COVID-19 has put Queensland's health system under severe pressure, with many of the state's hospitals now reaching "tier three".
But what exactly does that mean?
With hospitals forced to scale back or postpone non-emergency care and thousands of health workers caught up in the crisis as the state's third Omicron wave surges, hospital and health services (HHS) are overwhelmed.
The latest wave is being driven by the now-dominant BA.4 and BA.5 sub-variants, the most contagious yet.
In the early days of the pandemic, the state's health department developed a "pandemic planning and response" guideline, which is amended regularly to account for factors including outbreaks and waves, presentation and admission numbers, availability of clinical staff and emerging variants.
It also considers new government policies and recommendations by national health bodies including AHPPC (Australian Health Protection Principal Committee) and ATAGI (Australian Technical Advisory Group on Immunisation).
The guideline includes escalation tiers for HHS and outlines management measures that can be implemented to support an increased caseload across the system.
This year's flu epidemic and year-on-year increases in emergency department (ED) presentations has added more pressure on the already strained health system, prompting Queensland Health to make some changes to the tier framework.
Under the tiers, HHS can ramp up or down their responses based on the current risk level of COVID community spread.
Here's how it works.
What are the tiers?
All of Queensland's hospital and health services have their own tiered plan to assess how they are impacted by COVID and/or influenza and determine what operational changes are required to manage any impact.
Queensland Health says decisions regarding planned care, including elective surgery, are made by each HHS in response to their specific circumstances.
Tier zero: Hospitals operate as normal
There is no community transmission and cases are only detected among interstate or international arrivals.
Chief Health Officer John Gerrard has warned Queensland could face COVID waves "every few months", possibly for years, so it's unlikely we'll reach tier zero again for a while.
Tier one: Minimal impact
The impact on hospitals is minimal.
While there is community transmission, no cases are detected in vulnerable groups.
Models of care like Hospital in the Home (HiTH) are used when appropriate.
There is no impact on planned care.
Tier two: Moderate impact
The impact on hospitals is moderate, with locally acquired cases and clusters reported.
In-hospital care is restricted to patients who are too unwell for other models of care (e.g. HiTH).
Category one elective surgery proceeds as scheduled.
Public procedures listed as categories two and three may be moved to private hospitals.
Tier three: High impact
The impact on hospitals is high.
Category one surgeries proceed, category two surgeries are moved to private hospitals and category three surgeries are suspended and rescheduled.
Patients loads (both COVID and non-COVID) are shared across the hospital network.
Capacity is expanded to include private hospital beds.
Are any other measures implemented to ease pressure?
Queensland Health says HHS clinical representatives and the State Health Emergency Coordination Centre (SHECC) meet daily to discuss impacts and strategies to manage demand.
When COVID and/or flu cases and hospitalisations surge, other strategies are used across the health system to ease pressure.
They include:
- Expanding bed capacity
- Increasing staffing
- Using private hospitals to accommodate patients or perform non-urgent surgeries
- Facilitating more hospital discharges where clinically appropriate, including transferring rural patients back to their home communities
- Maximising use of alternatives to admission, such as HiTH, the virtual COVID ward and telehealth care
- Working closely with community partners and residential aged care facilities to provide outreach support
It's worth mentioning too that anyone who presents at an emergency department will be seen, but the most urgent cases will always be treated first.
If it's not a life-threatening emergency, book an appointment with a general practitioner or call 13 HEALTH for advice (13 43 25 84).
What are the elective surgery categories?
Category one surgeries are classed as "urgent" procedures that need to be performed within 30 days.
Category two is described as "semi-urgent" surgery recommended within 90 days. They treat conditions that cause pain or disability but are unlikely to escalate to an emergency.
Category three surgeries are classified as non-urgent, recommended within a year of being put on the wait list.
