Opportunity in the face of overcapacity

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This year Thunder Bay Regional Health Sciences Centre (TBRHSC) celebrates 10 years of advancing world-class patient and family-centred care in an academic, research-based, acute care environment.

When TBRHSC first opened its doors 10 years ago, it was hailed as the “Jewel of the North,” a stunning, state-of-the-art acute care facility serving the healthcare needs of people living in Northwestern Ontario.

Those were exciting and challenging times. Setting a goal to provide excellent healthcare to about 250,000 residents spread out over a region the size of France was ambitious, to say the least. But through innovative strategies, such as telemedicine, we are reaching out to provide care to the region. In 2011, our program met or exceeded all Accreditation Canada’s 2010 standards for best practices specific to a Telemedicine program. Additionally, Tele-visitation was designated a “leading practice” by that same survey team.

Today, TBRHSC, like many other hospitals in Canada, is facing another challenge, that of overcapacity. We are often faced with gridlock, a situation where there are more patients than beds available. As a result, new patients often have to wait in the Emergency Department (ED) for a bed to open up.

Our ED is the second busiest in Canada. In 2012-2013, there were 111,657 visits to the ED. Yet, it remains a provincial leader in wait times for non-admitted ED visits. And, despite the high rate of activity, admissions from the ED are not significantly contributing to overcapacity at TBRHSC. TBRHSC has the lowest admission rate versus the other Ontario teaching hospitals.

The increasing service volumes are attributable to systemic factors outside of TBRHSC’s control.

An ever-increasing number of beds at TBRHSC are occupied by Alternate Level of Care (ALC) patients who no longer need acute care, but cannot be discharged because there is no appropriate location available to them, such as a long-term care facility, the patient’s own home with support from community care providers, or rehabilitation. As a result, our Health Sciences Centre is often in an overcapacity situation.

A number of strategies were implemented to reduce the strain. This includes the addition of 10 beds to create an ALC Overflow Unit; the addition of a Utilization Coordinator, Social Worker, and Physiotherapist on weekends to facilitate the discharge of patients; twice-daily bed meetings with senior leadership to identify opportunities to reduce overcapacity pressures; and a staff member assigned to patrol the halls every 20 minutes to ensure fire routes remained clear.

Also, to enhance the level of privacy and safety for patients waiting for beds, TBRHSC completed minor renovations to a number of patient lounges to be made available as patient rooms when the number of patients admitted exceeds our regular capacity.

From 2010 to 2013, we further improved patient flow by implementing a Medical Short Stay Unit; Nurse-Led Outreach Team; enhanced Telehomecare (CHF, COPD) and a Telehomecare Steering Committee; Patient Flow Strategy Project Team; and participation in the Mobilization of Vulnerable Elders (MOVE-ON) Research Project.

System Partnerships including Home First (Transition Management); Resource Matching and Referral; TB Interim LTC Closure/Category 1-Crisis Planning Group; Self-Management Programs; and Integrated Non-Urgent Patient Transportation Planning Group.

TBRHSC has been identified as a high performer with respect to efficiency benchmarking measures. However, the ongoing situation presented opportunities to take a closer a look. While we were already operating efficiently, we were able to identify and pursue ways to further improve.

In 2013-2014, additional patient flow improvements included implementing Performance Measurement and Reporting; Standardized Admission and Discharge; ED P4R Investment; additional integrated patient flow software modules; Support positions (Data Analyst, IS); Temporary Additional Inpatient Bed Capacity (ALC Overflow Unit) – Business Case; and participating in the Senior Friendly Hospital Strategy. Also, TBRHSC continues to participate in the System-Wide Surge Planning Team.

The Home First Philosophy has also contributed significantly to addressing ALC pressures in the region. Since the Home First Philosophy was implemented in fall 2010, more patients are discharged home and fewer patients to Long-Term Care.   These initiatives are making a difference. In spite of ALC and overcapacity challenges, we continue to provide quality acute care, and to progress as an academic health sciences centre. Our commitment to Patient and Family Centred Care fuels our activity. We remain the only hospital to receive designation as a Leading Practice for Patient and Family Centred Care by Accreditation Canada, and recently welcomed our 100th Patient Family Advisor (PFA) to our team. Involving PFAs in our decisions ensures patients and families remain at the centre of everything we do, and that all of our strategies consider their needs first.

It is during times like this when I realize the value of a team of healthcare providers, staff and volunteers that is committed to Patient and Family Centred Care. Their ongoing dedication to ensure the best possible patient care during these times of overcapacity pressures is extraordinary. While it is, of course, the people who make the principal difference in healthcare, a state-of-the-art facility contributes to outcomes. Environment has a significant impact on peoples’ ability to heal as well as on the healthcare team’s effectiveness.

Nearly 10 years after its construction, TBRHSC is still attracting international attention for its innovative design. TBRHSC made sixth place on a list of the world’s 30 most architecturally impressive hospitals and is the only Canadian hospital on the list.

The website onlinemastersinpublichealth.com is a resource for those looking for information about careers and education in Public Health. It notes that “a new generation of medical facilities is changing the face of the hospital, literally. These places take a more holistic approach to healthcare – one that takes the healing environment into consideration. As a result, the hospitals on this list may be more welcoming. While patient care remains their primary objective, many have put almost equal care into their clients’ surroundings.”

I am tremendously proud of the people and place that is Thunder Bay Regional Health Sciences Centre.