Some heart attack patients may be bumped from intensive care beds as medical staff rethink room for Covid-19 cases ahead of the virus reaching Gisborne.
The plan at Hauora Tairāwhiti District Health Board to deal with a Covid surge is to split its six-bed intensive care unit (ICU) in half, making three beds available for those needing treatment for the virus. The remaining three would be for emergencies.
But ICU occupancy rates between August and October show more than three ICU beds are often in use.
It comes amid "major rostering challenges" for ICU nurses, and issues training staff to use ventilators because the region can go for days without a ventilated patient.
However, Green said they had recruited four ICU nurses.
Seven nurses had been trained up to deal with Covid-19 cases in ICU, with another cohort to commence at the end of November.
There were also six nurses with ICU experience working elsewhere in Hauora Tairāwhiti who would be available for redeployment, Green said.
The DHB's Covid-19 plan would be to put more people on hospital wards, with a second "intensive care area" set up if required.
Planned care will not be running during a Covid surge — which is also expected to free up space in ICU.
As the hospital prepares for the virus, clinicians questioned why they were routinely placing people with the less complicated form of heart attack in ICU, which doubles as the region's coronary care unit (CCU).
Hauora Tairāwhiti chief executive Jim Green said heart attacks of this type were not usually managed on CCU in other hospitals.
The rethink around heart attack patients came as they looked at workflows and how they were going to manage patients in ICU, Green said.
"We've always traditionally been admitting that group of people there, but even without Covid, do we need to be doing that?" he said.
The outcome of those discussions was that stable heart attack patients could be placed on either ICU/CCU or the medical ward depending upon the needs of the patient, he said.
Details of how Tairāwhiti will deal with Delta have prompted a renewed call from Green to get vaccinated.
Tairāwhiti has the lowest vaccination rates in the country with just 61 per cent of the eligible population fully vaccinated and 76.5 per cent having received one dose of the vaccine.
"We know for sure that we're going to have people in our community with the virus within a very short space of time," Green said.
"Some of those people will need to be hospitalised and some of those people will need to be ventilated.
"One of the important issues around the pandemic is that when we get the surge of people in our community who are Covid positive, we have to try to maintain all our other capacity for people who are having heart attacks, car crashes, all those sorts of things that might need ICU as well.
"We need to keep a stream of people who are able to care for those people at the same time as those people who may need ventilation with their Covid-19."
UK data shows that of 40,000 patients hospitalised in the six months to the middle of this year in the UK, 84 per cent of those people hospitalised hadn't been vaccinated and only 3 per cent of cases in hospital were fully vaccinated.
Data for New Zealand was similar, with only 1.7 per cent of people hospitalised in this outbreak being vaccinated.
"If people aren't vaccinated, it will really put our hospital under stress and strain," Green said.
Gisborne Hospital has seven ventilators, and anaesthetic machines that can be available for ventilation if needed.
Green said as the region could go for "days on end" without a ventilated patient, an anaesthetist had been working alongside ICU nurses to help with training, support and planning of care in anticipation of ventilating Covid-19 patients.
A report to the DHB's Hiwa i Te Rangi advisory committee last week said Gisborne Hospital had been dealing with "major rostering challenges" and staff vacancies among nurses on its intensive care unit.
Ongoing difficulties to recruit staff has been a theme of the pandemic, caused by an inability to recruit from overseas and many medical staff retiring or opting for a career change.
"Obviously [ICU is] at the forefront and could be at the forefront of our response around Covid, and people are considering whether they want to be a part of that. It's a high-stress environment," Green said.
According to ICU occupancy data released by National's health spokesman Dr Shane Reti last week, Tairāwhiti had more than three ICU patients on 17 days between August 4 and October 11.
On six of those days, five of the six beds were occupied.