About Anna Nowak

Nearly half of acute care beds filled with patients medically fit for discharge

Thursday 19 December 2024: Bermuda Hospitals Board today revealed that analysis undertaken on Wednesday 18 December showed that 42 of its 90 beds on the acute care inpatient units were filled with people who were medically fit for discharge. That is 46% of all inpatient beds in the Acute Care Wing (ACW). The average length of stay of these patients was 70 days (over two months) with longest stay patient being over nine months.

Medically fit for discharge refers to patients who no longer require acute medical care but remain in the hospital due to barriers to safe and appropriate discharge.

In the General Wing, where beds are used as acute care overflow, there are an additional 24 patients medically fit for discharge, with the longest stay being almost 2 years (23 months).

Minister of Health, the Hon. Kim Wilson JP MP, comments: “These figures will understandably concern the community, as behind each patient is an individual in need of assistance. We continue to support BHB’s efforts to enhance hospital capacity and remain committed to developing long-term solutions to improve care availability in the community.

“While healthcare systems must invest in these long-term solutions to address patients who are medically fit for discharge, families play a crucial role in the immediate response. By recognising the challenges faced by hospitals and the needs of their loved ones, families can make a significant difference by stepping up to assist in the discharge and care process.

“Ultimately, addressing this issue requires a collaborative effort among families, healthcare providers, and policymakers. By working together, we can ensure hospital resources are used effectively and patients receive the appropriate care in the most suitable setting.”

CEO & President Scott Perman noted that the number of patients medically fit for discharge in the acute care wing had increased over 50% since figures were last publicly shared in June 2023, when there were 25 patients in acute care inpatient beds.

“This is something we have been experiencing over the last few months,” he says. “Its biggest impact has seen rising waits for emergency patients needing an inpatient bed.”

The issue is mostly caused by patients who need either a nursing home or more care support at home in order to be safely discharged.

Mr Pearman noted, “We obviously implore families to take their loved ones home as soon as they are ready to be discharged, when possible. We know Bermuda needs more affordable nursing home placements and affordable care support for people at home, but the impact on hospital services of these delayed discharges is detrimental to others needing acute, surgical* and emergency services**, and those patients trying to return from medical institutions overseas. It also increases hospital costs that the healthcare system overall has to bear.”

Data from 18 December shows:

Acute Care Inpatient Units (ACW)
• 42 of the 90 acute care inpatient beds had people medically fit for discharge in them (46%)
• The average age of the patients whose discharge is delayed is 76 years
• The average length of stay for these patients is over 2 months (70 days)
• Of the 42 patients, 24 % have been in hospital 3 months or more and 12% have been in hospital 6 months or more
• The longest stay patient has been in an acute care bed for over 9 months.

Acute Care Overflow Beds in the General Wing
• 24 medically fit for discharge patients are staying on units in the General Wing
• The average age of patients is 78 years
• The average length of stay of these patients is over 9 months (262 days)
• 88% of these patients have been in hospital over 3 months and 58% of these patients have been in hospital over 6 months
• The longest stay patient has been in hospital for nearly two years (23 months)

“Our longest stay patients whose discharge is delayed will find themselves eventually on a bed on the General Wing side. These patients do not need BHB’s long term care service, which is for seniors with higher care needs than a community nursing home can offer. This means they are still using beds that others need. Most importantly, they are not in the environment best suited for their needs, impacting their quality of life and putting them at risk of unnecessary physical deterioration.”

A 100-day challenge undertaken at the beginning of 2024 had helped identify internal efficiency improvements relating to bed flow and some solutions were implemented. A task force was recently established to follow up on the improvements and work on some of the more complex solutions highlighted from this effort. But the increasing number of medically fit for discharge patients in hospital is something BHB cannot control.

Mr Pearman urged the community to use emergency services wisely and ensure relatives ready for discharge are supported to go home as soon as possible. These actions will help relieve some of the pressure.

