit and an admission by not ending up in a road accident.

Lamb Foggo UCC to reopen 1 March

22 February 2017: Bermuda Hospitals Board (BHB) will reopen the Lamb Foggo Urgent Care Centre (UCC) on Wednesday 1 March 2017. The east end facility was temporarily closed last month to install new vinyl flooring.

Marshall Minors, Vice President, Facilities Management & Estates, comments: “In addition to the flooring we also conducted minor repairs and upgrades to the facility. This included painting, installation of a shower stall, accreditation recommendations, and exterior glazing repairs, and storm water drainage improvements for the ambulance bay.

“The work was scheduled outside of hurricane season and ahead of the America’s Cup and busy summer season. We apologise for any inconvenience caused, but the public will be better served with the improvements now in place.”

BHB Chief of Emergency Services Dr Edward Schulz said: “We are happy to have our east end facility available to serve the community again. We are experiencing a busy flu season and the UCC reopening will certainly be convenient for many who require care at night and/or on the weekends.”

The public are reminded to use the BHB emergency services wisely and visit their GP if their situation is not urgent.

General Consent Form to take full effect on 30 January

26 January 2017: Bermuda Hospitals Board (BHB) wishes to remind the public that all patients have to expressly consent to their care before medical treatment or services can be afforded.

The General Consent Form was introduced in August but started with a few departments. On Monday 30 January, this requirement will be applicable in all departments located at King Edward VII Memorial Hospital.

Traditionally it has been assumed that anyone attending the hospital wanted treatment. Introduction of the General Consent Form now formalises this relationship. The General Consent Form covers routine medical care and non-invasive procedures. Simply put, it is your consent to care. It is worth noting that BHB has always required consent forms for invasive procedures such as surgery and blood transfusions, and that use of these will continue.

Members of the public do not have to sign the form, but failure to sign it means no treatment or services will be given.

Processes are in place for those who are vulnerable and unable to sign on their own behalf. These processes will be extended and used with this additional consent form.

Members of the public can visit the BHB website to review the form as well as frequently asked questions and answers. Anyone requiring more information about the form can telephone 239-1553.

• BHB General Consent Form
• BHB General Consent Factsheet

Notes to Editors
The Bermuda Hospitals Board is a quango (quasi autonomous non-governmental organisation) established under the Bermuda Hospitals Board Act, 1970. It has a Bermuda Government-approved Board and a Chief Executive Officer, responsible for King Edward VII Memorial Hospital and Mid-Atlantic Wellness Institute. At the heart of both organisations is high quality care to all patients.

With approximately 1,700 employees, the Bermuda Hospitals Board is Bermuda’s second largest employer. King Edward VII Memorial Hospital and Mid-Atlantic Wellness Institute are the only healthcare organisations in Bermuda accredited by Accreditation Canada, an independent organisation whose role is to help hospitals examine and improve the quality of care and service they provide to their clients. In addition to providing an extensive list of services for the community, the Bermuda Hospitals Board is part of a referral network that includes some of the world’s leading specialist hospitals.

For more information, please visit www.bdahospitaldev.wpengine.com or contact the Bermuda Hospitals Board Public Relations Department at publicrelations@bhb.bm.

BHB introduces Patient-Centred Medical Home

24 January 2017: Bermuda Hospitals Board has invested in a pilot project to help combat the impact of chronic disease including cost. The Patient-Centred Medical Home (PCMH) programme is an outpatient referral service for individuals with chronic diseases, such as diabetes, who are not currently seeing a GP and who are under- or uninsured.

“The goal is to keep this at-risk group as healthy as possible and help them manage their chronic diseases,” said BHB CEO Venetta Symonds. “This will help reduce emergency department visits, hospitalisations and complications, such as amputation and dialysis, which impact quality of life and are costly to the healthcare system.”

Patients require a medical referral to receive the service. Medical Director of the Programme Dr Stanley James said these referrals will likely come from GPs, the Emergency Department and the hospitalist service.

The pilot programme began on Monday 7 November. It will run for a year, at which time it will be assessed and a decision made on modifications or continuation.

To date, there are 28 patients registered with the service.

“These patients have complex chronic health conditions and the length of each of their visits correlates to the complexity of their medical and social needs. The complex nature of these patients is served by the cooperation of various healthcare providers—pharmacists, dedicated medical social workers, consultants, along with laboratory and diagnostic facilities that are readily available onsite,” said Dr James. “This approach increases these patients’ adherence to their treatment regimen and also decreases the likelihood that they will fall between the cracks.

“With regularly scheduled follow-up calls and return-to-clinic visits, we are better able to provide reassurance to patients, as well as assess compliance early in their journey towards control of their chronic conditions.”

The Patient-Centred Medical Home is staffed by a team of four: Medical Director Dr Stanley James, Nurse Practitioner Myrian Balitian-Dill, Staff Nurse Cheryl Maronie and Administrator Karen Henry. The service is located on the ground floor of the KEMH General Wing.

Notes to Editors
The Bermuda Hospitals Board is a quango (quasi autonomous non-governmental organisation) established under the Bermuda Hospitals Board Act, 1970. It has a Bermuda Government-approved Board and a Chief Executive Officer, responsible for King Edward VII Memorial Hospital and Mid-Atlantic Wellness Institute. At the heart of both organisations is high quality care to all patients.

With approximately 1,700 employees, the Bermuda Hospitals Board is Bermuda’s second largest employer. King Edward VII Memorial Hospital and Mid-Atlantic Wellness Institute are the only healthcare organisations in Bermuda accredited by Accreditation Canada, an independent organisation whose role is to help hospitals examine and improve the quality of care and service they provide to their clients. In addition to providing an extensive list of services for the community, the Bermuda Hospitals Board is part of a referral network that includes some of the world’s leading specialist hospitals.

For more information, please visit www.bdahospitaldev.wpengine.com or contact the Bermuda Hospitals Board Public Relations Department at publicrelations@bhb.bm.