B.C. Nurses Union president Debra McPherson suggested last week that the Fraser Health Authority should wake up and smell the coffee.
She was a little late with that suggestion, since Royal Colombian Hospital emergency department doctors had already decided on Monday evening that the Tim Hortons outlet in the hospital would be a much better place to look after patients than some hallway with a total lack of privacy.
It was a Canadian first, but I would not be surprised if we will see some repeats of this innovative but eminently sensible way of dealing with a deluge of patients with no place to treat them.
The province has set a target that 80 per cent of all admissions to any B.C. emergency department be transference out of the emergency to beds in other wards of the hospital.
Not a single emergency department in the Lower Mainland has met that target.
And it is not for lack of trying. Despite the fact RCH is the referral hospital for major trauma and, therefore, deals with a larger influx of severely ill patients – many of them requiring resuscitation and lots of human and other resources – RCH is the second best with a 69 per cent success rate. Mission hospital is tops with 72 per cent of patients transferred within the 10-hour time limit.
Contrast that with Ridge Meadows Hospital, where only 37 per cent of admissions are transferred out within the 10-hour target.
There are a number of reasons for the discrepancy. First, we have a relatively new emergency department with plenty of beds. As I predicted when the new facility was being built, it would serve as a parking area for patients since there would often be no place to transfer them to in the hospital.
Building a large emergency department for RMH was a bit like buying shoes that are one or two sizes larger than needed for your 10 year old son or daughter, in anticipation that they will grow into them.
It’s nice to finally have a well designed, spacious facility, be it was much delayed and way over budget. The initial budget was $8 million and the community had to raise $3 million of that to build it.
And we did come through with flying colors to meet that challenge. But the authorities did not nearly as well.
By the time the place was officially open, several years behind schedule, the bill was well in excess of $20 million.
At the same time, it had been known for years that there simply was an inadequate number of regular hospital beds to accommodate the demand, therefore it was no surprise that the emergency department would start to serve as a holding area, resulting in the 37 per cent success rate instead of the desired 80 per cent of timely transfer.
A major contributing factor to the bed shortage has always been that a sizeable percentage of beds are occupied by people who should not be in an acute care ward, but have no other place to go to. Then there are always a number of people who are occupying a bed, waiting for a test or procedure to be done. Occupying a hospital bed for no other reason than waiting for your turn is not an efficient use of a scarce commodity.
But once again there is a line up for most of the more sophisticated diagnostic tests and access to operating rooms is also at a premium.
Occupying a hospital bed, waiting for a test is also a wonderful way of getting priority to get the test performed in contrast to those people who are waiting at home with exactly the same problem. You can call it a subtle form of two-tier medicine, since it does speed up things for those who were lucky enough to be admitted. But it is not necessarily the most efficient and cost effective way to manage the shortage of beds.
What is the solution? I will address some possible approaches in the coming weeks.
Dr. Marco Terwiel is a retired family physician who lives in Maple Ridge.
