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Sudbury's main health care providers have come up with a number of strategies to tackle growing wait times in the city's Emergency Department. But it will be a few weeks before they can gauge how much of a difference they will make to people waiting for help in the ER.
The plan is a result of two days of meetings between Health Sciences North, the Community Care Access Centre and the North East Local Health Integration Network. At a meeting May 7, each group promised to return with three short-term strategies each. They met again May 9 and agreed to move forward with eight strategies that could be implemented relatively quickly.
Those strategies range from streamlining the flow of patients out of the ER, to providing more help for families carrying for terminally ill loved ones at home. The goal is to reduce the number of patients in hospital beds who don't need to be there, but are unable to find care anywhere else.
Alternative level of care patients, as they're known, routinely take up about 100 acute care beds at the hospital. Officials say once the ALC patient load exceeds 28, it causes major problems for staff in the Emergency Department. In turn, that leads to the lengthy wait times ER doctors fear will discourage people who need it from seeking care.
Terry Tilleczek, senior director at the NE LHIN, said the groups are at the beginning of the process, but are determined to make a difference quickly.
"It's not a home run, yet, to use a baseball analogy," Tilleczek said. "But we're working our way around the bases."
For example, help for people caring for terminally ill loved ones will be increased right away, so those people can die at home, which is where most people want to be, rather than in an acute care bed in hospital.
Community support for people who need other sorts of nursing care can be expanded, potentially helping to reduce the number of ALC patients in hospital.
To do that, the city has been broken down into coverage zones, where the organizations that provide home care — such as the Red Cross, the March of Dimes and the Victorian Order of Nurses — will be able to offer round-the-clock support.
"We can do mobile assisted living, 24-7, offering scheduled and unscheduled home visits to individuals who meet the criteria," Tilleczek said.
So when an ALC patient is discharged from hospital, they will be provided access to these home services so they don't end up back in hospital. It's taking time to put the parameters in place so the system will be effective and safe, but Tilleczek says they're making major progress.
Other approaches include new funding focused on helping patients with behavioural issues. Pioneer Manor, for example, has hired new staff whose job it is to work with caregivers on how to handle such clients and keep them out of the hospital system.
"That's another example of pieces of the puzzle that are right there at the cusp of having an impact," he said. "We have a lot more work to do, but we're getting there. We know the people of Sudbury need to go to their Emergency Department and have a reasonable wait."
Dr. Chris Bourdon, chief of staff at Health Sciences North, says the hospital is looking at ways of moving patients out of the ER faster. One idea would have ER patients who are admitted to hospital but don't yet have a bed moved to different floors of the hospital. While they still would end up in a waiting room or hallway, they wouldn't be in the ER.
"It's safer to move these patients out of the Emergency Department and onto these floors, even in the absence of a bed," Bourdon said. "The care they receive on these floors is better, it's more focused" than the care they would have received if they remain in the ER.
So while the process creates overcrowding in other areas of the hospital, it eases pressure where the overcrowding is most critical: the ER. And because the patients are being moved to the floor where they're going to end up anyway, their care is improved.
"We've converted a lot of non-patient areas already, so they're equipped with oxygen and suction to make it more like a patient room and the safeties associated with a patient room," he said. "So they go to a hallway chair, or a hallway stretcher and wait for a bed."
The plan doesn't create more beds, but it offers a way to ease the crunch in the ER, which is the short-term priority. There are seven different departments in the hospital where they're going to look at creating new overflow areas.
"The goal we have for this is to ensure the Emergency Department doesn't have any more than eight admitted patients at any given point."
In previous studies, they found that as long as no more than eight admitted patients waiting for a bed in the ER, the system works far more smoothly.
"When we get that number to eight, we become a very good wait time emergency department."
Another strategy the hospital is going to try is extending lab services later at night and over weekends so patients waiting for scans before they can be discharged can make their way through the system faster.
"We're going to go ahead and try it," Bourdon said. "We're going to get the data on whether or not the total hours saved and extra capacity created is worth the extra dollars."
Richard Joly, chief executive officer of the CCAC, said solving the ALC crisis is a long-term project, but there are a number of short-term steps than can ease the pressure on the hospital.
"There are seniors in the ALC beds who require rehab; there are seniors who require more home care; and seniors who require end-of-life care," Joly said.
Expanding those services to seniors helps keep them in their homes and is key to solving the ALC crisis at the hospital. Joly hopes to make progress on these fronts quickly.
"When we drafted these solutions, we were thinking weeks and months, not months and years."
He spent four hours last week in the ER to get a sense of what challenges staff face and what, if anything, could be done quickly to make a difference.
"And it immediately became clear that we need to implement a program after hours. It can't just be 9-5, Monday to Friday."
The focus is on creating capacity until November, when the Sudbury Finnish Rest Home Society will open an 82-unit long-term care facility at Finlandia Village. It should have a dramatic impact on the number of ALC patients waiting for a bed in a long-term care home. Easing the crisis until then is the current priority. How much of a difference all these strategies will make will be seen over the next little while, Joly said.
"You will see real results in the weeks to come."
See a full list of the strategies at www.nelhin.on.ca.
Posted by Darren MacDonald