He added, “While we are focusing on the impact of delayed discharges, we should also be wise about our own health and care. We have had as many as 30 people waiting for admission in our Emergency Departments and this impacts everyone coming in. So please use your GP in the weekday or go to the Lamb Foggo Urgent Care service between 9am and 9pm on Saturday and Sunday if it is not a true emergency. Avoid the need of emergency services by taking any medications for chronic conditions, getting available vaccines that safely prevent flu, measles and other diseases, and don’t drink or do drugs and drive. Make sure the emergency services can focus on the true emergencies, such as strokes, heart attacks and other life-threatening conditions.”

Related data:
*Below is a year’s data on surgical cancellations. Highlighted in the table is the number of surgeries rescheduled due to no beds being available. The highest cause of surgical cancellation, however, remains patients themselves not turning up or cancelling.

 

 

 

 

 

 

 

 

 

** Emergency wait times are posted monthly to the BHB Statistics page, and real-time wait times are available on a screen in the Emergency Department.

19 December 2024 Home Page, News

Celebrating blood donors this Christmas

Monday 16 December 2024: The Bermuda Blood Donor Centre will be thanking people who give blood over the holiday season in December with a gift kindly donated by the St George’s Group.

Everyone who donates always gets a drink and cookie as they rest for a short period after their donation. Through this month, they will also get a bar of Cadbury’s chocolate.

Chief of Pathology and Consultant Haematologist Dr Eyitayo Fakunle says they are grateful to the St George’s Group for helping them bring some holiday spirit to donating.

“The holiday season is very busy for many people and so we appreciate even more than usual the generosity of our donors, who give up half an hour of their time to donate blood,” he says. “Giving gifts is in the spirit of Christmas and we want to celebrate those who give the gift of life this year by donating.”

People who want to donate can contact the Bermuda Blood Donor Centre at 236-5067, WhatsApp at 533-9553 or email blood.donor@bhb.bm. Clinics run Monday to Friday, 8am to 3pm.

16 December 2024 Home Page, News

BHB and Johns Hopkins work together to improve local trauma care

Wednesday 11 December 2024: BHB staff and community surgeons were working last week with a trauma specialist from Johns Hopkins, Dr Kent Stevens, to improve the care and outcomes for trauma patients in Bermuda. This work is being undertaken as part of BHB’s clinical affiliation agreement with Johns Hopkins Medicine International.

Dr Stevens was joined by BHB staff from the Emergency Department, Intensive Care Unit, Surgery, Pathology, Pharmacy, Imaging Services and Executive Team and community surgeons to discuss local service improvements and a possible transatlantic clinical collaboration that will give local physicians access to Johns Hopkins specialists when managing the most challenging individual cases.

CEO & President, Scott Pearman, comments: “BHB’s vision is to pursue excellence through improvement, to make Bermuda proud and this week has seen our vision in action as we focused on improving trauma care for patients on island. We have amazing staff and community surgeons who work round the clock – literally – to save the lives of people injured through accidents, crashes, shootings, and stabbings. All of us in Bermuda rely on these individuals if we experience a medical trauma and it’s great to see our clinical affiliation with Johns Hopkins Medicine International provide the support our local providers need as they work to make improvements.”

Acting Chief of Staff, Dr Anna Neilson-Williams, adds: “This has been a fantastic few days of work with all the BHB departments and external surgeons who are part of the trauma response teams working together with Johns Hopkins to improve care for our patients in Bermuda.

“When a patient is hurt due to an accident, crash or violent incident, there are many moving parts in the medical response. The timing of all of these parts coming together is critical in getting a patient diagnosed and treated efficiently and effectively. Following a traumatic incident a fast response is often crucial to save their lives whether they can be fully treated in Bermuda, or require stabilisation before being sent overseas. Our focus has therefore very much been on how we can coordinate our response more effectively and quickly, and discussing solutions to the limitations of living on a small island where we don’t have on-the-ground specialists to cover every single trauma need. I’m looking forward to the next steps of working together to take all the issues, comments and ideas raised this week and turning them into improvements on the frontline that will directly benefit our patients.”

