Abbotsford Regional Hospital (ARH) has far more patients than fully funded beds to care for them.
And so, this month and last month and last year, patients have languished in discomfort in a hallways or next to a brightly lit nursing station. Constant noise, regular foot traffic and 24/7 lights make sleep difficult.
The news is anything but new. For years, the same story has been told by a revolving cast of characters. Last month, it was John Cook and Betty Rankin. Last year, it was Jack McKay decrying ARH as an “overbooked joint.”
Fraser Health frequently apologizes, says it has been an especially busy period of time, and notes that congestion is a challenge in hospitals everywhere.
But five years of provincial occupancy records obtained by The News show that no large B.C. facilities have been as overbooked as Abbotsford Regional Hospital and Chilliwack General Hospital (CGH).
Those figures show that, on any given day, the two major Fraser Valley hospitals are probably caring for 80 inpatients in unfunded “flex-beds” and that the problem is consistent and, through the end of the last fiscal year at least, not getting better.
The figures also confirm that the public shouldn’t expect the upcoming expansion of ARH’s emergency department to lead to the end of widespread hallway care in the hospital for admitted patients.
The numbers also show that the number of people in unfunded beds rose by more than 40 per cent after three dozen beds were cut from the two sites in 2015.
Last year, ARH’s annual occupancy rate in acute care wards was 118 per cent, while CGH’s was just shy of 120 per cent.
Fraser Health was warned, in a 2015 report it commissioned, that “maintaining high hospital occupancy (over 95 per cent) is associated with longer lengths of stay and higher risk for errors and adverse events.”
Fraser Health officials say there are no current plans to restore all those beds cut in 2015. Instead, they are pushing forward with efforts to increase community care services and residential care beds in the goal of reducing hospital patient loads.
But the president of the main group representing B.C. doctors says that while those goals are ideal and hospital care should be minimized, health officials must also maintain their facilities so there is enough room to safely treat patients.
• • • • •
The numbers obtained by The News show that nearly one in five patients at ARH end up in an unfunded flex-bed.
Not all such beds are created equal. Some are in rarely used corridors or rooms designated for non-medical uses. But as patient levels increase, flex-beds end up being placed in busier hallways where traffic is constant, or next to nurse stations where work takes places 24 hours a day and where light is constant.
“Every effort is made to limit the time they spend in these spaces and provide privacy,” a Fraser Health spokesperson said in an email. “Any time a patient is placed in one of these beds, we ensure they are medically stable, and often they are ready for discharge.”
Officials say hospital staff are continuously working to free up funded beds for patients.
It’s unclear just how frequently those that are considered the very worst are used.
But you don’t have to look hard to find people angry about the prevalence of hallway care at ARH.
When Dan Cook, a local Realtor, posted on Facebook last month about his father spending nearly a week lying next to a nursing station in Abbotsford’s emergency room, a half-dozen other people chimed in with their own unhappy stories.
And last fall, Tasha Kaila spoke to The News about her grandmother’s experience in an unfunded hallway bed with little privacy.
Not long after, Kaila found herself in an unfunded bed in a room. As she prepared to give birth, nurses rushed medical supplies and equipment in and out of her room, which was clearly not designated for that purpose.
• • • • •
Treatment in hallways and other areas not built for patient care has been shown to statistically result in worse outcomes for patients. That is the medical jargon.
In lay terms, that means that, if you are stuck in a hallway, one of the people caring for you is more likely to make a mistake, and you are more likely to suffer further illness, injury or death. That likelihood may not be high and you may not notice that increased risk. But it is still higher than if you were to be treated in a bed or place designated for care.
What you may notice are the lights and the noise.
Sleep is important for a patient’s recovery, studies show. But patients (and the family members of patients) who end up in busy hallways or next to nursing stations say their sleep and recovery is compromised significantly.
“You go seven days without sleep and see how you feel,” McKay said last year. “I haven’t slept, and the stress has raised my blood pressure and all kinds of crap.”
A variety of laws and ethical codes proclaim that the privacy of health information is of paramount importance. Doctors have a duty of confidentiality. But multiple family members of patients who end up in flex-beds told The News that it is impossible to discuss their loved ones’ care in private.
