Hallway medicine: Do we really need more hospital beds?

TheGlobeandMail.com – Opinion
November 7, 2017.   

The Ontario government announced recently that it will spend $100-million to add almost 2,000 temporary beds to deal with Ontario’s so-called overcrowding crisis.

Between now and March 31, the money will be spent opening a couple of shuttered hospitals, and sprinkling money around the province to open hospital beds (1,200 in total), as well as 500 “transitional care” beds and 200 supportive housing units.

On the surface, this seems sensible: If you have patients waiting for beds, then add more beds and, poof, the problem disappears.

After all, Canada has among the lowest ratio of hospital beds in the developed world, about 2.6 per 1,000 population. In Japan, the rate is 13.1 per 1,000 population, and in Germany, it’s 8.1.

Why don’t we just build more hospitals, triple or quintuple the number of beds we have now? After all, they don’t have patients in hallways in Japan or Germany.

If only it were that simple.

Hallway medicine has been the shameful norm in many institutions, in Ontario and elsewhere in Canada, for years, and it won’t be resolved by a panicked pre-election influx of cash.

The problem won’t disappear by simply adding more beds, temporary or permanent.

We won’t solve our chronic hospital overcrowding problem until we come to grips with the fact that it is a system-wide structural problem of which hospital misuse is only one element.

The ER overcrowding problem won’t be solved in the ER, nor will the hospital overcrowding problem be solved in the hospital. It’s about treating the right patients in the right place at the right time.

Instead of pointing to Japan and Germany, why don’t we turn our attention to Denmark and Sweden, countries that have even lower ratios of hospital beds than Canada, and also don’t practice hallway medicine?

There are currently 70,932 hospital beds in Canada (excluding Quebec) – and roughly half of those are for acute patients, the ones who end up on gurneys in hallways, and tucked away in converted coffee shops and auditoriums.

Before we invest in more hospital beds, shouldn’t we figure out if the beds we have now are being used appropriately and cost-effectively?

The answer to that question is decidedly “No.”

In Ontario alone, there are almost 4,000 “alternate level of care” (ALC) patients (7,500 Canada-wide), an Orwellian euphemism used to describe people who have been discharged but continue to live in hospitals because they have nowhere else to go, for lack of long-term-care beds and home-care spots.

Surely before we start reopening dilapidated old hospitals, we should start by getting ALC patients into more appropriate care.

More fundamentally, we need to ask ourselves if the people admitted to hospital need to be. Again, in many cases, the answer to that question is “No.”

Hospitalization should be a last resort, reserved for people who need surgery or are unstable and need acute 24/7 nursing care.

Yet, hospitals are filled mainly with people with chronic illnesses who are medically stable but suffering exacerbations or need “tune-ups,” fairly routine tests and procedures.

These patients end up in hospital by default because we don’t have anywhere else to do their scans, blood work, treatment initiations and so on in a semi-organized manner.

At Women’s College Hospital in Toronto, they have addressed this problem by creating an acute ambulatory care unit, where patients are referred directly by a provider, avoiding the dreaded ER visit. Instead, they make an appointment and are in and out of hospital within 24 hours.

This is just one example of smarter health-care delivery. Another is, after a patient is hospitalized, to ensure they get a couple of visits from a home-care nurse, an approach that dramatically reduces readmission.

The only sensible way to take pressure off hospitals, to alleviate hallway medicine, is to bolster services in the community.

We’ve known this for decades but we have failed to act decisively. How is that even possible?

When something is not working in Canadian health care, we tend to do more of the same, instead of doing things differently.

It is shocking that, politically and otherwise, it is easier for our health-care leaders to perpetuate the status quo than embrace innovation.

Until we stop tolerating that mindset, until we become more demanding as consumers, our system will continue to struggle and care will continue to deteriorate.

https://beta.theglobeandmail.com/opinion/hallway-medicine-do-we-really-need-more-hospital-beds/article36848856/

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