Fraser Health asks experts how to unclog hospitals
Admitting its latest push to cut hospital congestion is not yet working, Fraser Health has turned to a panel of outside experts for advice on what more it can do.
The six-member panel – which includes three consultants with expertise in health care, a facilitator and representatives from both Fraser Health and the health ministry – is to table recommendations by the end of March.
Fraser CEO Dr. Nigel Murray said the advisers will perform an independent and objective examination of the region's efforts to reduce congestion and "identify any ways we can continue to make improvements."
They are to focus on the heavily congested Royal Columbian and Surrey Memorial hospitals, but their advice may apply across the region.
Murray said turning to outside advisers shouldn't be viewed as an indictment of the authority's staff or internal vision, but added he wants to leave no stone unturned in seeking solutions.
"Our hospital network is at full capacity on a regular basis," he said.
A multi-pronged strategy was rolled out last fall to clear hospital beds faster, reduce lengths of stay, and discharge more elderly patients to home care rather than residential care homes.
A year before that, the province was trumpeting its shift to a pay-for-performance funding model to foster hospital innovation and efficiency.
But it's hard to detect any improvement in the face of relentlessly rising demand.
Emergency visits are up 7.3 per cent so far this year and patient days spent in hospitals in the region are up five per cent.
Surrey Memorial and Royal Columbian hospitals are "at least or at times even more congested this year than last year," according to the terms of reference handed to the expert panel.
Fraser Health doesn't expect the panel to simply tell the province more money and beds are needed, said Barbara Korabec, Fraser Health's vice-president of clinical operations.
"Are there strategies other than just building new beds that we have not maximized?"
Korabec said she's concerned hospital volume is up so much even without a typical outbreak of seasonal flu yet.
Murray said the Home is Best initiative launched last year to encourage home support as an alternative to residential care promises to ease demand for care home beds, helping reduce the numbers of patients staying unnecessarily in hospital.
"We are seeing thousands more people accessing home support services," he said.
Home support hours are up nearly eight per cent this year, Murray said, and fewer patients are being admitted to residential care that have never tried the option of home support.
The expert panel is also expected to consider Fraser's demographic challenges.
The region already has the largest and fastest-growing population in the province, as well as the largest proportion of both seniors and the young.
That's compounded by the fact Fraser Health has fewer family doctors and specialists than its size warrants, she said.
Fraser Health estimates it will gain another 327,000 residents, or 20 per cent more, by 2020.
"That's roughly like adding an entire Abbotsford and a Langley to the region's existing population," Murray said.
The population of seniors over age 65 is forecast to balloon 50 per cent by 2020 to more than 100,000.
Dr. Tim Latham, a cardiac surgeon at Royal Columbian, welcomed the appointment of the panel and said he hopes the provincial representative ensures Victoria gets a clear picture of what's needed.
"The biggest problem is capacity," he said. "You can't pour two litres of water into a one-litre container."
Dr. Sheldon Glazer, an ER doctor at Royal Columbian and Eagle Ridge hospitals, said it shouldn't take a panel of experts to conclude that the lack of inpatient beds is the key problem.
"At any one time in Fraser Health there are the equivalent of two hospitals full of patients being placed in hallways in emergency rooms," he said.
Glazer said staff at RCH are intensely frustrated by the endless game of "musical beds" and some are leaving.
Patients subjected to hallway medicine for too long suffer not just indignity and unrest, he added, but a higher risk of mortality.
"Their risk of dying is doubled if they spend more than 12 hours in emergency before they go up to a ward," Glazer said.
"In our hospital, we have patients spending literally days and days in our emergency. Sometimes weeks."
Fraser's latest service plan estimated 1,100 more hospital beds will be needed by 2020.
Some beds are being built.
A $512-million expansion at SMH will bring a new ER and critical care tower, including 150 beds.
But Surrey Memorial remains crowded even after the region opened the nearby Jim Pattison Outpatient Care and Surgery Centre, which was intended to decongest SMH by taking over its day surgeries and many of its clinics and diagnostics.
Fraser Health officials say they are working on a plan to expand Royal Columbian as well.
And more preliminary planning is underway to consider the needs at Delta, Peace Arch, Burnaby and Eagle Ridge hospitals.
But Glazer notes there's no timetable for the the Royal Columbian expansion and the SMH project was announced "three different times" before work finally began.
"I am not optimistic that things are going to change."
Fraser Health has to wait for the provincial government budget to be tabled to find out how much of a bump its $2.75-billion budget will get in the next budget year, which begins in April.
The province had previously signalled the health authority will get an extra 4.1 per cent, but officials are waiting for confirmation.
The advice panel isn't the only possible source of recommendations.
B.C.'s Auditor General has served notice it wants to examine funding flows in the health care sector.