More cost-effective health care needed
Programs for high-risk groups can prevent unnecessary and expensive hospital stays, writes JACK KITTS.
Programs for at-risk groups can prevent more hospital stays, writes Jack Kitts,
Canada’s health-care system is under strain. Our country has an aging population and our hospitals are moving from providing acute care to managing chronic diseases. With all these factors in play, Canadians must recognize that the current system is fragmented, inefficient and does not serve our patients effectively. We must do things differently.
Historically, hospitals have been paid for services, not results. But recent funding reforms introduced in Ontario are reshaping that practice. Instead of being allocated annual increases with few expectations for improved performance, hospitals are gradually being funded based not only on how many patients they treat, but also how well they treat them.
As CEO of The Ottawa Hospital, I’m proud of our staff for demonstrating success over the past year with innovative ideas that provide patients with better care at a lower cost.
One big idea starts with the deceptively simple premise that the way hospitals schedule their surgeries has a profound impact on the quality and cost of patient care.
By reorganizing the way operating-room time is managed and assigned, our hospital is giving patients faster access to urgent, life-saving surgeries for conditions such as internal bleeding, head trauma and muscle and joint injuries. The changes include setting aside more operating-room time specifically for urgent procedures and spreading elective surgeries more evenly throughout the week to reduce sharp swings in volume.
The payoff has been dramatic since the changes were introduced last January.
Of the 120 patients who require urgent surgery every week, nine out of 10 now get it within 24 hours of admission. Previously, some patients waited more than 72 hours.
For some urgent surgeries, the hospital is outperforming the wait-time targets set by the Ontario government. For example, patients with fractured hips now get to the operating room within 24 hours, which is faster than the provincial standard of 48 hours.
The faster route to surgery eliminates the need for patients to spend days in hospital waiting for an operating room. It allows them to recover more quickly because they are not left to weaken or deteriorate while they wait.
Indeed, because of the scheduling changes, our hospital is safer for patients today compared to three years ago, when we had frequent surgical backlogs.
Fewer patients now suffer from surgery-related adverse events, such as delirium and urinary tract infections. The mortality rate among urgentsurgery patients has dropped from 3.9 to three per cent, translating to 40 lives saved.
The improvements in efficiency — shorter hospital stays and better use of beds — have given our hospital the opportunity to do the same volume of cases with fewer beds, less staff and less resources. As a result, we have achieved an efficiency gain equivalent to $9 million, or nearly one per cent of The Ottawa Hospital’s $1-billion annual budget.
Doctors now care for more urgent-surgery patients in less time; there are fewer aggravations and logistical conflicts for staff, making the hospital much more efficient and a pleasant place to work.
More importantly, we have not cancelled a single surgery due to bed shortages — a dramatic change compared to three years ago when we cancelled more than 600 surgeries due to inefficiencies. This fact alone shows that a smoothly flowing hospital saves time and money, while providing better care for patients.
Another big idea comes from Dr. Jeff Turnbull, The Ottawa Hospital’s chief physician.
When Dr. Turnbull visits patients, it’s not always in the hospital. He tours the city’s homeless shelters and supportive-housing projects to inspect injuries, prescribe treatments or sometimes just to hold people’s hands to assure them that they matter.
Dr. Turnbull’s program makes it easier for the most vulnerable and hard-to-treat patients to receive the medical care they need. Many of them have spent decades in shelters and are considered to be beyond the reach of the health and social-services system.
Yet the paradox is that when they are in crisis, they frequently land in our emergency departments, an expensive service that rarely meets their needs. When they are admitted, they tend to stay in hospital almost twice as long as the average patient. They go to hospitals, not necessarily because they have medical emergencies, but because hospitals are the clinics of last resort.
We have learned that Dr. Turnbull’s program not only provides the most high-needs patients with more effective and compassionate care, but also reduces overcrowding and long waits in emergency departments. In the first eight months of operation, Dr. Turnbull’s program diverted 756 visits from our hospital’s emergency departments, freeing up extra capacity equivalent to $378,000. By comparison, the cost of operating Dr. Turnbull’s program over the same period was $170,000. These savings allow us to treat more patients with the same level of resources.
In recent years, we have put in place similar programs for other high-risk groups such as frail seniors, pregnant teens and the mentally ill, all of whom benefit from having hospital services brought to places where they are most comfortable receiving care. These programs are not only good for our patients; they are also good for the hospital because they allow us to use our resources more efficiently.