Situation frustrating, anesthesiologist says
It's a frustrating time to be a surgeon at Health Sciences North right now, according to Dr. David Boyle, an anesthesiologist and the medical director of the hospital's surgical program.
With more than 100 alternate level of care (ALC) patients currently at the hospital's main site, and another 30 in the ALC unit at the former Memorial Hospital site, about one-quarter of the 99 surgical beds at the hospital are occupied by these patients.
ALC patients are those who no longer need acute care, but remain in hospital because they're waiting for some type of community care.
Because there aren't enough beds for patients receiving surgery, the hospital has decided to reduce non-life-threatening inpatient surgeries from 19 to 15 per day.
But that's better than patients learning their surgery has been postponed right before they were supposed to receive it, Boyle said. High levels of ALC patients have led to the cancellation of more than 30 surgeries so far this month.
“When we have to cancel patients on a day-to-day basis, everybody's frustrated,” he said. “The surgeon is frustrated because they've already made plans. The patients will be indirectly upset, and vent at the surgeons. Everybody gets upset. It's been a tough time.”
The new schedule will come into effect Sept. 24, and is anticipated to be in place over the next two months.
Urgent and emergency surgeries will not be affected. Also not affected by the new schedule are outpatient procedures, as these patients return home the same day and do not require a hospital stay.
Boyle said the surgeries are being cut back by about 20 per cent because this is the number of procedures which can be safely done with only 75 surgical inpatients available.
Without the surgical cuts, staff have been working at 120 per cent, trying to care for the extra patients in the hospital, he said. Patients have been “doubled up” in rooms or are being cared for in the recovery room, which normally isn't operated 24 hours a day, Boyle said.
“So patients have had good care, but we just know we can't go flat out at 120 per cent of the time without it starting to become a risky environment,” he said. “We're just taking a pause and making sure that we provide sustainably high-quality care.”
Dr. Chris Bourdon, the hospital's chief of staff and vice-president of medical and academic affairs, said the hospital is taking these measures “to ensure an appropriate balance of safety” for patients.
“Also, in safeguarding the number of procedures booked in the ORs, we can eliminate the need to cancel surgeries daily, which is very difficult and disruptive for our patients and families.”
The surgical cuts will affect wait times at the hospital, Boyle said.
A hospital press release said that while the patients who will have to wait longer for surgeries have conditions which are not life-threatening, many are suffering from chronic, painful conditions which affect their quality of life, and in some cases, their ability to live independently.
The same situation also cropped up a few years ago, Boyle said.
“That was at the beginning of the ALC awareness in our community,” he said. “We made a huge number of changes to the process to mitigate that, and we were successful. By changing some internal processes and making efficiencies, our surgical program really meets most of the benchmarks.”
However, there probably aren't any more efficiencies to find which could improve the situation, Boyle said.
The hospital also receives some provincial funding for meeting wait-time benchmarks.
When surgeries have been scaled back in the past, the hospital has been able to mitigate funding loss by making sure these surgeries were done later in the year. This time, though, Boyle isn't sure this will be possible.
“We would try,” he said. “But the last time we did it, we had 50 or 60 ALC patients in our system. I'm not sure we're going to be able to mitigate it when we have 130.”
Boyle said he thinks the solution to the problem is ALC patients receiving 24-hour nursing care, if necessary, in their own homes.