BHB update on Oncology service

Wednesday 19 March 2025: Bermuda Hospitals Board today explained what is being done to stabilise oncology services following its two chemotherapy nurses being unable to work for unrelated and personal reasons.

Chemotherapy nurses are specialist nurses who are trained to give chemotherapy treatments to cancer patients. BHB has two nurses, with an additional nurse who is currently in training and still requires supervision. Recruitment has begun for additional chemotherapy nurses as the two nurses, who have provided an amazing service for many years, are close to retirement.

Chief of Nursing, Judy Richardson comments: “The sudden impact of our situation was only known on Monday. We have reached out to local partners, all of our clinical partners and nurse agencies to bring new resources to the island as soon as possible. Everyone in the oncology team is working to provide as much coverage as possible, but a significant number of chemotherapy treatments have been delayed. Patients for whom any delay in treatment will impact their outcomes, or those who have complex or specialised therapies that require chemotherapy nurse skills, will be supported in seeking overseas care. While we hope we can resume normal services in about a month, new oncology patients will also be referred overseas until we have chemotherapy nurses on island.

“We are so sorry for this impact, especially as we had just completed recruitment to fill our oncologist roles. The formal recruitment for chemotherapy nurses is ongoing with a sustainable training plan being developed with overseas affiliates. We are also exploring the recruitment of locum nurses as temporary resources as they can be organised more quickly.

“We will provide an update to the community as soon as we have secured locum resources,” Mrs Richardson adds.

BHB moves to Alert Level 3 due to capacity issues

Tuesday 18 March 2025: Bermuda Hospitals Board today upgraded its alert level to 3, with 4 being the highest, in response to growing pressure within King Edward VII Memorial Hospital, primarily driven by the number of medically fit for discharge patients causing a record number of people waiting for inpatient beds.

At one point this afternoon, 34 patients were waiting for beds. There were over 40 patients medically fit for discharge still in hospital, and all additional areas with available beds were being used.

To increase capacity, with immediate effect, two of the larger Acute Care Wing inpatient unit rooms on each floor will take two medically fit for discharge patients per room. As there are three units, this will open up six additional rooms for patients needing acute care.

The patients doubling up will be patients who are medically fit for discharge. The arrangement will impact visiting for these patients. They will be limited to one patient each at a time. Additional space in the Orthopaedic (Fracture) Clinic is already being used by four patients who are waiting for acute care beds, and available space in the children’s and maternity units are being used, as is created space in the long-term care units.

“This is an incredible pressure on our staff and hospital services,” says Acting Chief of Staff Dr Anna Neilson-Williams. “We have had to accelerate plans to increase capacity urgently today and this is helping us reduce numbers in the Emergency Department, but overall we are still under great pressure. We are grateful to our staff once again standing up to the plate. Our Emergency team has been under extreme pressure for many months, and it is being felt in our other units as they accommodate more patients.”

Chief of Nursing, Judy Richardson adds: “The community see the pressure when they come to the Emergency Department and find people being cared for on our corridors, or when they visit their loved ones in overflow units. Our staff are caring for increasing numbers of people and this is felt across clinical and support services. The changes we are making are helping us through this crisis, but in the long term we need solutions in the community for an increasing frail and elderly population.”

Acting CEO and Chief Operating Officer Preston Swan, stresses that families who are able to, must pick up their loved ones if they are medically fit for discharge.

“We understand that some people are very vulnerable and while they are medically fit for discharge from an acute care unit, they may have care or medical needs that must be in place in the community before they can leave. However, this is not all patients. We implore people who can take their loved ones home to do so. Every bed we can make available makes are big difference. There are other unwell people needing care.”

Chief of Emergency, Dr Chikezie Dean Okereke stated that the Emergency Department is currently facing unprecedented capacity issues and it is imperative that people only come to Emergency Department if absolutely necessary.

“If you can wait to see you doctor, please call and book an appointment,” Dr Okereke says. “People who experience significant trauma, have stroke symptoms, chest pains or serious bleeding etc. must come to us for care, but we ask that people with general aches, pains, or worries not requiring urgent attention to please contact their GP instead. And if you do need to come, please be aware that if your symptoms are not critical you are likely to have a long wait before you see a Physician.”

Dr Okereke stated that due to the space constraint issues, patients are advised to only attend with one person carer if absolutely necessary.”

Oncology update

Thursday 23 January 2025: Bermuda Hospitals Board today provides an update on the hiring of two new oncologists, both of whom will arrive by the end of January.

Acting Chief of Staff, Anna Neilson-Williams comments: “We are really pleased to be able to share that two oncologists are due to arrive in Bermuda by the end of January and will go through training and orientation in the first two weeks of February. This is great news for the patients of our oncology service. As the new oncologists arrive we will share their details with patients and the community. This means very soon our service will have three full-time oncologists on island, and we will be able to take on all new cancer cases as before.

“I would like to thank Bermuda Cancer & Health Centre and PALS, as well as to hospital physicians and staff, and especially our full-time oncologist Dr Alisha Tucker and locum Dr Christopher Price. To our patients, we appreciate your understanding through what we know has been a challenging period. I would also like to note that over the last few months we have been in discussions with some overseas hospitals on having locum agreements in place. Oncologists are specialist positions and the type of oncologist hired for an island service is increasingly rare, so the hiring time can take six or more months. If we are able to establish locum agreements, this could help us better maintain local services during hiring periods or oncologist vacations.”

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.