Dr Stevens comments: “It really has been a pleasure to visit Bermuda and meet with local healthcare professionals to improve the trauma pathway. I’ve been impressed with the facility and staff. Bermuda should already be proud, but in healthcare, improvements are always possible. I’ve been able to share knowledge about the quality standards and processes we use at Johns Hopkins and my experience of dealing with very similar issues faced by the teams here. I look forward to exploring additional opportunities to support local service improvements.”

Mr Pearman concludes: “The trauma care pathway is one of the many care pathways we are working to improve at BHB. The heart of this work is about collaborating with other providers and patients in Bermuda to make improvements that really make a difference to patient experience and outcomes. So far, we have developed integrated stroke, breast cancer, and prostate cancer care pathways. Johns Hopkins is currently helping develop improved pathways for trauma and burns at this time, much in same way this partnership has helped BHB establish its primary stroke centre programme.”

11 December 2024 Home Page, News

BHB publishes guide to help identify when medical care is needed for measles

Monday 25 November 2024: Bermuda Hospitals Board today issued a patient self-assessment guide to help patients and carers identify when medical advice and hospital care is needed for patients with suspected or confirmed  measles infections. Click here for the guide.

Chief of Emergency & Hyperbaric Services Dr Chikezie Dean Okereke comments: “While most patients can get through a measles infection by staying hydrated and taking fever medication, such as Tylenol and Ibuprofen, the complications of measles can be extremely serious and people need to know when medical advice or hospital treatment is needed.

“In recent US outbreaks, 20% (one in five) of unvaccinated people who had measles were hospitalised. It is an extremely infectious disease. You can catch measles by walking into a room that someone infected with measles left two hours before.”

The Measles Patient Symptom Self-Assessment Guide has been designed to help people decide when they should stay at home, and when they need to call for medical advice or emergency treatment.

Dr Okereke stated how it important it was that even when emergency medical care is needed, no one with measles or suspected measles should just turn up at the Emergency Department. Patients or carers should call in advance so the Emergency Department can safely attend to the patient in need without putting other people at risk.

“We also want to remind people that prevention is the best form of protection. History is full of stories of measles tragedies that vaccination for the most part has eradicated. We need to do all we can to stop it re-emerging as a threat to our children and families.

“On the back of the positive measles cases in Bermuda, we are encouraging masking in hospital waiting areas, and in the Emergency Department it is now a requirement.

“Vaccination remains best and safest way to safeguard against measles and its complications. It is extremely effective (97%) and according to the World Health Organization, has saved about 60 million lives since 2000. The vaccine is readily available here in Bermuda from your GP, paediatrician and the Government clinic (278-6460). It requires two jabs one month apart for the highest level of protection, but even after the first jab your protection from this disease will be vastly improved.”

 

25 November 2024 Home Page, News

Sterile processing department at KEMH to be upgraded

Thursday 7 November 2024: Bermuda Hospitals Board today announced that it is starting a major renovation project for its sterile processing department that will run from February to July 2025.

Sterile processing is the sanitisation of equipment and items used in clinical care. The highly specialised cleaning process ensures items are completely safe for use. All surgical tools are cleaned and packaged in this area to support the over 9,000 surgeries undertaken at KEMH per year. Any items that are re-used across the hospitals are also processed through this department.

Chief Operating Officer Preston Swan comments: “This is a long overdue upgrade project that will remedy the issues that have impacted SPD over the last few years, such as equipment failure and floods.  The equipment is over 14 years old and the area is in the older part of the General Wing so the infrastructure is in urgent need of work. A failure in SPD could impact our ability to deliver life saving procedures and deliver safe care across our inpatient and outpatient service. This is a priority project for us that will enable us to deliver the safest, most efficient sterile processing service in the support of patient care.”

The project will cost about $4.5 million in total and will include the replacement of equipment, furniture and the floor as well as an upgrade of the infrastructure.

