Skip to main content

Patient Transfer Changes Continue -- Boon or Bust for EMS?



Another LHIN-based initiative to restructure  "non-urgent patient transfers" is underway. 

Non-urgent transfers are ambulance-like transfers for patients from hospital to hospital, from hospital to long-term care, or from hospital to home. While the cost of these transfers often simply come out of the hospital budget, austerity has made this more difficult.  

The latest restructuring project is in the North East  -- and is funded by the North East LHIN.

Earlier this year, the government strongly endorsed a LHIN-wide plan for the South West.   As in the South West LHIN, the North East project is supposed to develop a standardized approach to the delivery of non-urgent transportation services throughout the LHIN.  

While EMS had provided much of the inter-facility transfers in the past, over the last 14 years that has changed, after the Mike Harris Progressive Conservative government introduced legislation in 2000 allowing hospitals to use for-profit "patient transfer" companies rather than ambulances to move patients between hospitals or long-term care facilities if the patient was in stable condition.

In many locations around the province, hospitals developed their own poorly coordinated systems of non-urgent transfers, creating quite a number of private providers. Reports from the CBC and the Ombudsman have shown that problems abound

In the North East, there are some differences from the South West restructuring, at least initially.  Instead of turning the work over to one provider for the entire LHIN, geographically based pilot projects have been established three parts of the LHIN: [1] Manitoulin-Sudbury, [2] Sudbury, and [3] Temiskaming.  

Large parts of the LHIN remain unaffected by these three pilots, (e.g. North Bay, Hearst, Sault Ste. Marie) but given the enormous size of this LHIN, that is unsurprising.

Another difference from the South West restructuring is that currently almost all of the 24,000 non-urgent transfers in the North East LHIN are being done by public EMS providers, which are highly unionized and pay reasonable wages.   CUPE represents many of the paramedics in the North East.   As noted, in most of the rest of the province, private transfer companies have already made significant inroads into the patient transfer industry, creating many problems and leaving workers in the industry with poor working conditions. 

Interestingly, two of the pilots in the North East are using public EMS staff, while the third uses a private company, according to a June report.  The 
Sudbury pilot project uses the public EMS employer, modified and designated EMS vehicles, and EMS paramedic staff (although some other transfer work continues to go out to a private company) .  Likewise, the Sudbury-Manitoulin pilot also uses the public EMS employer,  modified and designated EMS vehicles, and EMS staff -- but the staff are not paramedics. 


“From my perspective, I didn’t want someone coming in and assuming responsibility for a service that I’m currently providing,” said Manitoulin-Sudbury EMS chief Mike MacIsaac. 

In contrast, the Temiskaming pilot uses a private company.

In the past, a major problem for EMS patient transfer was that the transfer might be  stopped when too many emergency calls came in.  Creating modified, designated EMS vehicles means that the trucks will not be pulled off to do emergency work while doing transfer work. 
  
The project began in March 2013 and is supposed to be completed by the spring.  Participants in this project include all 25 hospitals in the North East LHIN, 41 long-term care homes, 8 municipal social service managers, 12 EMS providers, ORNGE, 5 Central Ambulance Communication Centres, and the EMS base hospital.

Here is the official plan for the period ahead:

  •          Two more project advisory committee meetings will be held in early 2014 to review the options for solutions and recommendations on governance, funding and operational improvements.   
  •          A final round of consultations with hospitals and EMS in February 2014.
  •          A project report to be submitted to the North East LHIN by early spring 2014. 
  •     The report will assess the current non-urgent transfer system in the North East and make recommendations for a future model for the services including costs, partnerships and funding options.
The government had promised over two years ago to regulate the largely privatized patient transfer industry, which has been plague by scandal and bad service.  With no sign of that, LHIN-wide restructuring of the industry may be the only substitute on offer, for now.  

Restructuring has come to the patient transfer industry. This latest 
project is suppose to test different approaches to delivering non-urgent inter-facility transportation using a common set of evaluation measures. 


We will see if this opens the door to more privatization, or to bringing some of the work back into the public sector.

Photo: Instant Vantage

Comments

Popular posts from this blog

Public sector employment in Ontario is far below the rest of Canada

The suggestion that Ontario has a deficit because its public sector is too large does not bear scrutiny. Consider the following. 

Public sector employment has fallen in the last three quarters in Ontario.  Since 2011, public sector employment has been pretty flat, with employment up less than 4 tenths of one percent in the first half of 2015 compared with the first half of 2011.


This contrasts with public sector employment outside of Ontario which has gone up pretty consistently and is now 4.7% higher than it was in the first half of 2011.



Private sector employment has also gone up consistently over that period. In Ontario, it has increased 4.3% since the first half of 2011, while in Canada as a whole it has increased 4.9%.







As a result, public sector employment in Ontario is now shrinking as a percentage of the private sector workforce.  In contrast, in the rest of Canada, it is increasing. Moreover, public sector employment is muchhigher in the rest of Canada than in Ontario.  Indeed as…

The long series of failures of private clinics in Ontario

For many years, OCHU/CUPE has been concerned the Ontario government would transfer public hospital surgeries, procedures and diagnostic tests to private clinics. CUPE began campaigning in earnest against this possibility in the spring of 2007 with a tour of the province by former British Health Secretary, Frank Dobson, who talked about the disastrous British experience with private surgical clinics.

The door opened years ago with the introduction of fee-for-service hospital funding (sometimes called Quality Based Funding). Then in the fall of 2013 the government announced regulatory changes to facilitate this privatization. The government announced Request for Proposals for the summer of 2014 to expand the role of "Independent Health Facilities" (IHFs). 

With mass campaigns to stop the private clinic expansion by the Ontario Health Coalition the process slowed.  

But it seems the provincial Liberal government continues to push the idea.  Following a recent second OCHU tour wi…

Hospital worker sick leave: too much or too little?

Ontario hospital workers are muchless absent due to illness or disability than hospital workers Canada-wide.  In 2014, Ontario hospital workers were absent 10.2 days due to illness or disability, 2.9 days less than the Canada wide average – i.e. 22% less.  In fact, Ontario hospital workers have had consistently fewer sick days for years.

This is also true if absences due to family or personal responsibilities are included.
Statistics Canada data for the last fifteen years for Canada and Ontario are reported in the chart below, showing Ontario hospital workers are consistently off work less.
Assuming, Ontario accounts for about 38% of the Canada-wide hospital workforce, these figures suggest that the days lost due to illness of injury in Canada excluding Ontario are about 13.6 days per year ([13.6 x 0.68] + [10.2 x 0.38] = 13.1).

In other words, hospital workers in the rest of Canada are absent from work due to illness or disability 1/3 more than Ontario hospital workers. 

In fact, Canad…