Ontario hospitals lack capacity for surges of critically ill patients, report says

Report recommends reserving beds for critically ill patients – and invest more in the health system to avoid unnecessary admissions Ontario hospitals lack capacity for surges of critically ill patients, report says Ontario hospitals…

Ontario hospitals lack capacity for surges of critically ill patients, report says

Report recommends reserving beds for critically ill patients – and invest more in the health system to avoid unnecessary admissions

Ontario hospitals lack capacity for surges of critically ill patients, report says

Ontario hospitals have struggled to cope with surges of critically ill patients in recent years, resulting in ambulance and hospital delays, a report found.

The Independent Hospital Review Panel report recommends making hospital beds available for patients who need care in emergency departments or intensive care units (ICUs) instead of inpatients, expanding capacity for adult ICUs and urgent care centres, and establishing a dedicated transportation space for ICU patients at two Toronto hospitals.

The report also proposes new initiatives, including: implementing a dedicated bank of ICU beds that patients could use as they need them instead of waiting, a dedicated lane to transfer people from emergency to another hospital when an ICU bed is available, and public awareness campaigns on how to use hospital emergency departments and ICUs.

“Patients and families should be encouraged to communicate plans for when something should happen to someone in critical care, including long-term living, with long-term care, with family and with the healthcare system,” said panel chair and Dalhousie University president Michael Airenfeld, adding that this should be mandatory for everyone.

The initial stage of the report is available for the public to read online. It covers the first three months of 2015, and has been deemed complete by independent reviewer and physician Janice Brown.

The health ministry began developing the report in 2014 after an investigation found serious lapses in patient care in Toronto hospitals. Between 2012 and 2013, the period the independent review was conducted, 81% of children and adults admitted to Toronto hospitals were transferred away within 24 hours, as were 62% of patients admitted from emergency departments.

Brown said her panel spent a year analyzing how hospitals in Ontario handle problems facing ICUs. “One of the most difficult things about this is remembering what we’ve seen before and learning from it and so this was the third cycle to go through.”

“When we look at the 14 hospital systems in Ontario, they all have the system we call overflow. That means a patient who is outpatients that a bed is available for; or a patient who’s moved into an ER is designated an outpatients, and therefore he doesn’t have to stay in an ER for 48 hours before going into an acute care setting.”

A regular provincial review of ICUs is under way, so the panel didn’t release those reports, Brown said.

Hospital leaders are largely supportive of the report’s recommendation of reserving beds in emergency departments for critically ill patients, and are confident that would not impact treatment of non-emergency patients.

Meredith Phillips, head of patient safety and quality at Queen’s Park, says the issues identified in the report are not unique to Ontario hospitals. The federal review found similar problems, she said.

“What is critical is for provinces, governments, hospitals and other health-care system operators across the country to have the wherewithal to invest, in innovative ways, in a full-time ICU network,” she said.

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