About 25 per cent of beds at Orillia Soldiers’ Memorial Hospital (OSMH) are currently taken up by people who could be treated elsewhere, but wait lists are long across the board, says the hospital's president.
A recent CBC News analysis shed light on hospital overcrowding province-wide, which has become so common in Ontario hospitals that patient beds are now routinely placed in hallways and conference rooms day after day, and not just during surge events such as flu season.
The impact of hospital overcrowding is also being felt locally.
“Hallway health care is absolutely our last resort,” said Carmine Stumpo, president and chief executive officer at OSMH, adding that while hallway health care isn’t a daily occurrence at the hospital, it does occasionally occur and is a concern.
He said the hospital has opened a 12-bed Way Home unit to help ease congestion, where patients stay while waiting to get into long-term care elsewhere.
“Sometimes, we have to do what it takes to make sure patients are being served,” he said.
Stumpo said that generally OSMH is seeing higher volumes and the hospital hovers at about 100 per cent occupancy, but an issue he said is more concerning is a higher complexity of care for patients coming through the doors.
“Part of it is a result of our success. People are living longer. That’s a good thing. We’re seeing patients who may have, in the past, needed more hospitalizations, are living more in the community. But it also means patients are increasingly coming in with multiple concerns,” he said.
Stumpo said that in addition to conditions such as heart disease or diabetes, patients will also now come in with more mental health concerns, as well as more complicated social concerns that contribute to health, such as housing stability or food security.
“When you combine all of that, it makes health much more difficult to achieve,” he said.
“About 25 per cent of our beds are taken by people who could be treated elsewhere, however we don’t have enough of the resources available in that ‘elsewhere,’” Stumpo said, adding that elsewhere could mean long-term care, transitional or complex care.
He said wait lists for those facilities can vary from weeks to years in some cases.
“It’s sad to see when you know there’s an alternative out there, but it’s just not available,” he said. “We need to work together as teams, because there are solutions out there but they’re not typical.”
Stumpo also has concerns for OSMH staff in light of overcrowding.
“Prolonged periods of surge is a real concern of mine,” said Stumpo. “In the long-term we are concerned about burnout and sick time, because it’s not the ideal position.”
“When you’re running on the edge, it’s very difficult to maintain that pace for prolonged periods of time,” he added.
OSMH is part of the Couchiching Family Health Team, which was approved by the province in December as one of the first of 24 new health teams across Ontario.
“Our target focus for our first year is frail seniors, so it’s a perfect opportunity to reduce hallway health care,” he said. “We’re just getting off the ground but we’re very excited about working with each other. It will take time.”
Janice Skot, president and chief executive officer of Royal Victoria Regional Health Centre (RVH) has also seen extensive overcrowding in Barrie.
She said RVH has been in a surge situation for their adult beds everyday for the past two years. Most days, she said the hospital is at 110 per cent capacity, but there have been days where it has reached 135 per cent.
“Everyday we’re experiencing crippling capacity challenges, and that puts in jeopardy our ability to provide safe, kindly care,” she said. “Unfortunately, it’s become our new normal.”
Skot said currently, RVH always has patients in beds in the hallways, and always has an extensive wait in the emergency department.
“It’s very hard on our patients and their families and on our staff and physicians,” she said. “They’re spending their time in unbudgeted, unconventional spaces such as hallways, temporary surge units without windows or washrooms and makeshift care areas.”
Skot said there were about 3,000 patients admitted to RVH in 2019 who never got into a proper bed and were admitted, treated and discharged from hallway beds.
“To operate a hospital safely, we should be at about 90 per cent occupancy,” said Skot. This way, they would have capacity should there be an emergency situation that would see an unexpected influx of patients. It becomes a situation where, it’s not easy to admit nor to discharge patients. We have more patients to care for than we actually have places for them.”
On Thursday, Skot said RVH had 94 alternate care patients.
“That’s about one in three patients that have actually been discharged from the hospital but can’t move on safely because they’re looking for things in the community,” she said.
Skot said about a quarter of those 94 patients are waiting for a long-term care bed. While she said the provincial government has approved additional beds, it is taking time to build those beds. Another quarter of those patients are waiting for home and community care support. Some are also waiting for retirement care beds.
“To organize that and finding the resources keeps people here,” said Skot.
Hospital gridlock occurs when in-patient beds are full, but patients continue to come in and present through emergency. If they need to be admitted, they have to wait in the emergency department on a stretcher until a bed becomes available.
“These are not the conditions in which we would want to provide care. We wouldn’t want it for our own loved ones, and we don’t want it for our patients,” she said. “Stretchers are uncomfortable, they’re not as comfortable as our in-patient beds. As people become more crowded in small areas, the chance of infection is higher.”
Skot said foresight is needed to see the changing demographics that will be coming through the health care system to they can be better prepared for challenges.
“With the demographic changes, we have a higher percentage of elderly people in our community and moving in to our community. We all know we use hospital services more as we grow older. This is going to have a significant impact,” she said. “Added to the impact of Barrie and South Simcoe growing, which means we not only need to plan for today’s patients, but also anticipating the population that will come and need health care.”
“It seems like a bit of a perfect storm,” she added.
Skot said work is underway locally to try to ease the burden on local health care to free up beds.
“It’s a complex situation where there are many groups and partners who need to work together, but when there are no beds available, this has a domino effect right across the hospital,” she said.