Mr Swan continues: “We anticipate the upgrade work in SPD will start in February and be completed by July 2025. While the department is upgraded, we will use a temporary sterile processing area that is currently being constructed in the old surgical area of the General Wing, just opposite the existing location.

“The capacity of the temporary area will be enough to meet most of our needs during the upgrade, but there will be some patient impact. We anticipate there will be a reduction in the number of major elective surgeries undertaken in any one day, such as hips and knee replacements, as these are very instrument intensive. I would stress, however, that we will be able to complete all emergency and time-sensitive surgical needs, for example trauma, emergency caesarians or cancer surgeries, and there will be less impact on procedures that don’t need much instrumentation, such as pain management, some cardiology procedures, endoscopy and urology procedures.”

Once complete, the upgrade will ensure a much more consistent sterile processing service, optimising safety, quality and efficiency.

“We apologise that there will likely be fewer major elective surgeries during the first half of year,” Mr Swan says. “We will continue to do all we can to minimise the patient impact across all our services. Certainly the upgrade of this critical area is required to ensure that the sterile processing service is as robust and efficient as possible to meet the long term needs of Bermuda patients for the years ahead.”

 

7 November 2024 Home Page, News

Oncology Service Notice

Friday 1 November 2024: BHB is close to bringing two new oncologists to Bermuda. The new oncologists are in the final stages of recruitment having completed their local registration with the Bermuda Medical Council and we are in the process of securing immigration approval.

Following the departure of Acting Director of Oncology Dr Michael Hawking in September, BHB has one full time oncologist until the new appointees arrive.  Urgent work continues with overseas partners in order to refer newly diagnosed patients for consultation and treatment during this transition period, until the on-island Oncology service is able to have those patients transition back to Bermuda for continued treatment and follow up.

New patients with insurance will be referred overseas following a review by the Tumour Board, and we will work on individual solutions for patients who do not have insurance or cannot travel.

Acting Chief of Staff Anna Nielson-Williams comments: “We understand that our oncology patients will be very concerned about what this means to their treatment, and we recognise patients with newly discovered cancers during this time may worry about what this means to their care.

“There are up to 300 oncology patients seen by the service each month, and existing patients will continue with their chemotherapy treatments, though some appointments with the oncologist may be rescheduled for patients who are stable.

“We will do all we can to facilitate overseas referrals as quickly as possible for patients newly diagnosed until we can either secure more locum coverage or the new oncologists arrive. We will work individually with patients who do not have the option of travelling overseas.”

“A cancer diagnosis is extremely stressful for patients and families, so we apologise for the additional anxiety caused and will continue to do everything possible to ensure we can return to delivering on-island care for all.”

1 November 2024 Home Page, News

Free public event to focus on treatments for urinary incontinence

Wednesday 16 October 2024: Bermuda Hospitals Board is partnering with Lahey Hospital & Medical Center, Optimum Wellness and the Bermuda College Division of Nursing & Allied Health to offer a free, public panel discussion about the latest treatment options for male and female incontinence.

The free event will take place from 3pm to 5pm on Saturday 19 October in the Bermuda College Lecture Hall H-100. The goal is to share the latest treatments for urinary incontinence and improve understanding about this common issue. No registration is required; people can just turn up.

The following experts will provide short presentations, followed by a Q&A panel discussion in which attendees can ask questions.

  • Dr Jonathan Makanjuola, Urology Consultant, Bermuda Hospitals Board
    Learn how your family doctor can assess you for lower urinary tract symptoms,
    and become familiar with questions you can ask about your urinary habits.
  • Dr Jessica Mandeville, Director of Endourology, Lahey Hospital and Medical Center
    Learn about medical and surgical treatment options for an enlarged prostate.
  • Dr Arthur Mourtzinos, Vice Chair Division of Urology, Lahey Hospital and Medical Center
    Learn what the current surgical options are for managing urinary incontinence for men and women.
  • Michelle Monk, Registered Physiotherapist and Pelvic Floor Provider, Optimum Wellness
    Learn more about the pelvic floor, treatment approaches, common misperceptions,
    what the common dysfunctions are and how to treat them early.

