Medical surge a daily challenge at the Ross
‘Hallway medicine’ still an issue at Ross Memorial Hospital in Lindsay
LINDSAY — In the past, Ontario hospitals like Lindsay’s Ross Memorial Hospital experienced patient surges a few times each year.
But in the last several years, those surges have become so much more frequent that they’ve almost become a daily occurrence.
A medical surge happens when patient volumes challenge or exceed a hospital’s servicing capacity, and it’s not always tied to a high volume of emergency department patients.
“We can have a large number of patients in the ER that only need stitches or to see a doctor for an immediate health issue who get taken care of and go home,” said Anne Overhoff, vice-president of patient care and chief nursing officer.
“Surge numbers specifically relate to admitted patients. We have regularly seen peaks and valleys ... Usually, these happen during influenza season or in the summer when we get high heat days, but it’s been a constant for the past two years.”
While Ross Memorial has 158 available beds, admissions peaks have regularly run as high as 170 patients, said Overhoff.
Exacerbating the problem is the fact that 39 per cent of patients at Ross Memorial are waiting for an alternate level of care bed in a long-term care or palliative care facility.
“That’s what’s really pushing us over the edge,” Overhoff said.
As a result, when the hospital does need to admit an emergency department patient, it’s a challenge to find an available bed.
“We aim to get them a bed within 30 hours but now it’s closer to two to three days,” said Overhoff, adding the hospital “opens” extra beds on a daily basis to ease the pressure. “We thought having 12 extra beds would be enough but now even 20 isn’t.”
But it’s not simply a case of putting clean sheets on an empty bed.
Hospitals are funded annually for a set number of beds. Budgets take a bit of a hit each time extra beds are used. Then there’s the fact that, like many other hospitals, there is simply not enough staff available to care for the extra patients. Currently, there are 60 job openings at the hospital, roughly 30 are for nursing staff.
Unfortunately, it’s something every other hospital is experiencing to varying degrees, on top of a lack of specially trained nurses for obstetrical, surgical and intensive care units.
In response, the hospital is actively recruiting for registered nurses and registered practical nurses and the emergency management branch has also been working with the Central East Local Health Integration Network. The hospital has also increased its float pool, improved nurse/patient ratios and brought team leaders back in.
“Everyone has been working as a team to get through this and continue to provide optimal patient care,” Overhoff said.
Influences beyond the hospital’s control are also having an impact, said Lisa Green, manager of patient flow and client services, such as the annual influx of cottagers and tourists, an aging population and insufficient longterm care beds.
When it comes to visitors, Green said the hospital takes its home first approach seriously. Patients are treated and sent back to their own community, working with health-care services there to ensure the best transition possible.
“Every discharge gives someone else a bed, “said Green, adding the partnerships developed with local agencies is vital as well.
Addressing the issue of alternate level of care beds is bit trickier.
Notwithstanding the existing wait list for long-term care beds — which can be up to two years — Green said there are many seniors who don’t think they need to go into a nursing home. That can change in an instant with a serious injury — a fall or a collision — heart attack or stroke.
“You can’t wait until you’re ready. Pre-planning is key ... I think most people don’t think there’s such a wait,” Green said.
Many individuals who have retired and moved to the area are also separated from their families who might offer a “fresh set of eyes” to any issues that could be addressed before a hospital admission is necessary.
But as hospitals do their best to weather daily surge challenges, the big question is what will be done for the long-term.
Ross Memorial Hospital and the Peterborough Regional Health Centre recently announced plans to merge into a two-site single hospital network. The plan will be submitted to the Central East Local Health Integration Network.
Prior to the election, Green said the LHIN had considered a multi-year plan that included adding 908 extra beds to Central East long-term-care facilities in need. Ross Memorial is still waiting to hear when it will roll out and how many beds are expected locally.
“We start each day with an average of 15 people in the ER looking for a bed,” said Overhoff, who looks forward to the impact those extra beds will have on the system. “We’re working to address it in the short-term but we (all hospitals) need a long-term solution.”
According to the Canadian Institute for Health Information, Ontario has the fewest hospital beds per capita of any province.
In 2008-09, Ontario had 2.5 hospital beds per 1,000 population. That number has since dropped to 2.3 compared to other provinces that average 3.5 beds per 1,000 people. On an aggregate per capita basis, this means that Ontario now has 16,440 fewer hospital beds than the national average.
In a report tabled the end of 2016 by Ontario auditor general Bonnie Lysyk, the audit team described a state of severe overcrowding in the hospitals they visited. Members viewed patients waiting on stretchers or gurneys in hallways and other public areas, sometimes for days.
The team’s research also noted that one in 10 patients requiring admission to hospital are waiting too long in emergency departments. The hospitals visited by the team also experienced transfer wait times of up to 23 hours for patients going to the intensive care unit and 37 hours for other acute care wards; the provincial target is eight hours.
Other situations described by the team included frequent and planned operating room closures due to funding constraints, little to no improvements in wait lists for elective surgeries from the previous five years and wait time targets were not being met for surgeries such as oral and dental, thoracic, vascular, orthopedic, gynecologic, ophthalmic and cancer.