How hospital overcrowding is a problem beyond the hospital
For many, the hospital acts as a crucial entry point into the Canadian health care system. From access to emergency health care to the management of chronic conditions, hospitals are an important niche in health care delivery and they must rely on a myriad of resources and hospital staff to meet the health care needs of the populations they serve. But what happens when there just aren’t enough resources? Specifically, what happens when the number of persons waiting to be admitted exceeds the number of beds a hospital has? And, most importantly, how and why does this happen?
“Code Burgundy”, a signal used by hospital staff to indicate when a hospital is at overcapacity, has been used several times over the past few years by hospitals all across Ontario. So much so that hospitals like Sault Area Hospital have eliminated its use completely. Ron Gagnon, the hospital’s chief executive, states that “People had just become immune to” Code Burgundy, which used to be “used there everyday”. Other Canadian hospitals that have been negatively affected by the code include hospitals within the Greater Toronto Area, Hamilton, Ottawa, London, Kingston, Windsor, Sudbury and Cornwall.
Typically, overwhelming surges in patient numbers are expected around certain times of the year, such as flu season, which lasts throughout the early fall and into the month of January. However, when patient overcrowding persists for a longer duration of time than that which was expected, the quality of care is impacted. Patients must be accommodated in unconventional spaces such as hallways, offices and storage rooms. Surpassing the recommended average capacity of 85% also yields longer wait times, an increased risk of disease transmission and a reduced surge capacity, in addition to reduced quality of care.
For Hamilton General Hospital, this translated into the cancellation of 26 surgeries between February and March last year. For Mount Sinai Hospital, this meant that a woman with visible symptoms of Crohn’s Disease was forced to wait 18 hours before receiving a bed and necessary care. And for the Great War Memorial Hospital, it meant that Dr. Alan Drummond, an ER physician, had to “… sometimes examine them [the patients] in the hallway or the triage area because there was no other space”.
Additionally, the overcrowding of hospitals leads to increased off-load times for ambulances. This increases the chances of a code zero, a state in which there are no ambulances available to respond to incoming 911 calls. In such situations, paramedics from neighboring cities must respond. Mario Posteraro, the president of the Ontario Public Service Employees Union representing Hamilton paramedics, expressed the urgency of the situation when he stated that ” …patients will literally die.”
So, why is hospital overcrowding occurring? Does it point to discrepancies in the way hospitals are run? Or is the blame to be placed on hospital staff ? Well, it happens to be neither of these reasons. Contrary to the obvious, experts agree that the problem lies within the health care system as a whole, and is not solely confined to hospitals.
Specifically, the shortages and shortcomings associated with long term care homes and home-care support result in senior patients occupying the majority of acute care beds in any given hospital. Referred to as alternate level of care (ALC) patients, such individuals have received necessary hospital treatment; yet require ongoing assistance with daily tasks. This is increasingly evident in individuals who are afflicted with physical and cognitive impairments due to various chronic conditions. For instance, up to 190 out of 950 beds at the London Health Sciences Centre are occupied by ALC patients. As journalist Randall Denley expresses “…Our hospitals can’t do the work they are supposed to do because they are busy doing the job of the home care and long-term care sectors.” Consequently, the solution lies in strengthening the health services offered outside of the hospital setting.
Patients First is one such provincial initiative that aims to alleviate the stressors among primary care and community care services. The creation of additional forms of congregate living arrangements with personal support workers would also effectively cater to the needs of the growing senior population.
Furthermore, overcrowding is evident within hospitals’ mental health care beds. This may be due to the nature of Canada’s mental health care system, which places a greater emphasis on crisis management, rather than the prevention and maintenance of mental health concerns. Health care leaders agree that “patients wouldn’t need to rely on hospitals as much if they were kept healthy in the first place.” As such, increased awareness, understanding, and de-stigmatization of community mental health services and resources would allow individuals to seek support in a timely manner, before their concerns escalate and require hospital admittance.
It’s clear that disparities in other parts of the health care system may directly manifest as subpar functioning at the hospital level. Combatting hospital overcrowding thus requires a collaborative effort from all key players of the health care system, including those who require it the most: patients.