The holidays are over. And in Canada, that means it’s now officially “hospitals ERs are bursting at the seams because of the flu” season.
After all, every year around this time, hospitals from coast to coast are beset with an “unexpected surge” in patients. Just one thing: There is nothing unexpected about it. It’s not a surge so much as it is an entirely predictable increase in demand that has an entirely predictable impact on an overburdened, mismanaged system.
When a retail outlet expects a surge in customers – for example, during the annual Boxing Day sale – they bring in extra staff, extend their hours and stockpile supplies. In the health system, however, we do the exact opposite.
When flu season arrives in early winter, as it has for time immemorial, we close medical clinics, scale back home care, reduce staffing in hospitals and even close hospital beds for the holidays. Everyone who needs care – primary care, chronic care, mental health crisis care, substance use counselling and more – is funnelled to emergency departments.
Then – surprise, surprise – wait times soar, patients end up on stretchers in hallways for hours or days, ambulances are diverted, and when occupancy rates hit 150 to 200 per cent, a crisis is declared.
Despite the chaos, hospitals, for the most part, do a remarkable job of dealing with untenable circumstances. ER doctors see mind-boggling numbers of patients per shift, nurses work excessive hours (sometimes mandatory overtime, and no meal breaks), and everyone, from lab technicians to janitorial staff, take on extra duties.
Patients, in true Canadian fashion, are also incredibly patient and tolerant, even when they are hungry, sick and left to fester on uncomfortable plastic chairs for countless hours, and stripped of their dignity, lying exposed on hospital gurneys.
It shouldn’t be this way. Not in a country where we spend more than $20-billion a month on sickness care.
In the short term, we need to get our act together on hospital and clinic staffing during the holidays. Maybe we need temporary urgent-care centres to cope with flu season. But the ultimate solution: a serious rethinking of the system.
What the “flu surge” reminds us each year is that we have a chronic capacity problem. If you think of a hospital as a bathtub, the tub is constantly full to the brim, the drain is plugged and there is no overflow drain. Any increase in patients – such as when the flu hits and when clinics close for the holidays – results in flooding. That flooding is most visible in the ER, but it is widespread.
The fundamental problem in Canada’s health system is not ER overcrowding so much as it is hospital overcrowding. The waits in the ER are due not to the inflow of patients but due to inadequate outflow – a lack of beds for patients who need to be admitted for care. That’s why we have a shameful amount of hallway medicine.
Ideally, hospitals should function at about 85 per cent capacity; those that do, don’t have painful ER waits or patients on gurneys in hallways. Instead, our hospitals routinely operate at 90 to 100 per cent capacity, which means, in practical terms, that they have no wiggle room.
Canada has among the fewest hospital beds per capita among developed countries – 2.5 per 1,000 population. That’s 32nd among the 36 OECD countries.
But before we implement a costly solution such as adding more hospital beds, we have to consider how well our existing hospital beds are being used. About one in six hospital beds – and one in three, in some parts of the country – are currently occupied by patients categorized as needing an “alternate level of care,” which, in plain English, means they have been discharged but have nowhere to go.
This misuse of much-needed beds is due, in turn, to inadequate resources in the community, including lack of home care and long-term care beds. In Ontario alone, there are 30,000 people on wait lists for long-term care.
In other words, we won’t solve our overcrowded ER problem without looking beyond the ER and making a raft of systemic improvements, from bolstering primary care to building more long-term care facilities, all the while ensuring that the patients who are hospitalized are those who truly need to be in hospital.
The sickness that has gripped Canada’s health system is not the flu. It’s something far more insidious and destructive: a systemic lack of vision and poor stewardship.
ER overcrowding is a symptom of that sickness – a canary in the coal mine that we ignore at our peril.