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Beds are not the answer

A sad story from the West Coast has emerged over the past few days, which is somewhat emblematic of a problem facing health care facilities across Canada. An 88-year-old man died on a stretcher in the hallway of an emergency department for lack of attention and treatment. A traumatic experience for the family, disappointing for the doctors and nurses who work at the facility, and ultimately embarassing for the Government of British Columbia.

As expected, the call has come for more beds, not only from members of the public, but from the doctors themselves. However, as I have discussed here, the actual number of beds is not the problem. The fact that people who have no need to be occupying the beds are in them - which, unless they intend to double up, prevents patients from being placed in the appropriate ward and receiving the appropriate treatment.

There likely are a suitable number of beds, it's just impossible to use them effectively while running the hospital the way they are. The secret is to discharge people 24 hours a day, as they have done in the UK. This effectively rectifies the 'bed-blocking' problem.

I have put this theory forward before. However, upon further reflection, I realize that it will likely never happen because of...and I know I'll make some enemies here...health care workers and their unions. The concessions that would have to be made to have people to clean and re-make the beds, and adequately treat new patients as people were discharged overnight would not be something I would want to negotiate.

Another problem is created in the way hospitals are staffed - why is the shift 8 to 4 for everyone? Hasn't it occurred to anyone that having your entire nursing staff (for example) get up and leave, and an entirely new complement of staff arrive may result in some patients getting lost in the rush to head out the door? This is not to say that nurses don't work hard, they do. But having this complete turnover during a busy time is madness.

Back in the day, when this stuff was actually my business, there was talk of employing industrial engineers to look at the problem. They would study the patterns of highest ER volume, and help hospitals plan staffing levels accordingly. The ability to respond with adequate levels of care would be enhanced by having an increased number of staff during peak periods. Do you expect the unions to approve of this? I certainly don't - it would require more people to be present at the least desirable hours.

Until we break the hold of the 'assembly-line' union culture in health care, we will never make any headway. The secret is not to add more capacity, it's to work more efficiently within your means. The present system of inflexible shiftwork is failing the patients, and it's time that front line workers stood up and showed they actually do care about the people they serve. And that's the word, serve. It's their job. They are not doing us a favour by treating us as an inconvenience. If you've lost your empathy because you feel the system keeps you from doing your job, help the system to work, don't take it out on people who are frightened and in pain.

And maybe, just maybe, another 88-year-old man won't die untreated on a cot in the hallway. That's just about the loneliest death I can think of.

Are there any journalists that have taken up the issue of flexible shifts and 24-hour discharge as an issue? I think I remember a buddy of mine telling me that when he needed a MRI he had to wait weeks, even though the machines stood idle overnight every night. He would gladly have gotten up at 3 to make his way to the hospital to get expedited service.

If there are any readers out there that work in hospitals, it would be interesting to hear what they think.

Thanks for posting this.

None that I know of - unfortunately these ideas are either unpopular or unthinkable in the current climate. The problem arises in some technical specialties when fewer people choose to pursue 'MRI Tech' as a profession - a situation that would be cheaper to rectify that buying more MRI's that are operating 5 hours a day at best. The biggest problem is the time factor - as I've said before, there has to be the political will to stay with a particular course until the dividends are clear, often considerably longer than the (usually) approximately four-year election cycle.

Flash, in places where people routinely travel 6 hours round trip to get to a qualified hospital, that's not the right strategy. People need to stay under the care of a doctor as long as they are likely to need the care of a doctor again within the day, and have no qualified person to care for the patient at their home.
To kick people out early like they do in Saskatchewan already is going to create more Paige Hansen cases [if you've been following that story].

I had read the story, but I needed to look at it again to refresh my memory.
I don't advocate people being turfed out the door unecessarily - if they require further hospital care, then they should get it. I just think that there are a number of cases when people who have undergone treatment and are ready to go home don't get discharged in a timely fashion. Here, for example, the time people are generally discharged is noon, or thereabouts. If you see your doctor at 6 p.m., and are told you can be discharged, you have to wait for the following day, effectively tying up that bed for no good reason. A more flexible system of staffing and discharge would make that bed available for the person coming into the ER at 3 in the morning.
As for Paige's story, that is a distressing state of affairs, and one that reinforces Kevvyd's point - these machines (in this case a bone scanner) have to run longer. It's the only way to clear the backlog and ensure people get care in a timely fashion. I'd hate to think what would have happened if Paige's parents hadn't decided to take her somewhere else.
There are some who would suggest that maintaining a level of overflow is in a sense maintaining job security for the poeple who operate the machines, and I'm beginning to think that view has some credibility.
That being said, some locations with lower volumes work fine as they are, and some health care workers will go to the wall for patients. I think the idea is something that bears closer examination, not immediate application everywhere, especially where it would be inappropriate to do so. Openness and flexibility have to be the new key words in health care, not self-interest.

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