Purpose: Hospital over-crowding has become a chronic and systemic problem in Ontario. Though policy-makers have tried to address this in the past, the total health and economic burden still remains quite high. This note identifies few important causes of hospital overcrowding and discusses cost effective strategies to reduce its overall burden. Background: Hospital overcrowding is a situation where the volume of patients seeking care at any given time, exceeds the capacity of the hospital to provide timely and adequate care. Patients typically wait for long hours to see a doctor in emergency department (ED), waiting even longer in case their condition requires hospital admission. Such delays can lead to risky medical complications for patients …show more content…
It was deemed more cost effective and simpler for hospitals to adjust patients in the EDs on wheelchairs and stretchers instead of finding efficient long-term solutions. [1] Canada’s economical and philosophical shifts in welfare reforms, also led to the healthcare sector witnessing massive transformations, shifting away from acute care leading to fewer hospital beds. With a growing aging population, scarcer hospital beds and support staff, “patient corridors” and overcrowded EDs had emerged as one of the most significant barriers to timely access and quality of healthcare. All provincial governments, including Ontario invest heavily in the upkeep and maintenance of healthcare systems and therefore participate extensively to assess existing gaps in access and quality of healthcare as well as its economic sustainability to maintain a healthy population. Thus establishing strong linkages between hospitals, community based clinics and their combined participation in long and short-term care centers becomes pivotal to provide timely and high-quality healthcare services to Canadians. …show more content…
to evaluate and manage patients only for 2- to 3-hour period. However, when the flow of patients is interrupted either towards discharge or for patient admission to a hospital bed, the wait-time increases leading to clogging of the ED. [5] Global standards suggest 85% occupancy capacity for optimal functioning. However, in Ontario, most hospitals incessantly operate on more than 100% occupancy. This problem peaks particularly during flu season when some EDs run at 130% capacity, pressurizing already scarce staff and resources. This presents challenges in admitting new patients on a daily basis. Further, to manage overcrowding of hallways, hospitals are forced to use ‘unconventional spaces’ like patient lounges, staff classrooms, offices and even storage spaces as temporary patient accommodations. [6] Furthermore, it is estimated that 90% of the patients in EDs do not have high acuity conditions and thus can be discharged. Efficient patient management to prioritize need becomes critical to ensure quality of care, effective patient movement and prevent unnecessary congestion in the ED. Setting up a rapid assessment unit within the ED with triage nurses to assess the acuity of patient condition and classify them based on the level of need. Such units are already being tested in a few hospitals across the province and have shown to improve the patient flow and wait-times. Further nurses and ancillary medical staff
Monitoring staff levels is an important factor. Also leveling the flow of patients in and out institutions could help to reduce wide fluctuations in occupancy rates and prevent surges in patient visits that lead to overcrowding, poor handoffs, and delays in care. Studies show that overcrowding in areas such as the emergency rooms lead to adverse outcomes, because physicians and nurses having less time to focus on individual patients. One study found that for each additional patient with heart failure, pneumonia, or myocardial infarction assigned to a nurse, the odds of readmission increased between 6 percent and 9 percent (Hostetter and Klein, 2013). All of which costs the hospital money.
The challenges that all acute care hospitals and facilities faces are the demand for highly specialized services has increased. The US population is constantly aging and the elderly tend to need more acute care services. Because many people lack health insurance, they tend to use emergency rooms in the hospitals as their source of care. The increase demand in acute care prompted hospitals to expand their facility
The Saskatchewan heath care system is made up of several provincial, regional and local organizations, which provide the people their basic right to reasonable health care (“Health Systems,” 2014). Not having enough health care providers seem to be a problem, which Canada as a whole has struggled with (“College of Family,” 2014). The shortages of medical providers have lead to major discrepancies in the level of patient care between major urban centers and rural areas (Howlett, 2013). In the case of Saskatchewan many communities are facing this challenge, not only rural areas but also the capital city of the province (“Saskatchewan ER,” 2013). Stats Canada has showed that the number of physicians is at a historic high, yet Saskatchewan still face shortages (Howlett, 2013).
I found your post interesting, having worked in an emergency department during my paramedic years. In my career as a nurse working in a clinic on occasion we must send a patient to the emergency department. I always call to speak with the charge nurse to provide report prior to just sending the patient, often I am on hold for greater than 15 minutes. This often results in the patient arriving at the ER before I can give report. Adding to this the charge nurse on more than one occasion is calling me on another line to ask why the patient it there! However, from past experience I do know how busy the ER can be at any given time.
