Originally published as a front page story for the Kingston Whig-Standard
The total time spent in the emergency room for patients with complicated conditions at the Kingston General hospital is almost double the provincial time, according to data from the Ontario Ministry of Health.
According to the data, nine out of 10 patients with complex care issues arriving to KGH’s ER could wait up to a maximum of 17 hours for a bed after they’ve been assessed by a physician and provided a care plan. The average time at all hospitals in Ontario is 10 hours.
Dr. David Zelt, executive vice-president and chief of staff at KGH, said the reason behind this is that the hospital receives the most complicated cases of the region.
“We get referred large volumes of the more complex patients that does create that longer time to require your full assessment and then time to get into the hospital.”
Zelt acknowledged that KGH faces some major challenges with the flow of patients, but said he and his team are ensuring that patients get the best care possible. The problem is getting them to a bed.
The average time spent in the ER at KGH for patients with complex conditions is about eight hours. Services a hospital provides and the number of patients it treats can impact that time.
KGH provides acute care for patients with short but severe illnesses, like a broken bone or an asthma attack. It also provides complex care for long-lasting illnesses like dementia and heart disease.
Much like KGH, Toronto General Hospital also provides complex care. The total time spent in the ER in Toronto is roughly 13 hours — four fewer hours than KGH.
But the issue of flowing patients in and out of the ER at KGH has been a challenge for three consecutive years, according to annual performance reports.
The reports outline that the hospital provides fast access to physicians, but the time it takes to get the patient into a bed in timely manner is in the red zone.
Given the challenges, Zelt said the staff in the emergency department does all it can to eliminate inefficiencies.
He said the team recently mapped out the entire patient care process from when someone arrives in the ER to when they are placed in a bed.
In doing this, he said, the team identified that it could get its specialists down into the ER more quickly and has made efforts to do so.
The team also realized that were issues in knowing when a bed was ready.
“There was a challenge in the way we were notified that a bed was ready for the next patient.”
To deal with this, Zelt said, the hospital has improved its electronic bed recording system. Basically, those who clean the bed are notified quicker. “That then allows us to get patients to that bed more quickly out of the emergency department,” he said.
KGH is facing other issues that are out of the hospital’s control, Zelt said, including an increase in the number of patients arriving in the ER who need alternative levels of care.
These patients — who often suffer from chronic disease — are waiting to be discharged to a more appropriate setting, like long-term care or nursing homes.
Although these patients, whom Zelt called “stuck in our hospital,” are being cared for, the hospital is having difficulty finding space for them, he said.
Dr. Chris Simpson, chair of the Canadian Wait Time Alliance, said KGH is not the only hospital in Canada dealing with these issues.
Simpson said Canada’s aging population and the increase of complex conditions is really putting a strain on the health-care system.
“We now have a landscape that is much more of chronic disease,” he said.
And to deal with these incurable diseases, Simpson said Canada needs more out-of-hospital alternatives.
“We’re always going to need hospitals, but the problem is we need to free them up to do what hospitals are supposed to do, which is to look after people with acute illness,” he said.
“We need a national senior care strategy,” he said, adding that he believes the strategy should invest in alternatives such as home care, long-term care, affordable housing and support for families helping their aging relatives.
The Local Health Integration Network (LHIN) is the authority that funds the health-care system in Ontario and deals with access or major hospital issues.
Paul Huras, CEO of South East LHIN, is aware of the challenges KGH is facing. He said although it is a very complex process, the network has made efforts to ease the number of patients going to the ER.
Early this year, the network started an outreach program across the region. A group of nurses go to various homes to provide medical support to patients and training to staff.
“The intent will be that the home will have less of a need to send a patient to the emergency department,” Huras said.
Over the past year, seven centres — called Health Links — have opened up across the region. In the centres, doctors and nurses provide long-term care plans for patients who regularly visit the ER.
Huras said although it is too early to evaluate these programs, he’s hopeful that will help keep patients out of the ER.
Despite these efforts, Simpson believes improving the health-care system is not purely a provincial matter.
“It cannot happen without federal leadership,” he said.