COVID-19 – Rehabilitation houses relieve hospitals again

With the increasing number of Sars-CoV-2 infections, the hospital staff is also burdened by more Covid-19 sufferers. The highs from the second and third waves have not yet been reached: on November 26, 2020, 714 and on April 12, 615 people with Covid-19 disease had to be treated in an intensive care unit. However, according to the data reported to the Ministry of the Interior and Health, there are now 441 with Covid-19 who require intensive medical treatment. A total of 2,455 people across Austria have to be treated with this disease.

The situation in Upper Austria is particularly stressful, where on Sunday with 92 patients 28 percent of the intensive care capacities were occupied due to corona and a further 449 therefore had to be treated in a normal ward. In Salzburg, Governor Wilfried Haslauer (ÖVP) emphasized on Friday that intensive occupancy in the state was far from the overload limit of 33 percent. On Sunday, 16 percent of the available intensive care beds were occupied with 22 Covid 19 patients, another 174 need a bed in the normal ward.

With a seven-day incidence of 1,520 in Salzburg, which the Ages dashboard shows on Monday, which is almost twice as high as the Austria-wide current of 690, Haslauer wanted to have “no illusions” on Friday. The governor expected an increase in Covid-19 sufferers in the hospitals – and had relief proposals for the hospital staff in their lockdown luggage, which, however, “are still being legally checked”, according to the office of the responsible regional councilor Christian Stöckl (ÖVP) called.

However, the relocation of patients from acute hospitals in Upper Austria and Salzburg to the rehabilitation facilities of the Pension Insurance Institute (PVA) is already in “execution”, as PVA General Director Winfried Pinggera confirms in an interview with the “Wiener Zeitung”: “In the context of a fast Track procedure, we take over those cases from the acute hospitals that are not Sars-CoV-2-positive, have already received acute first care and are stable. “

“Fast track” especially in cardiology and orthopedics

As a typical case for a fast-track procedure for rapid transfer, Pinggera describes the case of a woman who had an operation in the acute hospital in St. Veit because of a femoral neck fracture, i.e. an operation that cannot be planned. Until she is released, however, she will not stay on site, but – because stable – will be transferred to the Rehabilitation Center in Saalfelden.

So it is particularly about the non-plannable cardiological and orthopedic follow-up care. “Not about operations that stay in the acute hospital, but about wound care, observation, activation afterwards, for example, our core business. We also have the specialists and nursing staff for this,” explains Pinggera.

At the moment we are talking about the 150 to 200 beds in each of the PVA rehab houses in Saalfelden and Bad Schallerbach for Salzburg and Upper Austria. With Bad Hofgastein, Großgmain and Bad Ischl there are more of the 17 rehabilitation centers in the region. “Of course it makes little sense to bring someone to Bad Tatzmannsdorf now. But it would be possible if necessary. We have stretched the reserve network across Austria.”

The transfers are organized directly by the doctor at the hospital and the doctor at the rehab facility via the normal follow-up treatment, “which starts faster” or also via the short route via the PVA chief doctor. The difference to normal rehab is that patients are discharged home after just one week – and not only after the usual three that a stay usually takes. Because of the different paths and because the “fast track” is not shown separately in the budget, but is part of the billing of all rehabilitation stays, Pinggera cannot provide any information about the number of times it is and has been used. But he says: “In the third lockdown there were very many in Bad Schallerbach, Saalfelden and Großgmain – around a third of the beds estimated, and sometimes more.” Now there are the first cases again.

The nine rehab facilities of the social insurance for the self-employed are “again playing an important role in relieving the burden on hospitals”, the “Wiener Zeitung” asked: “The aim is to continue to relieve the hospital sector as best as possible and at least to drain the relevant acute settings to ensure.” Contribute to “clearing hospital beds in general hospitals”. Just like the rehabilitation facility “Mein Peterhof” of the Austrian Health Insurance Fund in Baden near Vienna: “However, no need has been reported by the hospitals or the federal states to date,” said the ÖGK spokeswoman.

What to do with Sars-CoV-2 positives

Covid 19 sufferers who had to go to hospital for treatment cannot be transferred to rehab facilities as long as they are still at risk of infection. “Because we can’t isolate them, we don’t have the infrastructure for that,” says Pinggera. Governor Haslauer explained that around 20 percent of those with Covid 19 had no need for further clinical action in the hospital. “But your CT value is still in a range where you are still contagious.” Haslauer envisions so-called “Covid transfer stations” for these sick people.

For the second group, however, Haslauer hopes for care similar to the rehabilitation centers. Namely people in need of care from homes, where there was a shortage of staff due to Sars-CoV-2-positives. “They often end up in the hospital for lack of other care,” said Haslauer on Friday. These patients cannot be taken over by rehabilitation centers, says Pinggera: “We are hospital replacements.” Therefore, care facilities cannot be replaced – and those who are purely in need of care cannot be looked after.

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