Those stuck near nurses stations, meanwhile, are easily able to hear conversations about other patients.
“When there are people being treated in a hallway, privacy is a major concern,” Doctors of BC president Eric Cadesky said.
Even exercising the most basic of privacy needs – the ability to relieve oneself out of the sight of others – can be a matter of difficulty. Cook, Kaila and a third woman who spoke to The News all expressed concern with the difficulty with which their hallway-bedded relatives could access the bathroom. With those issues in mind, Kaila’s grandmother received a commode, one that was placed in full view of other patients.
(Fraser Health said it later offered to move the patient another location, but the offer was declined. The woman’s granddaughter said her grandmother knew she would be leaving the hospital soon and didn’t want to put another person in that situation.)
In an email after this story went to press, a Fraser Health spokesperson wrote that “Ensuring the privacy of patients is something staff are very aware of when caring for patients. Some general measures include using privacy screens, moving stretchers to private rooms for issues that require increased privacy and being aware of the volume at which we speak.”
Several family members say their loved ones avoided protesting their conditions to be nice and agreeable towards those treating them. And that overly positive information, then, is used to make important decisions.
“It’s not unique, and if you don’t have a strong advocate, it’s even worse,” said the mother of one patient, who was in a hallway for eight days.
Halfway through that stay, the mother’s son developed a staph infection.
The mother said she also felt pressured to allow her child to be discharged to her care, despite her feeling that it would be unsafe to do so. Other relatives of patients echoed that concern in interviews with The News.
Lynn Johnson said the hospital wanted to discharge her mother either back to her assisted living facility or to stay with family before she was ready.
“We said, ‘We’re not taking her, we refuse to take her,’ ” Johnson said. “We thought, there’s something that’s going to happen if she goes home in this condition.”
• • • • •
ARH site medical director Dr. Michael Newton told The News in November that ARH usually operates at between 110 and 130 per cent capacity. But he added that, several years ago, the hospital “had a lot more unfunded beds open in the hospital than we do now.”
The News has requested, but not yet received, occupancy figures for the current year. The provincial government has also added 10 surgical care beds.
Newton and ARH executive director Rhonda Veldhoen told The News that there is a constant effort to ensure all patients, including those in unfunded beds, are properly cared for.
“Our public can be confident of the care that they receive at Abbotsford Regional Hospital,” Veldhoen said. “They can be confident of that.”
They also say there is a constant focus on making sure that patients awaiting discharge are sent home speedily, without unnecessary delays.
“There are a lot of services that have been developed in the last year or two that are very responsive at getting patients home,” Newton said, pointing to a program to ensure emphysema patients needing oxygen quickly get that help in their homes, forestalling their need to be admitted.
Irene Sheppard, the executive director of community services in Abbotsford for Fraser Health, said out-of-hospital health care is improving things for patients.
“To just look at the hospital without looking at the context of the whole continuum, I think does a disservice to our public,” she said. “It’s an old-school model to think that health care equals hospital.”
Health Minister Adrian Dix had a similar message when he was in Abbotsford earlier this month – although he also noted that health care supports must keep up with the region’s rapid population growth.
“These are all issues that are tied together,” he said. “The answer, in some ways, to the challenges in the hospital are found in the community.”
That doesn’t reassure family members of patients who have recently languished in hospital. While patients and their relatives generally hail the work of nurses, they question why a hospital that is barely 10 years old is unable to provide space for all its patients.
Cook’s father spent more than a week in the hospital’s chaotic and noisy emergency room before his story drew the attention of a TV reporter.
When he was subsequently moved upstairs to an acute care ward, he was placed in another hallway, albeit one more removed from the bustle of a ward.
“You’re thinking, ‘Man we’re thankful he’s in a hallway, but at least it’s a better hallway,’ ” Cook said.
Doctors say that while health authorities are right to focus on community care, they should not neglect hospitals and the people in them.
“We should never accept that patients being treated in a hallway is a new standard of care,” Cadesky, the president of Doctors of BC, said. “Why are we not able to give people the care they need, when they need it?”
• • • • •