The OHA makes it okay to talk about overcrowding

The Ontario Hospital Association may have made it okay to talk about hospital overcrowding.

As we noted January 27, the OHA has been asking the province to look at capacity planning, noting that only Mexico and Chile have fewer hospital beds per capita than Ontario. It’s fair to question where the province is going on this issue given ongoing funding restraint.

Overcrowding has its consequences.

London Health Sciences Centre’s Dr. Michael John is tasked with infection control for the hospital and believes there is a connection between Ontario’s battles with superbugs and overcrowding.

In the Minister of Health’s own backyard, London’s University and Victoria hospitals have averaged 104 and 102 per cent occupancy from April to December last year according to the London Free Press.

Anything in excess of 100 per cent usually means patients are receiving care in the corridors.

John says overcrowding means no empty rooms are available for patients who need to be isolated and support staff are under pressure to clean vacated rooms quickly for waiting patients. That does not make for the best infection control.

John told the Free Press that outbreaks usually happen on more crowded wards.

Dr. Samir Sinha, who the province tapped to draft recommendations for a Senior’s Strategy, told the Free Press in a separate story that progress on freeing bed capacity in the province has stagnated and “everyone agrees that’s (more than 100% occupancy) not a safe level to run.”

A Globe and Mail editorial recently estimated that 200,000 Canadians are subject to hospital-borne infections each year of which 8,000 are fatal. However the Association of Medical Microbiology and Infectious Disease Canada is critical of Ottawa for not making actual national infection data public.

Last November the Canadian Association of Emergency Physicians updated their position on hospital overcrowding, noting that “multiple countries show increased numbers of patients may die or require a second emergency department visit within a week of their first if they are seen in an ED at a time of crowding.”

While recognizing Ontario has made progress over the last decade, the Association says there is no excuse for continued inaction in Canada.

Many countries set targets for maximum hospital occupancy, usually between 80-85 per cent. The most recent average for Ontario hospitals – reflecting last summer’s activity – was 92 per cent. However, summer is traditionally a time when demand is lighter for most of the province’s hospitals.

Overcrowding is not just a matter of infection control, but having the capacity available during surges in demand. That surge is usually in the winter flu season – around the same time that CCACs have to cut back home care services because of inadequate funding.

The Emergency Doctors are calling hospital overcrowding in Canada a “public health crisis.”

Matthews has predictably played down the link between overcrowding and infection control. She also states her goal is to reduce demand on hospitals through community-based funding.

However, at an overall health care investment of two per cent nominal funding increases per year, there clearly is not enough money to maintain the status quo, let alone shift resources in a meaningful way. After two years of 1.5 per cent increases to base funding, hospitals have had to cope with zeros for the past two years. The expectation is the freeze will continue until such time the province balances its budget. The question is, can hospitals truly keep up with demand over that period of time when the evidence suggests Ontarians are already being placed at risk?

We’ll see if the province has second thoughts when the spring budget arrives.

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