Defend Public Healthcare

Well here's a new one: hospital and fire officials are meeting in Sudbury to determine if it is okay to keep patients in hallway beds on medical floors, according to a report from the   Sudbury Star .   Apparently, some believe it may be safer to keep surplus patients in the hallways of medical floors rather than the hallways of Emergency Rooms. Two senior doctors have complained that recent hospital bed closures were hurting ER operations, including Hospital chief of staff, Dr. Chris Bourdon.  Bourdon says solutions proposed two or three weeks ago haven't done much to ease ER pressures, adding that although the ideas were great "when you look at them in depth, they're recycled ideas and enhancements of what we've already done." The   Star   reports that fire officials have expressed concerns about patients being placed in hallways. But there have long been complaints that patients were placed in inappropriate places due to overcrowding at the

With long line-ups at hospital Emergency Rooms, people are beginning to call ambulances to take them to the ER, hoping the ambulance and paramedics will speed them through the ER.   "We call them beat-the-queue calls," John Prno, regional director of emergency medical services reported. Paramedics have to stay with the patient until they are seen by hospital staff, which reduces  ambulance   availability, the Waterloo Record reports, creating offload delays where paramedics must wait in the hospital rather than save other patients in the community.   Offload delays at Waterloo hospitals increased by 20 per cent in 2011 for a total of 6,990 hours, the equivalent of an  ambulance  parked 24 hours a day for 291 days. The good news?  The number of Code Reds, where no local  ambulances  are available for an emergency call, dropped to 12 per month from an average of one a day in 2010. The EMS director noted that the hiring of  five paramedics last year and another five

A new research study based on 14 million patients who visited Ontario hospital emergency rooms concludes  that showing up at an emergency department during shifts with longer waiting times is associated with a greater risk in the short term of death and admission to hospital. The findings provide strong support for policies targeting reductions in length of stay in emergency departments.  The increasing risk to patients associated with increasing length of stay in an emergency department suggests that any reductions, regardless of magnitude, could benefit a wide array of patients. In our analysis, reducing mean length of stay by an average of one hour could have potentially decreased the number of deaths in our study in higher acuity patients (8625) by 558 (6.5%) and in lower acuity patients (2054) by 261 (12.7%). Further research needs to evaluate whether these benefits are in fact seen when waiting times are decreased. Emergency rooms in Ontario often back up when there are no

A new study in the Journal of the American Medical Association  concludes that diverting patients from overcrowded hospital Emergency Rooms (ERs) is linked to a 3 percent higher risk of death for heart attack patients. The study was based upon 14,000 medicare patients in California. "For every hundred patients there are three avoidable deaths," said Dr. Renee Hsia, an emergency physician at the University of California, San Francisco who led the study.  "Now we actually have empirical evidence to show crowding affects patients in a very real way," Hsia told Reuters . "We know as practitioners it's very unpleasant to work when it's crowded," said Hsia. "You kind of know that you're not able to give patients enough attention because everybody is running around. Now we know we have to pay more attention to this, because patients are dying from it." Steven L Bernstein of Yale University School of Medicine told Reuters that ambulanc

Ambulances and their patients waited outside London, Ontario emergency rooms (ERs) for more than 685 hours in March — that’s an average of one working paramedic crew unavailable for emergencies for every hour of every day that month, according to the London Free Press .  Based on Ontario’s 2009 benchmark figures of $146/hour/ambulance unit, the cost to sit and wait in that month alone exceeded $100,000. As usual, the blame is put solely on too many alternative level of care (or "ALC" ) patients in hospital beds, as if the ER backlog was simply a problem of bad management rather than government policy to squeeze hospitals.   No mention is made of bed cuts or dangerously high hospital bed occupancy levels.  But this is not simply a bad management problem.  It exists around the province at too many hospitals for that.   So, on the same day as the London report, a Durham report  indicates that ambulance 'off-load delay' in that region increased from 16,00

A new  report  indicates that on average in February 2011, 773 patients were in Ontario Emergency Rooms waiting for an acute care hospital bed.  These patients alone would fill 4.9% of the existing stock of 15,711 acute care beds in the province.  Bed occupancy at Ontario hospitals is about 97.9% dallan@cupe.ca

The Ontario Hospital Association (OHA) reports a surge in patients visiting hospital emergency departments (EDs) in January, in part, because of the flu season. Over January, the OHA noted a 22% increase (150 patients) in the number of patients in EDs waiting for admission to an inpatient bed, and a 10% increase (253 patients) of Alternate Level of Care (ALC) patients in acute care beds. The OHA adds: "Because occupancy levels in hospitals are already at maximum capacity, this influx of patients has pushed some hospitals to take great measures to ensure patients have access to the care they need."   The OHA is collecting data for a February report.     dallan@cupe.ca

