Hospitals uneasy over ER targets

Posted on February 17, 2009 in Child & Family Debates, Governance Debates, Health Debates – Ontario/ – Hospitals uneasy over ER targets: Until programs set for elderly, cutting wait times will be a tough go, hospital association warns
February 17, 2009.   Theresa Boyle, HEALTH REPORTER

At the same time the province is rolling out new initiatives to address long waits in emergency departments, the president of the Ontario Hospital Association is warning that budget shortfalls could compromise the efforts.

To address the problem of overcrowded emergency rooms, the province is expected to announce later this week targets for total time spent in emergency departments. But Tom Closson said Ontario’s 157 hospitals will be hard pressed to meet those targets, given that 70 per cent of them are being forced to cut positions to balance the books.

“The immediate budgetary pressures are going to make it challenging to achieve the wait times targets,” he said.

Meantime, the Ontario Nurses’ Association has started an advertising campaign, warning that the cuts will lead to “thousands” of lost nursing hours.

Hospitals are in the midst of preparing their budgets for the 2009-10 fiscal year, which begins April 1. They have been told by the province to expect an increase in operating funds of 2.1 per cent. Last year, they received a 2.4 per cent increase. But the OHA says hospitals need a 3.5 per cent funding boost just to continue to provide the same level of care that they provide now.

In addition to cutting positions, hospitals are faced with cutting beds and services such as outpatient physiotherapy, lab work and outpatient nutrition programs, Closson noted. As well, they could lower the overall volume of their work.

The cuts will also affect waits for hip and knee replacements and cataract and cancer surgery, he said.

The province last week announced a new initiative aimed at easing the pressure on hospital emergency rooms by linking patients with family doctors and clinics close to home.

This week, the province is expected to announce targets for ER waits. Wait times in individual hospital ERs will also be made public on a website. In addition, there are also expected to be new initiatives unveiled that will move frail, elderly patients out of hospitals and into community care, freeing up beds for patients waiting in ERs.

Every year, hospitals struggle to balance their books.

But Closson said the number of people in hospital beds who don’t really need to be there has grown. On any given day there are more than 3,000 frail, elderly patients in Ontario hospitals waiting to be transferred to other facilities or back to their own homes with help from visiting healthcare workers. They are known as ALC or alternative level of care patients. They take up about 19 per cent of all acute care hospital beds, up from 10 per cent in 2006-07, according to the OHA.

He said hospitals are looking to find more efficiencies by changing the mix of staff in various units.

Still, at the end of the day, there will be fewer people employed in hospitals, he said.

He noted attempts are being made to minimize involuntary layoffs by cutting positions through attrition and offering buyouts.

A final tally on positions cut won’t be available until April, he said.

But Linda-Haslam Stroud, president of the Ontario Nurses’ Association, said her organization has already received notices of hundreds of cuts to RN positions. Each nursing job translates into 1,950 hours of patient care a year, she noted, adding patients are known to suffer an increased risk of developing complications and even dying when workloads for RNs increase.

Health Minister David Caplan has said his government is committed to improving health care and while it’s not abandoning hospitals it’s pouring more money into community care.

To that end, he is expected to make more announcements on new initiatives to treat ALC patients in the community.

Still, Closson said that until the ALC patients are actually out of hospital and in community care, it will be a tough juggle.

Toronto Star

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