Rrrrroll Up the Rrrrrim to Live?

This is not a new situation.  Chronic shortages of nursing home beds mean an excess number of potential nursing home residents occupying acute care beds in hosptial.  When the hosptial has no beds, it takes longer for patients in the ER to be admitted into the hospital proper.  Each admitted patient parked in the ER for lack of beds means another patient in the ER's waiting room can't be brought in.  As the flow of incoming ER patients continues, there is an inevitable break point at which the ER is full to bursting. 

At that point, the ER has several options - none of which is ideal.  One is to shut the ER down to new patients.  This is widely considered a dangerous way of handling the problem, since sooner or later, a patient will die en route to another hospital.  A second way to handle a surge in patients is to activate a crisis plan that accelerates the emptying of beds in hospital for new patients.  This is not always successful, since you frequently encounter situations in which there are no patients who can be safey sent home or transferred elsewhere.

The third option is to create space for more patients in the ER.  That's what was done when the Tims was pressed into service.  Elsewhere, ER patients are cared for on stretchers placed in the corridors.  Earlier this season, we aired a story about corridor medicine at the Jewish General Hospital in Montreal.  There, as many as 40 patients may be nursed at one time in the ER corridors - in some cases for days at a time.  The ER there has turned the corridors into makeshift wards - complete with curtains for privacy.

Check out the third item in our show on Corridors of Medicine.

The Royal Columbian's director of public affairs David Plug told CBC News that the Tim Hortons is a "designated overflow area" to be used in extreme high-volume situations when the ER has an unexpected surge in the number of patients. 

To me, co-opting the Tims is a disaster plan, not a surge plan.  That's what you do when a football stadium collapses - and you have mass casualties - not when you have more than your usual volume of patients.  I would suggest that the ER director and the hospital should have been been kicking serious butt much earlier in the day to move admitted patients to more appropriate settings. 

That they didn't tells me the system is in serious need of a shake.  And I don't mean an Iced Cap.