Why adding beds might not solve the problem of 'hallway medicine' anytime soon

Beds announced at the end of October to alleviate overcrowding at some hospitals may be slow to come on stream as hiring staff takes time, but some doctors say the move also doesn't address the underlying cause.

Dr. Paul Pageau, President of the Canadian Association of Emergency Physicians says rather than adding new beds, hospital administrators should look at how they can use the ones they have more efficiently.

"There's still a significant issue with patients that remain in hospital, but who really should be transferred to another facility or in some cases can go home with the appropriate community resources," says Pageau.

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But Instead of acute care, he says, these patients require what's called an Alternative Level of Care that could be better provided in a long-term care facility, such as, a nursing home.

Calls to make public wait times, ER patients

Pageau says his groups would like for all hospitals to make public their wait times and number of admitted patients in beds in emergency departments.

"That, I think, would start a level of accountability with hospitals and government. The public would be able to see which regions aren't meeting their targets. To incentivize shorter wait times."

Pageau says that packed emergency departments are not a symptom of too many people showing up with non-urgent problems, but an inability to transfer admitted patients to the appropriate hospital wards caused by a bottleneck in discharging patients.

Ontario's Ministry of Health is trying to address that problem at the five hospitals within the Central Local Health Integration Network. This weekend it re-opened Humber River Hospital's Finch site, now re-named the Reactivation Care Centre (RCC).

Overcrowded hospitals will be able to transfer patients there who no longer need the acute services of a traditional hospital, but do not have a place to go yet or lack supports to return home.

How to hire for surge periods?

 Pageau says another problem with getting the beds announced online is a question of funding levels.

"The new beds may not have been funded at the same level as the beds that the hospital already has," he says. "Hospitals are trying to figure out what the exact funding is and it doesn't seem to match up with what a normal hospital bed would be funded at."

That makes it difficult for hospitals to hire staff including nurses needed to take care of the patients that will be in them.

Doris Grinspun, CEO of the Registered Nurses' Association of Ontario, says the funding is specifically for extra beds during the "surge" period, when more patients are expected to end up in hospitals due to a predicted severe flu season.

"You cannot hire for surge capacity beds meaning you will hire them for a few months and then what?" says Grinspun. "We will not succeed to staff those surge capacity beds because people want permanent full-time work."

Grinspun says U.S hospitals actively recruit Ontario's nurses because they are well-trained, so hospitals here have to be competitive with their offers.

"Why would they take casual part-time positions that will only last a few months? Or why would they take two or three days a week in a hospital when they want full-time work? So they go somewhere else," she says.

Dr. Dick Zoutman is a professor in the School of Medicine at Queen's University and the chief of staff at Quinte Health Care and infectious disease specialist.

He says if the experience in the southern hemisphere is any predictor, this will be a particularly bad flu season.

'We should reduce the delay'

"It was two and times more cases and morbidity and mortality," says Zoutman who recently returned from Japan, not to study their healthcare system — but their automotive industry.

"When there's pressure on the system like we are seeing now we really have to get down and think of process engineering. How do we do what we do?" says Zoutman. He says concept of "daily Kaizen" or constant improvement employed by Toyota can hold lessons for hospitals.

"It is very much the scientific method. Everyday is like a Grade 9 science experiment. We have a theory we implement it and measure the effect," says Zoutman.

One example he gives is they found that calling the family of a patient the night before they are discharged and asking them to arrive 30 minutes earlier than their discharge time freed up beds a total of six hours earlier.

"I rarely meet a patient who wants to stay in a hospital longer, so we should reduce the delay," he says.