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Over capacity forecast to cost hospital $7M in 2016-17

Need to partner with the community 'has never been greater,' V-P says
Health Sciences North continues to battle with capacity issues, as the hospital operated at a critical level for as much as 75 per cent of last year. If that trend continues into 2017, it could cost the hospital as much as $7 million. File photo.

Health Sciences North continues to battle with capacity issues, as the hospital operated at a critical level for as much as 75 per cent of last year.

Most days, HSN is sitting at 110 per cent occupancy, or in the red level of the hospital's surge plan that is divided into four categories, with red identified as "Escalation Level 2," just one level before the fourth and final, black category, "Escalation Level 3 - crisis."

In the 2015-16 fiscal year, overcapacity cost HSN $3.5 million and that number is projected to double for 2016-17, up to $7 million. A report presented to the HSN board on March 14 by David McNeil, the vice-president of patient services, indicated the hospital is forecasting 5,000 patient days over capacity, with the average cost per patient per day pegged at $1,400.

"We're in the black (Escalation Level 3) almost 50 per cent of the time," said David McNeil, vice president of patient services, HSN. "In that instance, we're shutting down to any patient that is non-life or limb (critical). Obviously, if there's a life and limb patient we help them." 

Despite overcrowding, McNeil said the hospital has improved wait times in its emergency department, even with the volume of ED visits gradually increasing from 57,000 in 2009-10 to 73,000 in 2015-16.

Health Sciences North also moved up the ladder for wait times from 74th in the province to 38th. McNeill said the hospital is running efficiently in terms of cost to the hospital per patient stay.

"We're below the cost for the Northeast LHIN and the province as a whole in terms of cost of a standard hospital stay," said McNeil. "It's costing $5,345 at HSN compared to $5,473 for the Northeast LHIN and $5,407 for the province."

Where the issues arise for HSN is the length of stay, in that patients categorized as ALC (alternative level of care), who are generally older patients that don't necessarily need to be in a hospital, but can't access services in the community (such as homecare or long-term care).

Oftentimes, these patients are staying in lounges and hallways in the hospital, with as many as 60 patients at a time being put into the makeshift quarters.

Last month, the Ontario Council of Hospital Unions (OCHU) said overcrowding in Ontario hospitals, including Health Sciences North, should not be treated as "the new normal", but as a symptom of the province underfunding hospitals.

The OCHU said the province should fully fund 40 new, permanent beds at HSN to deal with constant overcrowding, bringing the number of beds at HSN from 458 to 498.

But, McNeil said, more beds won't really solve the problem.

"This isn't a matter of having an inefficient hospital, it's a matter of being overcapacity," said McNeil. "We can't solve this alone and more beds aren't the solution, it's a matter of getting patients in the right place at the right time."

Doctors are becoming increasingly frustrated with overcrowding at the hospital, and nursing staff are being stretched to their limits.

"This hospital is not a flophouse for people to just come and drop off their loved ones," said Dr. Killian de Blacam, vice-president of medical staff. "Having patients in ALC beds who do not need medical care is a criminal waste of taxpayers' money."

Not only is it a hit to the taxpayer, but also poses risks to patients as there is an ever-increasing risk that surgeries could be cancelled, a concern that was raised by HSN board chair Nicole Everest.

"Luckily that hasn't happened yet," said McNeil. "We need 127 beds for surgery weekly, and the window for high-priority surgeries is only one to two weeks."

HSN board member Karen Rowe asked what other avenues were being pursued by HSN to get patients out of the hospital and into other care facilities.

"Are we reaching out to community organizations? I know there's much more to it because the model is just so complex," said Rowe.

HSN is piloting a project with Finlandia Village that would open up eight new beds funded by the LHIN for ALC patients, including those with complex behaviour issues. The hospital is also working with the city to try to attain six more beds through excess housing that the city may have at their disposal.

"The LHIN is engaged but the solutions are not coming as fast as we need them to. It took 18 months to get these eight beds with Finlandia, eight beds in 18 months doesn't increase capacity, it's too slow," said McNeil.

"Our need to partner with the community has never been greater, we need to be discharging patients faster and getting them into long term care homes."

Matt Durnan

About the Author: Matt Durnan

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