With omicron, private hospitals in SP reinforce patient screening

The relaxation of preventive measures, the arrival of the omicron variant and hospitalizations for respiratory syndrome, which rose again after a period of stability, put private hospitals in São Paulo on alert.

Although admissions for Covid-19 in the private system remain declining, many institutions have beds with more than 90% occupancy with other health demands that were repressed during the pandemic.

The Hospital Israelita Albert Einstein, for example, has beaten historic records in elective surgeries in recent weeks, with more than 800 per week, and bed occupancy above 90%. At Hospital Alemão Oswaldo Cruz, the number of surgeries is 15% above the rates recorded before the pandemic.

Multiprofessional committees are daily evaluating the pandemic data and there was also reinforcement in the screening of patients with flu-like symptoms.

Francisco Balestrin, president of Sindhos (São Paulo’s union of hospitals, clinics and private laboratories), says that guidance has been given to affiliated institutions so that they have a greater epidemiological concern than they had been having.

“We still don’t have a clear picture of the situation of this new variant in Brazil. So we need to work on these cases, in addition to the point of view of assistance, which is also sanitary, epidemiological. We have to help public health as well,” he says.

This means adding new questions to patients who arrive at the emergency room (ER). “We are checking whether they have been to countries in Europe, Africa and the United States and reinforcing the need for protective measures, such as a mask, the use of alcohol in gel”, says Antonio da Silva Bastos, chief medical officer at Oswaldo Cruz.

At the same time, managers say that this period of pandemic has brought lessons, such as the consolidation of the concept of so-called “hospitals without walls”, which allows for more efficient management of beds if there is an increase in admissions by Covid.

Within this metaphor are virtual consultations, which prevent people from traveling to emergency rooms, and adaptations in the physical structure according to demand, which allow the rapid creation of new beds.

“We learned a lot from the pandemic. It is possible to train [profissionais de saúde] in record time and you can offer the same result when you have the infirmary interchangeable between apartments, semi-intensive beds or ICU”, says Sidney Klajner, president of Albert Einstein.

According to him, other management processes that were already being adopted before the pandemic were strengthened by the health crisis, such as the creation of a patient flow team that allows for more efficient bed rotation.

This team developed an algorithm capable of predicting the need for an inpatient bed with an accuracy of 90%, as soon as the patient arrives at the emergency room.

“Because of this flow team, we transformed medication infusion units in oncology into beds, polysomnography in beds, classrooms instead of medication infusion. And there was no shortage of space for those arriving at the ER”, he says.

In the second wave of the pandemic, says Klajner, the hospital even carried out ten intubations of patients in apartments on the same day and only later took them to the ICU. The institution had 310 patients hospitalized with Covid. Today is 12.

Another of Einstein’s novelties during the pandemic was to create, in partnership with the company Enebras, a portable system that made it possible to transform normal apartments into areas of negative pressure, preventing the spread of the virus within the hospital environment.

This negative pressure is obtained through an exhaust system. The air pressure inside a room is controlled so that it is below that of other environments in the hospital. Contaminated air passes through a high-performance filter and germicidal lamps and is expelled to the outside environment without the contaminants.

“The pandemic has taught us to be versatile, to be agile to convert units into others as needed”, says Felipe Duarte, manager of inpatients and medical practices at Hospital Sírio-Libanês.

According to him, the Covid-19 units are being closed with the possibility of returning to the same function if there is an increase in cases. “The plan is already designed and structured.”

The hospital still maintains the crisis committee structure, with weekly meetings and no longer daily as they used to happen months ago. Two new 23-bed ICU wings were built during the pandemic.
Sírio had 260 patients hospitalized with Covid, with close to 100% occupancy. Today it ranges between 12 and 16.

Due to the advance of vaccination in the country and, in São Paulo in particular, the expectation of managers is that, even in a scenario of increase in cases due to omicron, the demand for hospital beds is lower than in previous waves.

“What we have been reinforcing is that it is not possible not to take the vaccine. We are staunch supporters of vaccination. And we do not feel safe to let down our guard in relation to the use of a mask”, says Duarte.

Sidney Klajner, from Einstein, is also emphatic in stating that the greatest risk is the relaxation of protection measures. In his opinion, this is the main reason for the increase in cases and hospitalizations in countries in Europe and Asia, even with vaccination rates above 70%.

“When you say you no longer need to wear masks, it ends up being a stimulus not only to not protect yourself, but also a stimulus to crowding. And this will increase the number of cases,” he says.

The institutions claim to guide patients and visitors about the importance of vaccination, but they do not have legal support to condition it to care or circulation within the institution.