Hospital ‘in crisis’ because of ALC patients - Dr. Peter Zalan

What are the effects of ALC patients on the hospital system? Let me explain.

In 2004, the Sudbury Regional Hospital had 49 ALC patients. It has been going up ever since. If a hospital can’t move patients out, then its ability to function becomes severely compromised. Our hospital system is in crisis.

Ontario’s hospital wards are constantly in “overcapacity,” meaning they are caring for more patients that they have room for. This means patients are placed in hallways or rooms not designated for care.

Patients’ surgeries are cancelled when there is no bed available for post-operative care.

There can be delays in accepting critically ill patients from outlying hospitals. Sudbury Regional Hospital is the tertiary care and trauma centre for northeastern Ontario. Twenty-six hospitals rely on us to accept their sickest patients.

People have long waits to see a doctor in the emergency department. While critically ill patients get immediate attention, others may have to wait for extended periods for lack of stretchers and space to be examined. Our emergency department has gone from being one of the best performing in the province to being one of the worst.
Ambulances at times cannot offload patients for lack of emergency department beds and staff to take over care, leaving parts of the city with limited ambulance coverage.

Admitted patients can remain in the emergency department for days, waiting for a hospital bed to become available.

This means lying on a stretcher, in the midst of noise and bright lights, without privacy.

So how does one juggle all these needs and responsibilities in a fair and just manner, with the proviso that that we cannot ever close a hospital to new patients? There is no easy answer. The guiding principle is to do the least harm and the most good. It is a constant struggle for nurses, physicians and administrators.

What are the effects on our staff? Front-line staff are increasingly frustrated at not being able to provide high quality care in a proper setting. This may lead to burnout and retention issues.

There are 60 nursing positions unfilled at the hospital, and the emergency department is short of six physicians. Working conditions are a significant part of the problem.

What about prevention and greater personal responsibility to decrease the load on the health care system? Rates of obesity and diabetes are climbing, threatening to inflict ever-mounting costs in the future.

In 2008, 18 per cent of the population was obese, 50 per cent were physically inactive, and 39 per cent had inadequate fruit and vegetable intake. A recent Statistics Canada study showed that fitness levels among Canadian children declined and body weights increased measurably.

Reversing these trends will be difficult but not impossible. It will require a major cultural shift to bring physical activity back into our daily lives, starting in early childhood.

This will require significant changes in our education system and in the infrastructure of our communities and workplaces. It will require making healthy eating affordable. It will require personal effort and commitment.

In my next column, I will explore the work of the Sudbury ALC Community Steering Group. In the concluding column, I will offer suggestions on what the community can do.

Dr. Peter Zalan is the present of Sudbury Regional Hospital’s medical staff. This is the third in a series of six columns about the issues surrounding ALC patients.