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Thirty HSN patients in unconventional beds as hospital battles capacity issues

Health Sciences North's ALC numbers well above average for summer months

We're a long way from flu season, but overcrowding at the hospital is an issue staff have been battling with high occupancy rates all summer, a Health Sciences North vice-president told today.

As of July 30, Health Sciences North was operating at 107-per-cent capacity, with 97 patients designated as ALC (alternate level care), a sharp spike from the same time last year.

"We have seen higher than normal numbers for the summer months of May, June and July when it comes to ALC," said Mark Hartman, HSN's VP of patient experience and digital transformation. "Last year at this time, we were mostly in the mid-60s, this year we're seeing numbers in the 80s, 90s and almost up to 100."

There is no one silver bullet solution when it comes to hospital overcrowding, he said, and the now common term "hallway medicine" that refers to patients who are staying in unconventional hospital areas such as washrooms and lounges.

One HSN patient shared her story on Facebook on July 30, describing the experience as degrading, as she was admitted for a severe kidney infection and has been staying in a makeshift room that is actually a TV lounge.

"For me to use the restroom I have to unplug then drag my IV with me down the hall take a right and hope to god I can hold it in till I reach a room that isn't under some type of isolation," said Sammie Kelly in her Facebook post.

"Not only am I in this situation; I also have a very sweet lady beside me who's much more mobile than I am and she is still finding it difficult. Their solution? Commodes side by side in our TV lounge. I've never felt more low or degraded than the feeling of not able to hold my urine and the fear of peeing my hospital gown on the mile journey to the nearest restroom."

While there is no single solution to overcrowding, Hartman says that high ALC numbers do have a direct correlation to occupancy issues and that dealing with those numbers requires system-wide solutions.

"About half of the ALC patients are waiting for access to a long-term care bed, the other half includes a variety of reasons like waiting for additional rehab in facilities like St. Joe's, York Extendicare, or in some cases patients are requiring palliative care in locations like the hospice," said Hartman.

"It seems to be, as is typically the case, about half of the ALC is associated with long-term care access, and the other half is a variety of reasons."

With many long-term care, rehab and palliative care facilities also operating at capacity, a backlog is created at the hospital as these patients who don't require acute care are left in wait with nowhere to go.

Health Sciences North staff have been working to keep the ship on course, in spite of obvious overcrowding issues. There have not been any capacity-related surgical cancellations at the hospital since May, and Hartman says the biggest impact is being felt on the frontlines.

"Surgical access hasn't been impacted, the biggest impact really is in the Emergency Department. We're seeing patients getting admitted and having to wait there or being put in unconventional spaces and neither of those locations is where we want to be providing care," said Hartman. 

"We know it's not ideal and we certainly empathize with those patients but unfortunately they have to be cared for in those locations. Our staff do a tremendous job of accommodating the patients as best they can, but there's no doubt it creates additional stress on the staff who want to provide the best care that they can, and it's stressful for them to provide care in spaces that weren't designed for that purpose."

Health Sciences North has submitted a proposal to the Ministry of Health, requesting an additional 37 bed spaces for the hospital. Hartman says that proposal is currently in the review process, but is at best a short-term solution.

"Really the total capacity within our system is what's most important. We know HSN was built too small to meet the needs of the population that we serve from right across the region," said Hartman. 

"That's why we have asked for this additional renovation, it's also why the first goal in our strategic plan was to develop a longer term capital master plan that would address some of these capacity issues, but in both of those cases they are longer term strategies to address the problem."

In spite of the high number of ALC patients and patients in unconventional bed spaces, HSN has managed to keep a handle on their wait times when it comes to admitting patients from the Emergency Department. 

Health Sciences North is still better than the provincial average when it comes to wait times, from the time a patient arrives in the ED to the time they're admitted.

"That aspect of the time period we do very well. It tends to increase when the Emergency Department is full and we can't flow patients through, but on average we do very well," said Hartman.

"Where we don't do as well is after a patient has seen a physician and they get admitted. That time from admission to access to an inpatient bed is longer than the provincial average. What we typically see when ALC goes up and our number of patients waiting in the Emergency Department goes up, we see those times go up."

Hartman says that HSN's ability to admit patients quicker than the provincial average, but inability to hit that target when it comes to getting patients into bed spaces is indicative of the larger issue within the system as a whole.

"It just reinforces that the problem is not with how efficient our Emergency Department is, when they have the space and capacity they're very efficient; the problem is being able to move patients to inpatient beds."

Health Sciences North is working closely with their partner organizations such as St. Joseph's Continuing Care and Extendicare in looking at possible solutions to have patients getting the correct level of care at the right time.

"It's a system approach that we need to take. I would say that we see the provincial government making this a priority ... their intent to open up more LTC beds, to break down silos in the system to improve co-ordination of care, recognizing that the overcrowding is a system problem, that's the first step in trying to address the issue," said Hartman.

"We certainly feel that our strategic plan is aligned with the direction of the government."