Emergency medicine healthcare delivery

The Hamilton Spectator article on emergency services in the area.

The issues highlighted are common healthcare delivery issues in North America and the UK (I can't comment on elsewhere because I don't know).



ER worst at Jo Brant
Just not enough beds,
Joseph Brant Memorial Hospital is battling the worst emergency room waits in Ontario, two years into a public monitoring program.

Ninety per cent of the sickest patients spent up to 25.2 hours in the Burlington hospital's emergency room in April before being discharged or admitted.

That's the longest total ER wait time for seriously ill patients at any Ontario hospital measured that month. It's virtually identical to the 26-hour statistic Jo Brant reported in 2009, the first year Ontario made wait times public online at the Ministry of Health website.

Emergency room wait times remain a problem for Jo Brant, said Mary MacLeod, vice-president of patient care services. But she said the problem isn't the ER — it's the lack of beds for patients admitted to hospital.

MacLeod pointed out Jo Brant's reported wait time for less serious ER patients, who are often usually treated and discharged, is 4.9 hours.

That's not far off Ontario's target of four hours.

By contrast, the hospital sometimes triples the province's eight-hour wait time target for seriously ill patients.

Like most hospitals, Joe Brant has many acute care beds “clogged” with older patients who no longer need hospital care but must wait for beds to open up in a long-term care facility or nursing home.

About 52 of the hospital's 248 acute care beds, or 21 per cent, are filled with patients in limbo.

MacLeod said the high percentage is due partly to an increasingly elderly population in Burlington. About 15 per cent of city residents are 65 and older, according to census data, but MacLeod said she's noticed a “significant” bump in patients over the age of 80.

The Local Health Integration Network is working with hospitals and associated agencies to help keep more complex-care patients in their homes, rather than in hospital, said Donna Cripps, the executive director for the Hamilton-area LHIN.

For example, the LHIN found one-time funding last year for the Community Care Access Centre to provide more hours of “home care.”

MacLeod said Jo Brant simply needs more beds.

The hospital has pitched a $300-million redevelopment plan to the province that would add at least 70 acute care beds.

“We're hoping for approval … The plan calls for us to add (beds) by 2013 or 2014, but we need them now.”

Burlington isn't alone in its struggle to cut wait times.

In Hamilton, no hospital serving adults came anywhere close to the eight-hour wait time target for seriously ill patients — or even the provincial average in April of 11.4 hours.

April was a “tricky month” for all Hamilton ERs after McMaster converted its emergency room to a children-only operation, said Ida Porteous, administrative director for emergency services at St. Joseph's Healthcare.

Porteous said she's “cautiously optimistic” the hospital's wait times will improve this summer, especially after the addition of several “short-stay” beds funded by the province in May.

Over time, average ER wait times in Ontario are creeping down, said Dr. Chris Simpson, a spokesperson for the Wait Times Alliance that represents more than 14 Canadian medical associations.

The alliance just released a report card on wait times nationally for major medical procedures such as hip replacements, knee replacements, cataract surgery, radiation oncology and cardiac services.

“We have to give credit where it's due: Ontario scored straight As for those indicators,” Simpson said.

Bed shortages are a national problem, so nobody gets good grades for ER wait times.

“But most provinces aren't even making wait times public,” Simpson said. “I give kudos (to Ontario) for being brave enough to report it.”