Dr Makanjuola comments: “In the UK it’s estimated that at least 7-10% of the population have urinary incontinence, but this could well be under-reported as people feel embarrassed. If the same is true in Bermuda, that translates to over 6,000 people. Women are five times more likely to experience it, but men are impacted too. We will be sharing some great information that will help people know what to ask their doctor, for example, as well as what the latest treatment options are available.”

Dr Mourtzinos comments; “Lahey is excited to help share the latest treatments available for incontinence for men and women.  Lahey is dedicated to helping care for the Bermuda community. Our specialist urology services along with the treatments and care available on island give patients not just hope but effective treatments when dealing with incontinence.”

Ms Monk adds: “I’m looking forward to sharing some of the physiotherapy options available to improve pelvic floor health and bring relief from urinary incontinence. If you or a family member is experiencing an issue, however minor, it’s a great opportunity to learn more about the latest treatments and therapies available. In fact, there are early treatments that can make a big difference so people shouldn’t wait.”

BHB and Lahey are also partnering to deliver a physician continuing medical education symposium in the morning providing an update on urology. Details about the morning session for physicians can be found on the BHB website under CME events. BHB delivers a year-round educational calendar for free to all local physicians on various medical topics in partnership with leading hospitals from overseas.

 

Watch on YouTube

16 October 2024 Home Page, News

Caring for patients at KEMH

Tuesday 15 October 2024: Bermuda Hospitals Board has posted a frequently asked questions (FAQ) on its website that explains how patients are cared for and by whom at King Edward VII Memorial Hospital (KEMH).

CEO & President Scott Pearman says: “We want to demystify as much as possible how care works at KEMH. BHB follows the same quality standards as the UK, US, and Canada, with inpatient acute care led by onsite hospitalists on our acute care inpatient units, with other specialists leading in critical and emergency care units. We often get questions from patients about their inpatient care, especially about the role of their general practitioners (GPs) while they are in the hospital. We hope the factsheet posted on our website will help.”

Acting Chief of Medicine and Director of the Hospitalist Programme Dr Nevin Williams explains: “A common question is about the role of a patient’s GP while they are in hospital. In KEMH, a patient’s care is led by the ‘most responsible physician’ (MRP) and this will be the main contact for the patient and family. At KEMH, your most responsible physician may vary depending on the area you are in, but it will always be an on-site physician specialist with the most appropriate training for your care.”

  • In the Emergency Department, the MRP is an emergency physician.
  • For a patient admitted after planned surgery, the MRP will be the surgeon.
  • Patients admitted to an inpatient unit from the Emergency Department will have a hospitalist as an MRP.
  • If a patient becomes critically ill and is moved to the Intensive Care Unit, the MRP will be one of the anaesthetists trained in critical care.

Click here for a factsheet and click here for a short animation about the role of hospitalists on the inpatient acute care units.

The MRP directs the clinical team of nurses, allied health staff (such as physiotherapists and dietitians), and other doctors who might need to advise on a patient’s care, like a cardiologist (heart specialist) or geriatrician (a specialist in senior care). A BHB physician is only the MRP while the patient is in the hospital.

Dr Williams continues: “There are over 3,100 inpatient acute care admissions to KEMH each year, mostly cared for by hospitalists. Hospitalists are doctors with special training in internal medicine and hospital care. They are on site 24/7, so they can quickly respond to any sudden issue a patient experiences.

“The hospitalist’s key focus is providing acute care until a patient is discharged home to their GP. For over 60% of our patients, the hospital stay is under seven days. The relationship between the hospitalist and GP is therefore very important. The patient’s GP is notified by email when the patient is admitted to an inpatient acute care unit under a hospitalist’s care and information is sent when they are discharged to ensure patient care is coordinated when they leave the hospital. We are working to improve this communication, especially using our electronic medical record, PEARL.”