Alan Drummond, chair of Public Affairs with the Canadian Association of Emergency Physicians, writes this today in the Globe and Mail   regarding emergency room overcrowding: "For a decade, we allowed governments of all stripes to portray it as an issue of inappropriate use by patients with minor health concerns; we all knew, however, that the problem primarily rested with government cutbacks in the funding of health care, leading to a critical reduction in hospital and community bed capacity. " Tomorrow, the Ontario Council of Hospital Unions will rally at the Ministry of Health and LTC to defend those very same beds. See you there! dallan@cupe.ca

The Ontario government has probably spent millions on advertisements suggesting people use family health teams, urgent care centres, telehealth or just about anywhere except a hospital emergency room to get treatment for less serious medical problems.  So it is interesting to see Dr. Peter Toth, president of the Canadian Association of Emergency Physicians, say this about patients that could be treated elsewhere showing up at hospital ERs:  “These are extremely minor contributors to the problem (of overcrowded ERs), and they serve to take focus away from the root cause, which is hospitals are currently running at capacity of 100 per cent. Because of the overcapacity of the hospital, the backflow of its admitted [serious] patients happens in the emergency department, reducing our access to emergency patients.” The ER back ups are caused by overflowing hospitals and very high bed occupancy.  It is that problem that the government has got to solve, not stopping patients going to ERs.

The provincial government has slowed down the implementation of the new response time standards for emergency medical services. A revised provincial regulation now allows municipalities two more years before they must report on response times and their response time plans. On September 17, 2010 Regulation 368/10 came into effect, amending the earlier Regulation (257/00) on response times. Under Regulation 257/00, municipalities were required to submit a response time performance plan to the government by 1 October 2010 for the following year.   Under the revised regulation, municipalities will now have until 1 October 2012 to do this. When filed with the Ministry of Health these plans will be publicly available. Given the overcrowding in hospitals and the attendant backups in Emergency Rooms and  "offload delays" for paramedics , the government probably appreciates putting off the reporting of the local plans until after the next election (now less than a year away).

Ontario Health Minister Deb Matthews has confirmed that no cuts to small and northern hospital emergency rooms will occur until at least after new small and northern ER Task Force  reports this spring. "I know that all of the LHINs across the province are going to be very, very interested to see what recommendations come out of this report," Matthews said in the small hospital town of St. Mary's on Friday. "I fully expect that they will not be making any decisions related to emergency rooms until this panel has completed their work."   With an election coming next fall, this is hardly surprising.  After that?  All bets are off, I'd say.     dallan@cupe.ca

Under the title of "Improving ER Services In Rural And Northern Ontario," the provincial government has asked "a group of leading health care experts to examine and develop recommendations for improving emergency services in small and rural communities." The new "Emergency Room Task Force" will develop recommendations for emergency rooms in rural and northern areas to adapt to staffing challenges. The government notes:  "minor staffing challenges -- a doctor's unforeseen family emergency or a nurse's unexpected illness, for example -- can impact a hospital's emergency services." The Task Force is certainly high powered: six of the fourteen panel members are either Ministry or LHIN leaders, including two Assistant Deputy Ministers.  The Task Force is supposed to submit a final report to the government in the spring. The government claims that "there have been no unplanned ER closures in Ontario since 2003." What it doe

As part of ongoing provincial cutbacks, the Niagara Health System hospital closed the Emergency Departments (EDs) in two of its smaller sites last year, converting them into Urgent Care Centres (UCCs).  The hospital now recognizes that it "has been experiencing serious issues with off load delays" at its three remaining EDs despite a policy for ambulances to bring at least some patients to the converted UCCs (and the maintenance of similar patient volumes at the UCCs).  Nevertheless, sicker patients are now being brought to the EDs. The hospital notes: At the same time while our volumes in the Emergency Departments in Welland and Niagara Falls have remained relatively stable the acuity level of the patients presenting are higher. As the acuity increases the resources required to manage these patients expands, resulting in more diagnostic testing and physician assessments. This causes an increase in the “time in the ED” hence increases congestion, crowding and potential

