EXPLAINED: How are Swiss hospitals resuming outpatient consultations and surgeries?

Starting on April 27th, hospitals in Switzerland can again schedule pre-planned, non-urgent surgeries that had been delayed during the Covid-19 outbreak.

EXPLAINED: How are Swiss hospitals resuming outpatient consultations and surgeries?
HUG is one of Swiss hospitals to resume outpatient consultations. Photo by Fabrice Coffrini / AFP

Why have non-urgent interventions been suspended?

Hospitals have not performed any pre-scheduled, non-urgent surgeries since the Federal Council has declared the state of emergency on March 16th.

The aim of the suspension of these services was to ensure that all beds and medical staff were available to treat Covid-19 cases.

Why are outpatient treatments allowed now?

With the Covid-19 numbers steadily declining in Switzerland, all the major medical centres now have fewer coronavirus patients to care for. This means they can resume surgeries and interventions which had to be put on hold during the pandemic. 

For instance, Switzerland’s two largest hospitals, Lausanne’s CHUV and Geneva’s HUG, have the backlog of 500 and 1,500, respectively, of previously scheduled surgeries. 

“We will increase the capacity of our operating theatre, resuming approximately 75 percent of our normal activity, prioritising patients according to the urgency and the repercussion of their disease on their health “, CHUV’s director Philippe Eckert said in an interview with the RTS television

What security measures are hospitals implementing to prevent outpatients from contracting COVID-19?

All the medical facilities are following the same safety rules for outpatient consultations and surgeries, such as those displayed on the websites of HUG, CHUV, and university hospitals in Zurich  and Basel.

For instance:

  • Only patients who have a confirmed appointment will be allowed to enter the hospital.
  • People with appointments must await their turn at the entrance of the building. Control is in place to ensure that the number of people present in the hospital at the same time is limited.
  • Consultations are spaced out over time and waiting rooms are redesigned to facilitate maintaining distances.

Also, 'regular' patients will never be in the vicinity of those treated for Covid-19, hospitals pointed out.

 READ MORE: UPDATE: What you need to know about the coronavirus crisis in Switzerland 

Will hospitals still keep beds available for coronavirus patients?

Yes, for instance HUG in Geneva will reserve 130 beds for COVID-19 cases.

“We must be ready to a second wave. The big uncertainty is related to how the population will respect the rules of hygiene after the lockdown”, HUG spokesperson Nicolas de Saussure said in an interview. 

The CHUV too will be ready “in the event of new wave,” the hospital said.

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Covid-19: How will a priority triage system in Swiss hospitals work?

As Switzerland’s medical facilities are near their saturation points, medical authorities are preparing a triage plan to decide who will get priority for beds in intensive care units.

Covid-19: How will a priority triage system in Swiss hospitals work?
Hospitals like CHUV in Lausanne might have to resort to triage of patients is Covid rates don't drop . Photo by AFP

According to Virginie Masserey, head of the infection control department at the Federal Office of Public Health (FOPH), “the limit to intensive care units could be reached in five days”.

In response, the Swiss Academy of Medical Sciences (ASSM) and the Swiss Society for Intensive Medicine (ASSM) are working out the emergency protocol for triage of patients in intensive care units (ICUs).

The two organisations say that triage system should be based on equity — that is, resources must be made available without discrimination of any kind, in order to avoid any arbitrary decisions.

“The guidelines provide assistance to ICUs, so that any triage decision can be made according to the same criteria across Switzerland,” regardless of whether patients have Covid-19 or another critical condition that requires immediate treatment, said Franziska Egli, communications officer at the ASSM.

READ MORE: Switzerland faces lack of hospital beds as coronavirus infections soar 

“The objective is to save as many lives as possible, but the short-term prognosis is the deciding factor for the decisions”, she added.

This means that patients whose prognosis for recovery or improvement is favourable with intensive care therapy, but unfavourable without this treatment, have top priority.

Age in itself is not a factor, but it is indirectly taken into account in the context of the ‘short-term prognosis’ criterion, since the elderly often suffer from pre-existing chronic conditions, defined as two or more diseases. 

Official directives list illnesses that are deemed to be incompatible with hospitalisation if there is shortage of beds. They include advanced cirrhosis, cancer with a limited life expectancy, and severe heart or neurological problems.

“So far, this directive has never been applied in Switzerland,” said Philippe Eckert, director of the Vaud University Hospital (CHUV).

If it becomes necessary to implement it, “the decision would be taken at the national level”, by the group of experts specialising in medical and ethical questions, Eckert added.