There are pros and cons. Some medical people believe that the EMTALA legislation creates some problems for hospitals. Knowing that hospitals must take care of every person, people may use the ED for routine doctor visit situations. These people believe this contributes to the sometime overcrowding of ED’s. Another problem is that EMTALA legislation mandates caring for everyone no matter what. The hospital therefore, may not get paid. “According to the American College of Emergency Physicians, 55 percent of emergency care goes
If Canada wishes to improve upon the quality of health care and tackle down generic issues in health care, one should consider integrating services. Integrated health services are considered part of the solution for the recurrent problem, one example being the continuous problem of chronic disease in Canada’s health care system. Integrated services come in many formats; horizontal, vertical, clinical, and physician.
The Crowded Clinic: Critical Analysis The Crowded Clinic Case Study (Colorado State University - Global, n.d.) discusses the issues of practice management as they apply to access to care. Access to care may be as inconvenient as lengthy patient wait times to issues far more serious that may have a profound effect on the health and well-being of a single patient or an entire cohort. In order to properly address the issue and look for a remedy, it is necessary to understand the underlying conditions that create the problem before creating the means to manage the change required to correct the problem. The Crowded Clinic has multiple issues, including social and operational, which are creating the associated inaccessibility to services.
... wait times and the problem of our physician shortages. Becoming aware of the reasons why our physicians leave Canada, will be the stepping stone to create/match the attractive deals that steal them from us. The shortage of our physicians and the long wait times in the emergency room is closely connected. The government needs to look at all propositions that have been mentioned in order to fix these issues. There are all kinds of advanced health care providers that can help with this problem by aiding in the emergency rooms and remove the burden of overworked physicians. If we organize our health care providers in a new way, the wait times in our emergency rooms could be greatly reduced. The public should take control of their health by not tolerating the present state of affairs. Their health is being harmed by extended wait times and lack of health care workers.
... a lot of criticism about the wait times; some have been known to wait in the emergency room for four hours. Although on the other hand, there is an upside to having to wait. By prioritizing the high risk patients verses the lower risk patients, help to eliminate patient mortality rates. The government has since stepped in to help alleviate the long wait times. Unfortunately, the wait times on average are just as bad, if not worse here in the states, with one important difference. In Canada no one gets turned away, while in the states, if you do not have the proper documentation according to your plan, you may end up waiting double the amount of time.
Under the Emergency Medical Treatment and Labor Act of 1998 (EMTALA), health providers by law are supposed to follow the federal guidelines and the EMTALA when you work in an emergency medical care at certain hospitals (facilities that participate in Medicare-includes 98% of hospitals in the United States (U.S.)). This also means that any part of the hospital that can perform an evaluation and treatment of EMC is considered an ED., for example, a women's hospital that delivers babies is subject to EMTALA. As a health care professional under this law, you have to make sure that every person entering a hospital in need or requesting receives a medical screening examination (MSE), and an emergency medical condition (EMC) evaluation to determine
For centuries people have relied on public housing each year in Canada. Public housing is a known problem that does not get talked about often. Public housing is defined as a federal, provincial or local housing program that is provided for people with low incomes (XXX).
In the past, Canada’s government-funded, universally accessible, health care system has been praised and admired both at home and abroad as one of the finest in the world. A great source of pride and comfort for many Canadians is that it is based on five fundamental principles. Principles that are a reflection of the values held by Canadian citizens since the formation of Medicare in 1966. These principles were reinforced in the Canada Health Act, (CHA), of 1984 and state that the Canadian system is universal, accessible, portable, comprehensive and non-profit.
The healthcare system in Canada is funded largely by the federal government as determined by the constitution. However, the actual healthcare delivery and social services is left up to each province and territory. Each province has the power to pass legislation that governs the financing and delivery of healthcare services to Canadians residing in that province. This fact encourages all healthcare professionals who have a strong provincial association and want to advocate their position on healthcare to speak up, if they want something different. If a physician wants to start delivery of telemedicine to rural areas of the province, he or she can advocate their position and
If we were to conduct a back-of-the-envelope calculation on the average time that patients wait before entering the care process, it would result in approximately one hour for the average time. We can calculate this by adding the time it takes for the nurse to perform the triage (about 2-3 minutes), plus 10 minutes for the administration entry (registration). Then we need to average out the amount of time it takes to for someone to be assigned based on the different degrees of emergency. I.e. the first degree is immediate (zero minutes), the 2nd degree wait time is approximately 20 minutes, and the third degree average wait time is about 120 minutes (2 hours). If we take the average of these three we get approximately 47 minutes and we can add that onto the 12-13 minutes prior to get an average wait time of about one
Emergency is defined as a serious situation that arises suddenly and threatens the life or welfare of a person or group of people. An emergency department (ED) or also known as emergency room (ER) is a department of a hospital concentrating in emergency medicine and is accountable for the delivery of medical and surgical care to patients arriving at the hospital needing an immediate care. Usually patients will arrive without prior appointment, either on their own or by an ambulance.