Health Sciences North is implementing extraordinary measures to deal with overcrowding and avert issuing a Code Orange, an alert that triggers an emergency response to an external disaster that taxes a hospital’s bed capacity and resources.
Those measures include the cancellation of a dozen elective surgeries at HSN last week and the strong likelihood more surgeries will be cancelled Wednesday.
A Code Orange is called to deal with external or community disasters such as accidents with mass casualties, chemical or oil spills or other incidents that could cause an influx of patients.
For instance, a Code Orange was called April 23, 2018 at Sunnybrook Health Sciences Centre after the terrorist van attack in Toronto that killed 10 people and seriously injured many more.
In what he called a pre-Code Orange memo, HSN chief of staff Dr. John Fenton advised the hospital’s professional staff this week that HSN is diverting patients from other communities who are “non-life and limb threatening cases” to hospitals closer to them and not to HSN. In some cases, patients with life or limb injuries will be sent to hospitals in North Bay, Timmins and Sault Ste. Marie if they can provide appropriate care for them.
Some patients in hospital have also been granted what is called Category 1A-Crisis Status by the Ministry of Health and Long-Term Care. It’s a designation that moves people in hospital awaiting a long-term care bed up the list of applicants so they are on equal footing with people in the community who are in crisis and need a long-term care placement.
Hartman said remaining in that crisis designation too long, though, can have the unintended effect of sending people in crisis in the community to the emergency department, compounding problems.
The only Code Orange issued in recent memory in Sudbury was in June 2007 when a fire at the former St. Joseph’s Health Centre disrupted electrical power and closed the city’s only emergency department. The Ministry of Health and Long-term Care deployed Ontario’s Emergency Medical Services Team to help what was then Sudbury Regional Hospital provide critical services while fire damage was repaired at St. Joseph’s. The team operates a self-sufficient, 56-bed acute and intermediate care field unit complete with its own medical supplies and equipment.
A Code Orange hasn’t been issued here, but HSN’s Ramsey Lake Health Centre site was stretched way beyond capacity Tuesday morning, according to Mark Hartman, senior vice-president of patient experience and digital transformation at HSN.
In all, 34 patients were admitted to hospital in the emergency department, which only has 36 spaces to treat emergency cases, so that “really jams up the process in the emergency department,” he said.
Another 36 patients were housed in unconventional spaces such as lounges and shower rooms because the hospital’s 470 permanent beds were filled. Meanwhile more than 90 alternate level of care patients remained in acute hospital beds awaiting a long-term care placement or community care to return home.
In his memo, Fenton made staff aware of the impact the bed shortage is having on patient care.
Hartman said overcrowding creates serious challenges in the emergency department. Emergency physicians aren’t sure what has caused a recent sharp increase in the number of ALC patients, generally frail elderly people who are admitted or remain in acute hospital beds as they await placement or community supports. Two weeks ago, there were 77 of them at HSN, but the number spiked into the 90s. ALC numbers often rise during flu season and fall again with the arrival of spring.
Dr. Killian de Blacam is president of the medical staff at HSN, and speaks for doctors with hospital privileges. “We don’t need any more hospital beds,” de Blacam said Tuesday. “We need (more) nursing home beds.”
The backup of patients is particularly heavy on medical floors, said de Blacam. To ease that pressure, the hospital is focusing on the length of time patients remain in hospital and discharging them as soon as appropriate.
“That’s the big push at the moment,” he said. “We’re doing that as much as we can and that’s where we really need to apply our pressure.”
Cancelling surgeries because of a shortage of beds should be the last measure a hospital takes to deal with overcrowding, he said.
Hartman said the hospital tries to give patients at least a day’s notice that their operations will be postponed, but that isn’t always possible, particularly if people are travelling to Sudbury from other communities.
De Blacam and the doctors he represents have been advocating for a physician to be appointed medical director of utilization at HSN. That doctor would act as a flow co-ordinator, “putting the heat on the individual doctors who are responsible for the patients,” discharging them in a timely fashion so surgeries don’t have to be cancelled.
“We can’t have 98 acute care beds occupied by nursing home patients,” said de Blacam. “It’s crazy.”
Hartman said HSN administrators have heard from de Blacam and other doctors that appointing a utilization chief might assist with some of the hospital’s challenges.
HSN does have a team in place for care co-ordination and to flow patients through the system. The team relies on physicians to be assessing patients regularly and discharging them when suitable.
The hospital will consider the doctors’ recommendation, said Hartman.
But de Blacam thinks the root cause of serious overcrowding is the shortage of long-term care beds.
He agrees with plans by the Progressive Conservative government of Premier Doug Ford to build 15,000 new long-term care beds within five years, 30,000 within the next decade. De Blacam points out the cost of caring for a patient in hospital is roughly $1,500 a day as opposed to about $200 in long-term care.
Fenton said HSN is working with the North East Local Health Integration Network, emergency medical services personnel and other partners to reduce pressures at HSN’s Ramsey Lake Health Centre site. The situation is being reassessed every 24 hours and staff is being informed about updates.
Kerby Audet, interim vice-president of home and community care with the North East LHIN, said it is working with HSN to review patients waiting for long-term care and assigning a crisis priority for individuals to help give them timely access to long-term care. Patients who receive a crisis priority designation keep that until they are placed in long-term care, said the LHIN.
While doctors, hospital staff and administrators deal with system pressures, HSN is appealing to the public not to attend the emergency department if they require less than urgent care. People should instead contact their own primary care providers, visit walk-in clinics or consult Telehealth Ontario.
Patients at HSN’s emergency department are triaged so the sickest are seen first. That means patients with less urgent complaints could have to wait 12 to 15 hours to be seen. “That’s just not a good experience for them so if they can go elsewhere, we encourage that,” said Hartman.
He commended doctors and staff for the good care they are giving to patients despite serious challenges, in the emergency department and throughout the hospital.
HSN doctors and staff feel particularly bad when surgeries have to be cancelled. They realize people organize their lives around these procedures “so we know it is hugely disruptive” when they are cancelled, said Hartman.
Overcrowding is not expected to ease at HSN any time soon. While doctors and staff provide the best care they can, administrators are working on a short-term plan to build 37 new conventional bed spaces and are finalizing a long-term capital plan to add more beds.
“We know HSN was built too small,” said Hartman.
Carol Mulligan is an award-winning reporter and one of Greater Sudbury’s most experienced journalists.