Lack of policy on surge capacity may come to bite us this flu season

Could this be the season where our reckless policy of removing all hospital surge capacity comes to bite us?

The Toronto Star recently reported of a Canadian man stuck in a St. Louis hospital because there are no beds available for him back in Toronto.

The man had a heart attack while in the US Midwest, where he has admitted to hospital in St. Louis. His wife has been trying to get him transferred back home without any luck. In fact, the stress was so much for her, that she was also felled by a heart attack in St. Louis, and wound up for three days in the same hospital.

“The flu season has overwhelmed hospitals and we have to take our patients who are in the emerg first,” Scarborough hospital spokesperson Tracy Huffman told the newspaper.

Dr. Ian Fraser, chief of staff at Toronto East General told the Star: “There is not a lot of surge capacity within the whole system and that is a challenge.”

Meanwhile, Windsor-area hospitals have declared a state of emergency, threatening alternate level of care (ALC) patients with charges of $600 per day if they refuse to take the first long term care bed available to them. Likely not many will be faced with that choice – only six beds are available in the region.

In Ottawa spouses are unable to be reunited with their partners in the city’s nursing homes despite a policy that makes such transfers a priority. Why? The city’s hospitals are filling up any available nursing home bed to move out their ALC patients.

Several years ago we asked an advisor with then Health Minister George Smitherman’s office what the government was doing about the shortage of acute care beds.

We had disclosure from the Rouge Valley Health System on a challenge we were taking before judicial review. The hospital provided us with a number of comparisons with peer hospitals to suggest they could close down more acute care beds to save money. Most of the peer hospitals in the comparison were well over 90 per cent capacity, and about 25 per cent were over 100 per cent capacity. When you exceed 100 per cent, it means you constantly have patients in your hallways.

The advisor admitted that the numbers were correct, and in fact, might even be a bit higher. However, he expressed no concern about the lack of surge capacity.

This is not how it works in other countries, where the possibility of a bad flu season or pandemic could throw the health system in crisis.

In the UK, the only G7 country that has fewer acute care beds per capita than Canada, they set a target of 82 per cent average occupancy. When a media report showed that there were a significant number of hospitals over 85 per cent, it was considered a scandal.

High occupancy rates have been proven to be linked to an increase in mortality rates, longer waits and a spread of hospital-borne infections.

In 2005 the average bed occupancy in 30 OECD countries was 75 per cent. The Australian Medical Association has warned that bed occupancy rates above 85 per cent negatively impact on the safe and efficient operation of a hospital.

The Irish Medical Association recognizes 85 per cent as an “internationally recognized measure” that should not be exceeded.

Yet here in Ontario we are over 90 per cent, and for many hospitals, they exceed 100 per cent.

In Canada we have 2.7 acute care beds per 1,000 population. In Japan it’s 8.2 and in Germany it’s 5.7 beds. Yet Germany spends about the same as Canada on public health care, and Japan spends less. Both rely less on private health care.

The present mania for emptying ALC beds raises an interesting question – once these patients are no longer in the hospital, and the beds are filled by acute care patients who cannot be moved elsewhere, where does the surge capacity come from in the event of a crisis? Without the options of moving these patients to alternate settings, there will simply be no room.

Having a hotel at 100 per cent capacity is efficient. Having a hospital at 100 per cent capacity is a recipe for disaster, as we are beginning to see this month.

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