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Jammed Royal Columbian Hospital turns Tim Hortons into overflow ward
Hallway medicine is hitting new highs in congested Lower Mainland hospitals, as was demonstrated Monday night when Royal Columbian Hospital was forced to use its Tim Hortons outlet as an overflow ward.
Fraser Health officials say a combination of multiple trauma case airlifts earlier in the day and heavy pressure on the emergency department led staff to put patients in the hospital coffee shop.
It's an unusual example of what has become a routine problem across the region: too many patients and not enough beds.
"Last night the hallways were two and three stretchers deep with patients," said Dr. Sheldon Glazer, an emergency physician at Royal Columbian, the region's trauma centre.
"This is just a natural progression of what we've been dealing with for a long, long time," Glazer said. "We are forced to see patients in waiting rooms, in hallways and, now, in the Tim Hortons."
The veteran ER doctor says halls jammed with stretchers are both inefficient and dangerous – particularly if a fire broke out.
The persistent crowding region-wide suggests the region needs to build at least one or two new hospitals, he said.
"It's like playing musical chairs," Glazer said. "When the music stops, somebody gets left out."
One measure of hospital congestion – the number of patients admitted through ERs who don't yet have a bed – has climbed in Fraser Health from a daily average of 136 in 2008 to 148 in 2009 and reached 175 for the first six months of 2010.
In recent weeks, Fraser has averaged 220 admitted patients who are stuck waiting for beds at any given time, although officials note that coincides with the traditional winter surge when ERs are at their busiest.
"We do have a noticeable trend upward," Fraser Health public affairs director David Plug said.
Emergency department visits are up, he said, because of population growth, aging, and the rise of chronic disease.
Another yardstick of hallway medicine is the percentage of patients who get a hospital bed within 10 hours of the decision to admit them.
Eleven Lower Mainland hospitals – including busy Surrey Memorial, Abbotsford Regional, Richmond and Lions Gate – are averaging less than 55 per cent of patients admitted within that 10-hour standard, far below a provincial target of 80 per cent that was set back in 2005.
Mission Memorial at 72 per cent, Royal Columbian at 69 per cent, Burnaby at 68 per cent and Vancouver General at 64 per cent are closest to reaching the goal.
Worst are the smaller hospitals – Delta (23 per cent), Peace Arch (29 per cent), Eagle Ridge (32 per cent) and Ridge Meadows (37 per cent).
At those facilities, Plug said the problem isn't so much ER demand as the large numbers of elderly and chronically ill patients who often end up in hospital, occupying beds that can then slow admissions through the ER.
"For community hospitals serving areas with a sizable seniors population or significant chronic disease, that can increase pressure," Plug said.
The growing traffic jam in hospitals comes despite construction of some new facilities and various tactics to improve patient flow.
The $450-million Abbotsford Regional Hospital and Cancer Centre opened two years ago, replacing its predecessor and adding a significant number of beds.
Hospitals have also tried everything from improved triage procedures to opening separate minor treatment units to pull less severe cases out of crowded ERs.
New hospital construction is also underway.
A new $237-million outpatient hospital opens in Surrey June 1 that is expected to help decongest Surrey Memorial by taking over day surgery and diagnostics.
And an entire new emergency department and critical care tower, at a cost of $525 million, will bring more relief at SMH in 2013-14 by adding another 151 beds.
"The next top priority is Royal Columbian Hospital," Plug said, adding a similar critical care tower is under consideration there.
Planning processes are also underway to look at the future needs for Peace Arch and Delta hospitals, with Eagle Ridge to follow.
Building new hospitals is not the only answer, Plug said.
"We need to do that but we also need to be operating as efficiently and effectively as possible and we all need to live a healthier lifestyle," he said.
Back at RCH, Plug said, congestion was well down by Tuesday and Tim Hortons was again serving coffee drinkers instead of patients.
Plug said the coffee shop is not a formally designated overflow area, but staff are empowered to use various non-clinical areas when conditions warrant.
He calls it a short-term temporary solution and not what the health region prefers to see.
"It was cleaned before and after," he said. "There were no communicable disease concerns."
Six stretchers with privacy screens were put up in the Tim Hortons, which had closed by that time of night, and about four patients were monitored there, including one with angina who was hooked up to cardiac monitors.
In many ways, Glazer said, the coffee shop is preferable to hallways because there's a bit more privacy.
"It's very difficult to do a full examination in a hallway or take a history in a hallway, which is quite public," Glazer said.
Staff have sensitive conversations with patients – like whether they want a do-not-resuscitate order – in the busy waiting room, underneath a TV, he said.
One man at Surrey Memorial who was parked on a stretcher in a busy hall for more than a day while awaiting a bed recounted having to use a portable urinal beneath the sheets to relieve himself.
"It's just unacceptable," the patient said.
None of those experiences is ideal, officials say.
"Certainly our daily experience is challenging," Plug said.
"Long term, the prospect is for growth – both in people and the severity of their conditions. We are working on short-, medium- and long-term strategies to improve the situation."
HOW LONG TO GET A BED?
The percentage of patients who get a bed within 10 hours of the decision to admit them through ER is a key benchmark of hospital congestion. Provincial target is 80 per cent. Figures are year-to-date for 2010/11.
Abbotsford Regional Hospital – 52 %
(was 43 % in early 2009)
Burnaby General Hospital – 68 %
(was 60 % in early 2009)
Chilliwack Hospital – 45 %
(was 45 % in early 2009)
Delta Hospital – 23 %
(was 14 % in early 2009)
Eagle Ridge Hospital – 32 %
(was 29 % in early 2009)
Fraser Canyon Hospital – 47 %
(was 67 % in early 2009)
Langley Memorial Hospital – 42 %
(was 41 % in early 2009)
Mission Hospital – 72 %
(was 48 % in early 2009)
Peace Arch Hospital – 29 %
(was 49 % in early 2009)
Ridge Meadows Hospital – 37 %
(was 43 % in early 2009)
Royal Columbian Hospital – 69 %
(was 47 % in early 2009)
Surrey Memorial Hospital – 52 %
(was 41 % in early 2009)
VANCOUVER COASTAL HEALTH
Vancouver General Hospital – 64 %
(was 79 % in early 2009)
Lions Gate Hospital – 52 %
(was 68 % in early 2009)
St. Paul's Hospital – 56 %
(was 80 % in early 2009)
Richmond Hospital – 50 %
(was 89 % in early 2009)