STATE OF EMERGENCY: Hospital congestion a structural issue, ER doctors say

ER doctor says congestion caused by hospitals operating at or beyond their capacity, not by people with minor illnesses

This is part of a multi-story Special Report on Abbotsford Regional Hospital and its emergency department. For more stories, scroll to the bottom of the story or click here.

Politicians and health officials need to stop blaming people with minor illnesses for clogged emergency rooms, according to Dr. Alan Drummond, the point person for the group representing Canada’s ER physicians.

Drummond, who is co-chair of public affairs for the Canadian Association of Emergency Physicians, said the notion that people with ailments better addressed by family physicians or walk-in doctors are to blame for clogged ERs is a “common myth” spread by politicians of all stripes.

While such patients do consume some resources, Drummond said congestion’s main cause is hospitals operating near, or beyond,100 per cent capacity. When a hospital is full – whether because of a lack of beds in acute care wards, or in residential care facilities for those who can be discharged – it falls to ERs to take the brunt of any surge in activity.

Only they can’t close their doors to new patients, he noted.

“When a hospital’s trying to function at 100 per cent occupancy, crowded ERs happen all the time,” Drummond said. “You’re not going to solve crowding by telling people not to go to the ER in the first place.”

In the third quarter of 2013/14 – the most-recent time period for which hospital occupancy rates are publicly available – only one of Fraser Health Authority (FHA) hospital was operating below 100 per cent capacity.

Those figures are found within a three-year strategic plan created at the behest of the B.C. government. In 2013, the province had taken the rare step of ordering a full review of Fraser Health after the region failed to meet its budget in three consecutive years. The region was also beset by major quality-of-care issues at several hospitals. Several sites – but not Abbotsford’s – were ranked among the worst in the country on measures of patient safety.

View the whole plan here.

The 90-page strategic plan issued in June 2014 was meant to address the issues, and called for a shift of resources towards residential and community care.

The News has spent more than two months examining the report and its outcomes and has found that while some areas – including quality of care – have shown improvements, the region has fallen even further behind on other important measures.

That report noted that “hospital overcrowding creates inefficient processes of care and compromises clinical care.” Those issues make it difficult to implement system-wide strategies, the report said.

Since then, the overcrowding figure cited in the report – the rate of patients being admitted within 10 hours – has grown even worse, with Abbotsford the second-most congested in the system.

The issues are not confined to the emergency room.

Over the last two years, FHA hospitals have also seen an increase in the number of beds tied up by people waiting to be discharged from elsewhere in the system.

FHA opened more than 400 residential care beds last year, but the number of beds-per-capita for seniors is lower than three years ago. A report by the Senior’s Advocate earlier this year showed increases in wait times to get a residential care bed in the region.

FHA CEO Michael Marchbank told The News Thursday that he was confident that conditions in the health authority were improving and that congestion would ease in the spring.

He said increased capacity can be found by being more efficient and caring for patients in their homes. He also said the opening of 10 hospice beds last year has helped.

Marchbank said the public has a right to continue to demand progress toward the goals set out in the strategic plan.

“I think the public has absolutely a right to ask those questions and they need to see progress on a regular basis.”

• • • • •

Drummond linked Canada’s congestion issues to cuts to federal health transfers in the 1990s, which left provinces scrambling to reduce costs. He said ER doctors would like to see other wards take emergency room patients waiting for admission.

Drummond said it would spread the burden of overcrowding across an entire facility, rather than concentrate it in the emergency department.

BC Nurses’ Union president Gayle Duteil isn’t in favour of any approach that doesn’t increase hospital capacity, which she said can be accomplished by opening up other areas of the hospital and hiring more workers.

Fraser Health says it can place beds in inpatient and outpatient areas outside of the emergency department to ease pressure and that other locations were “inappropriate” for such care.

Drummond agreed that stopgap measures won’t solve the underlying problems, but he noted it could spread the increasing burden until long-term solutions are found.

“The demand for hospital beds will never diminish,” he said. “They have to acknowledge that, like it or not, we are going to have to increase bed capacity for the aging population.”

• • • • •

Asked about the recent issues at ARH, Abbotsford Mayor Henry Braun said he’s been in contact with Fraser Health and was satisfied it was taking the concerns seriously.

Braun – who is chair of the Fraser Valley Regional Hospital District, which provides some capital for local hospitals – said the city has raised issues in the past regarding waiting times for police who bring mental health patients to the facility.

Asked about congestion issues, Braun said: “It concerns me, but I think it’s a concern that is shared by many, many hospitals as well.”

Braun said he is also cognizant that other jurisdictions are also frequently requesting more services and facilities as the population ages.

“The asks keep getting bigger and bigger.”

• • • • •

The News requested to speak with Health Minister Terry Lake on Tuesday, but was told Wednesday he was not available for an interview. The News has requested to speak with Lake at any later date that can be arranged.

tolsen@abbynews.com

 

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