Emergency room overcrowding: causes and cures

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  1. Frustrated

    “An example of that is the rising number of patients who are in hospital despite not needing hospital level of medical care. Rather, they’re waiting for long-term care, respite beds, rehabilitation beds, or other supports before being sent home. These patients are formally designated as “alternative level of care,” or ALCs. ALCs make up about 13 percent of patients in acute care beds across Canada.”

    As Yogi Berra would say, it’s deja vu all over again: https://www.thestar.com/news/ontario/2008/04/23/plan_will_free_up_hospital_beds_ers_smitherman.html

    Tired of hearing this talking point again… and again… and again. Look forward to reading next year’s article on the “ALC problem”. The politics of the the “ALC problem” are obviously quite favourable as it has worked so remarkably well since at least the George Smitherman days.

    I wish “our” physician leaders (i.e., Joshua Tepper) would actually hold government to account for a change, but maybe the pay is too good. You know, call them out when the track record on the “ALC problem” is clearly a heap of garbage with the odd sexy pilot project that never amounts to anything and serves as a distraction from making meaningful investments that will actually make a difference for patients and burned out front line staff.

  2. Jennifer Dee

    Patient flow and availability of hospital beds for admission, is frequently a problem in the ER on long weekends and special holidays like Christmas or Thanksgiving. It is really hard for me to watch a complex care individual being wheeled in from the ambulance bay; I immediately pray for them to survive their latest excursion to the ER. These patients who have complex needs often do not have a comprehensive care plan that is easily accessible and always current (electronic health record). Some of these patients are unloaded and left in the waiting room to become progresively more fragile as the wait time unfolds. I do not envy the patient or the care provider in this case. Canadians have a fragmented system that has too many levels of government to answer to, and resources that are consumed by duplication of tests and services. The system will not be fixed by minor changes, we all need to demand that stakeholder self-interest does not prevent us from inovating and making bold and courageous changes to the health care offered across the nation.

  3. Franklin Warsh

    The entire debate over ER crowding has become surreal in its willful ignorance over LTC capacity. Unlike hospital beds and even home care, where demand will always catch up an expansion of capacity within time, there is an upper limit to the number of LTC beds we need. People that don’t want or need LTC don’t go into LTC, so once the backlog is cleared it’s cleared. And yet there’s still this fixed belief that we can penny-pinch and micro-manage the problem away.

  4. Etienne O'Connor - Strata Health

    I could not agree more. Having worked in the ED for a few years and now representing a solution that helps drive down ALC rates by 50% within the first year this is dear to my heart. I am happy to chat about this. Can be reached at etienne@stratahealth.com

  5. Flora Knight

    I see the problem of overcrowding in the ED as threefold. The first problem is that GPs are not available afterhours or on weekends so patients are advised to go the ED department for emergency care (in many cases not the case). In the UK GPs when not available must provide coverage for their patients by another GP. The second problem is the lack of Long Term Care beds despite the increase in the numbers of senior in our province. The Provincial Government should use the information from Statistics Canada in providing more Long Term Care facilities as the situation will only get worse. Many acute care beds in our hospitals are being occupied by seniors while waiting for a bed in a Long Term Care Facility. The third problem is due to the budget cuts and laying off of nurses in many of our hospitals. Perhaps it is time for the Provincial Auditor General to do an audit of the state of care in hospitals across the province and make recommendations to the government as I do not foresee any change in the present unacceptable situation.

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