Hospital stays 'too generous,' chair says

The peer review report of Health Sciences North shows that perhaps the hospital has been “too generous” with who it allows to stay at the facility, according to the hospital's board chair.

“Maybe we just say there isn't community support, so stay here,” Russ Boyles said.
“The real issue seems to be from that report, is we should say we're an acute-care hospital and when the acute episode has passed, you're discharged. We're not going to throw people out on the street, don't get me wrong.

“But we really have to look at that whole process. That's really difficult. That's a cultural change for our staff and for the public.”

The peer review report, released Oct. 9, is 92 pages long and contains 55 recommendations.

The review was ordered by the North East Local Health Integration Network (LHIN) in July, and was led by Hamilton Health Sciences CEO Murray Martin.

Martin's team looked at a number of ongoing problems at the hospital, including high numbers of alternate level of care (ALC) patients and the $3.3 million deficit the hospital posted for the 2011-2012 fiscal year.

“When the LHIN appointed Mr. Martin as the peer reviewer, we were concerned with the high rates of ALC, and the challenges in the emergency department through to discharge,” North East LHIN CEO Louise Paquette said.

“We firmly believe that Sudburians and people across Northern Ontario who depend on Health Sciences North for the acute care to episodic needs expect and deserve timely access to care.”

Both Health Sciences North and the North East LHIN said they're in the process of coming up with a plan to implement these recommendations.

“One thing will be for sure, the report will not be sitting on a shelf,” Paquette said.
 

One thing will be for sure, the report will not be sitting on a shelf.

Louise Paquette
North East LHIN chair

Martin said he doesn't expect that all 55 recommendations will work in Sudbury, but said his report has been well received.

“I hope that they can gain and benefit from it,” he told Northern Life.
One section of the report examines the fact that a high number of patients are admitted from the emergency department.

“If we look at peer hospitals, it appears to be on the high side,” Martin said. “Eighteen per cent of visits to the emergency are admitted. There are some other peer hospitals that admit that high, but that is quite high.”

Boyles said perhaps when it comes to emergency situations, Health Sciences North is “more compassionate, more caring, more concerned to the extent that when in doubt, we admit the patient.”

In Sudbury, though, higher smoking and cancer rates lead to a sicker population, so maybe these admissions are warranted, he said.

The report also identifies a number of areas that could help reduce the ALC numbers, including looking at the number of ALC patients it designates each week as being destined for long-term care.

Many of the ALC patients occupying hospital beds are waiting for a long-term care home bed.

Martin recommends senior hospital managers oversee the designation of ALC patients as being destined for long-term care, and a weekly target for such designations be established.

The report also talks about the fact that the Home First program, which would see ALC patients sent home while they wait to be placed in long-term care, is being underutilized in this region because of concerns that patients won't be properly cared for.

Martins recommends that the Home First program be re-launched.

“What we strongly suggested is they work very closely with the CCAC to work very hard on trying to find alternative community supports as opposed to long-term care necessarily,” he said.

“I think it's something like 65 per cent of their designated patients were to go to long-term care. Eventually you fill up all of the nursing home beds and then the flow stops.”

Martins said in the report he'd like to see ALC numbers decreased to 10 per cent at the four largest hospitals in the northeast by 2015.

“I personally would like to say that's a great target,” Boyles said. “That's a very ambitious target. Whether we can make it or not I don't know, but I certainly believe that's where we should be.”
 

Eighteen per cent of visits to the emergency are admitted. There are some other peer hospitals that admit that high, but that is quite high.

Murray Martin,
peer reviewed HSN's operations for the North East Local Health Integration Network

With regards to the hospital's budget, Martins has several suggestions for the hospital, including a monthly review of the institution's finances to ensure it's sticking to the financial plan and a more disciplined monitoring process.

The report points out HSN is performing more surgeries than for what it has budgeted, which naturally costs the facility more money. Staying with spending, it also suggests a need to review how much the hospital is paying for food services.

HSN had been given until Sept. 30 to submit a balanced budget projection for the 2012-2013 fiscal year. However, Boyles said the hospital is still a little less than $1 million away from meeting this goal.

“We've got to find ways of doing things better than we did before, in a more efficient and cost-effective manner,” he said. “Every hospital in Ontario is faced with exactly the same issue.”

Martins also has several thoughts on how the former Memorial Hospital site, now known as the Sudbury Outpatient Centre, should be used.

He said the facility is needed for ambulatory clinics, as it would be more expensive to rent space in the community.

However, a business case for new clinics should be developed, and existing ones should be subjected to a review to “ensure the hospital is only undertaking activity that appropriately belongs in the hospital,” Martins said in the report.

The report also recommends the 30 ALC beds at the Sudbury Outpatient Centre be kept open until Sept. 30, 2013, six months longer than its March 31 closing date, and that the North East LHIN consider funding these beds.

“That really is to allow some transition time,” Martins said. “You don't put in place different processes and new processes overnight.”

But Boyles said this recommendation puts the hospital “between a rock and a hard place.”

“It would be nice to say 'Yes, let's keep it open,'” he said.

“But that's countered by the other side of these recommendations, that you have to balance your budget. We cannot balance our budget with an extra cost of $3- or $4 million. That would have to come out of some other area.”

To read the full report, visit the North East LHIN's website at nelhin.on.ca.