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Letter to the Editor: Patients await placement, clog hospitals, get sicker

September 27, 2009

Lately, I’ve been drafting a few Letters to the Editor instead of just complaining to colleagues about the giant holes we see in our health care system. When you work every day in the hospital or in a community clinic, you begin to see the cracks widening and the holes deepending, as you begin to personally face them. Whether as an advocate for a patient, or as a health care provider simply trying to make some sense of the bureaucracy, one seeks out creative solutions to the problems that weigh on us. What do you think about my letter below? Other ideas?

Patients who are well enough to leave hospital, but not well enough to care for themselves at home, wait months for a spot in Assisted Living. This is not good for anyone.

Hospital wards throughout the province are clogged. Yes, there are nursing shortages and doctor shortages, but a big portion of the problem lies with ‘placement.’ Dozens of elderly, often demented – though medically stable – individuals bide their time on the hospital wards. This bustling, high-intervention environment is not conducive to good health or happiness in the long run. Eventually patients will contract a new illness, simply because they weren’t discharged early enough. Prolonged hospital stays mean an increased risk in complications (like the dreaded C. Difficile, deep-vein thromboses, and all kinds of hospital-acquired “nosocomial” pneumonias). Likewise, due to the lack of familiarity of the environment, an ever-changing layout, and lacking the familiar comforts of a constant routine and caregiver, elderly patients are more susceptible to confusion and falls. These can have dire sequelae.

There can also be a negative impact on other patients. For example, when working in the ICU, once we have stabilized a critically ill patient, we attempt to transfer them to the medical ward. This will make space for us to receive a new critical patient. Often, our requests are delayed – by a number of days – because there are no free beds. The inappropriate presence of a mostly healthy patient, who does not require 1:1 nursing, mechanical ventilation, and cardiovascular support, is preventing us from using those facilities to provide care to a sick patient who really needs it.

Many solutions have been proposed. Opening more Assisted Living facilities is one option. However, there are already empty assisted living beds in the province, with nurses and care aids at the ready. These beds are designated “private” beds, meaning patients must fund them out of their own pocket. With many elderly being also marginalized, they are unable to afford a private bed and must go into the queue for a publicly funded one. In the meantime, their presence in the hospital costs the government. It costs more to keep someone in hospital than it would for our government to ‘rent’ the private long-term facilities’ private-pay beds.

If Minister Campbell would consider what is best for patient care, and what is most cost-effective at the same time, he would consider this.

Instead, our government has decided to neglect our elders, leaving them in unsafe environments, designed for medical but not comprehensive (social, spiritual, physical, etc.) care. This clogs up the hospital wards, which backs up into the Emergency room, prolonging wait times for admission and compromising the overall quality of care we can deliver. We can do so much better.

It really could be a simple fix.

2 Comments leave one →
  1. simonpierre permalink
    September 27, 2009 3:06 pm

    Also, let’s not forget the “turfing” ;
    i.e The decision to call a patient “turfed” depends on the balance of the values of effectiveness of therapy, continuity of care, and power. For example, if the receiving physician cannot provide a more effective therapy than can the transferring physician, medical residents consider the transfer inappropriate, and call the patient a turf. With appropriate transfers, these residents see their service as honorable, but with turfs, residents talk about the irresponsibility of transferring physicians, burdens of service, abuse, and powerlessness. leads also to; “turfing”

    Tremendous time and energy are spent finding a way to get a patient out of a particular unit to another floor, when what really needs to patient is a long term care home with nursing supervision. Vancouver Island will be hit hard, when all the healthy retirees grow older and loose their autonomy.

    Simon-Pierre Landry

    • September 27, 2009 4:09 pm

      thanks SP

      What would really be incredible was if the ‘family unit’ reverted to a more traditional form, where younger people were very involved in the care of their elders; unfortunately, not all people and not all families suit this model, so it is up to Assisted Living to fill the void.

      I agree with you about the negative sentiments that surround ‘turfs.’ We talk all the time about inappropriate transfers, ‘bogus’ consults, and so on. It may sound negative, but in the end, I think most doctors are thinking of making sure the patient has the appropriate level of care. Beds must be allocated according to need – not simply according to duration of stay in hospital. The sick sick patient in the ER should not face delay in coming to the ICU or to a surgical bed, where they can get the care they need, simply because someone else (who is not sick) is physically occupying the space.

      It’s a poor arrangement for both of those patients, since we will be more prone to intervene if they are in an intense, monitored setting. Thinking more of House of God, “you can’t find a fever if you don’t take a temperature.” Of every 10 healthy people we test, 1 will have low potassium, and we will supplement it. It’s very hard in a medical-oriented institution to address the full care needs of an individual. What little autonomy these retirees have is taken away in hospital.

      Medical wellness does not a complete and fulfilled life make.

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