Chief of Family Practice Dr Burton Butterfield, the GP representative on the BHB Medical Staff Committee, acts as the link between community-based GPs and BHB.

Dr Butterfield explains: “As GPs we know our patients well since we see them over long periods of time. Our expertise is in caring for patients with illnesses and injuries in the community, managing chronic illnesses, and knowing when a patient needs hospital care or a specialist. It is important that GPs get timely and accurate information when a patient is admitted. We may speak with the hospitalists in cases where our understanding of the patient’s history may help in making decisions, but most critical for us is getting the discharge summary so we can smoothly coordinate the patient’s care back in the community.”

Dr Williams notes: “BHB is responsible for sending a patient’s discharge summary to the GP listed on the patient’s admission file, but it’s very important patients confirm their most current information, including their primary GP. They should do this when they come to the Emergency Department or are admitted. It is not uncommon for members of our community to sometimes have more than one GP or change their GP over time. Making sure we have the right details ensures the information goes to the right GP.”

Currently, GPs receive BHB discharge summaries by fax, email or by having read access to the BHB electronic medical record, PEARL. BHB is planning to follow the lead in the UK by discontinuing the use of fax in the future due to issues of reliability and confidentiality . This requires collaboration between BHB and community physicians. The chief medical information officer position, held by Consultant Anaesthetist Dr Simon Morton, is being expanded to lead the work required, and a physician committee that includes GPs is already meeting to help optimise the use of PEARL in sharing secure and confidential patient information.

15 October 2024 Home Page, News

Baby Sarai born in the eye of Ernesto

Sunday 18 August 2024: Hurricane Ernesto brought more than wind and rain on Saturday, with the birth of a baby girl, Sarai Bailey, at 8am to proud parents Stephanie and Keenan Bailey. Sarai is a new sister for 18-month-old brother, Kaden.

Stephanie and Keenan were at home when Stephanie’s contractions started at 4am, four days ahead of the baby’s due date.

“Thankfully the contractions started just as the eye of Hurricane Ernesto was coming over so the winds had died down,” said Stephanie. “Even though we live close to the hospital, however, we had to navigate roads blocked with trees to get in. I was surprised at how fast Sarai was born. Just four hours after contractions started.”

“Sarai was here before I could get back to the hospital from dropping Kaden off at my mother’s,” Mr Bailey added. “When I walked back in, there Sarai was.”

Mr Bailey was unable to stay long as the hospital was in lockdown and the second half of the storm was beginning to be felt, but he was able to return later that night.

18 August 2024 Home Page, News

Bermuda blood donors celebrated with help from Hamilton Princess

Monday 8 July 2024: For the fourth year in a row, the Hamilton Princess & Beach Club has sponsored prizes to celebrate and recognise Bermuda’s blood and apheresis donors.

Regular and new blood and apheresis donors were eligible for one of two prizes. Regular donor, Pamela Outerbridge, won a night’s stay at the illustrious hotel and Malcom Swan, a new donor this year, won a champagne brunch at the hotel.

Acting Pathology Manager Giselle Ming comments : “It makes us very happy to be able to appreciate our donors. We have an entirely voluntary blood donation service, which is the gold standard for safety and quality around the world. The Hamilton Princess & Beach Club are helping us thank these heroes who ensure lives can be saved with safe, voluntary blood and apheresis donations. Hamilton Princess is also a regular participant in our Corporate Blood Drive Competition, which means they not only help us recognise our donors, but support and encourage their colleagues to donate too.”

General Manager of the Hamilton Princess & Beach Club Tim Morrison adds: “It is our pleasure to support the Bermuda Blood Donor team as they seek to recognise their donors. Blood donation is vital in for our community, saving lives and supporting critical care for patients who need therapeutic treatments. We are proud to help celebrate the donors who are making such a valuable contribution to healthcare in Bermuda.”

8 July 2024 Home Page, News