With hospital cuts, there has been some problems with ambulance offload delay, as paramedics wait longer to offload their patients to overloaded hospital staff.  As noted earlier , Niagara region reports a 68% increase in offload delays This in turn puts pressure on EMS response times as paramedics are forced to wait in ERs. Some municipal leaders have mused about sending more fire trucks to EMS calls, as a way to respond to this problem.    But fire trucks are among the most expensive items for municipalities. The 2007 Performance Benchmarking Report (from the Ontario municipal Chief Administrative Officers and City Managers) reports that  each fire vehicle cost $281 per in-service hour in Hamilton, $284 in Toronto, $239 in London, $270 in Thunder Bay, and $207 in Ottawa. The median cost for urban municipalities was $239 per hour, the same as the Toronto rate. In contrast, one hour of in-service ambulance time cost $147 in 2007. With a $92 differential that means a savings of

A new report from Niagara EMS suggests that hospital cutbacks, including the closure of two hospital Emergency Rooms in Fort Erie and Port Colbourne, has resulted in longer "offload delays" for paramedics, as they wait to transfer their patients to hospital staff at the remaining three ERs in the area. In fact, the offload delays are projected to increase 68% in 2010, reaching 10,000 unit hours for paramedics. Since the restructuring of hospital ERs last year and the resulting increase in patient arrivals by ambulance to the three remaining ERs, "off-load delays have increased significantly and have now surpassed the previous peak of 7,075 unit hours set in 2008." Niagara Falls Liberal MPP Kim Craitor said he had heard ambulance off-load delays are increasing and he's concerned about the situation. "I don't disagree with anything they say in that report."  Without sufficient beds to move patients into, the problem will not be resolved, he a

The City of Port Colborne passed a motion Monday night to seek legal advice on legal actions it might take  regarding the shutdown of the local hospital's emergency room, the Tribune reports . "We have made the move to seek that legal advice and take the appropriate steps," said Mayor Vance Badawey.  Barbara Butters, a councillor for Ward 4 in Port Colbourne was even franker:  "Do whatever it takes to make sure these charges get laid because there's no way those SOBs should be getting away with this," Butters said as citizens cheered from the public gallery.  Municipalities are playing are bigger role defending local hospital services. Good on them!

Deb Matthews is staunchly defending the decision to close the emergency rooms in Fort Erie and Port Colborne despite the sharp critique of the LHINs (illegal) consultation process by Andre Marin, the Ontario Ombudsman.  Matthews told Niagara area papers "We're not revisiting that decision. The decision remains the right decision...we're absolutely not going to be reopening that decision."  Obligingly, the LHIN chairwoman Juanita Gledhill said her board doesn't plan to revisit its earlier decisions either.  Big surprise. This does not bode well for other smaller hospitals.  Even in the face of months of community outrage, calls from the opposition parties, and an Ombudsman's report suggesting a phony consultation process, Matthews will not even consider a review of the decision to close the small hospital ERs. Now there's a government official determined to do some damage. So it is interesting to hear that  Port Colborne Mayor Vance Badawey says &

The Champlain LHIN is "Rethinking Healthcare".  And it's pretty scary. For populations of 50,000 to 100,000, the LHIN suggests that ‘polyclinics’ (like the new ‘Orleans Family Health Hub’) could be a substitute for local hospitals.   In fact the document specifically promotes polyclinics for urban and suburban settings. And whether it is a hospital or a polyclinic, facilities for these communities should not do surgeries requiring overnight stays, but rather be limited only to day surgeries. The thinkers at the Champlain LHIN also opine that  "So much of what a hospital does could be done anywhere".  So strip malls would provide dialysis and primary care facilities (doctor’s offices and the like) would provide Urgent Care. Hey Dude , where's my ER? Some distance away, it seems.  Only "District Hospitals" serving 100,000 to 200,000 people would get to keep their emergency rooms. And they could be an hour away.  (I think you can pretty much

Ontario was lucky the H1N1 pandemic was not worse, the province’s Chief Medical Officer of Health says in a report this week. Dr. Arlene King says had more people swarmed emergency departments for longer than they did “that might very well have tipped the system.” So it's good to know that since the pandemic, the province has stepped up cuts to our hospital services. (JK!).

The provincial government has just coughed up an extra $14 million for the Niagara Health System (a multi-site hospital) for the 2009-10 fiscal year, i.e. a year which will end in just over a month (March 31). Apparently, the money will be rolled into the hospital's base funding. This following solid community campaigns against cutbacks and closures of emergency rooms (reaching a terrible culmination when a young victim died while being driven to a more distant emergency room). This also follows the recent successful campaign to get the government to keep the Grace hospital in Toronto going. -- Doug dallan@cupe.ca