Daily Bed Census may not capture full extent of hallway health care

Ontario's Ministry of Health and Long-Term Care conducts a daily count of occupied beds which is used to calculate hospital capacity. But not all the beds counted can accommodate patients waiting for one.

Province's tally of occupied hospital beds treats all beds as equal

Hospital overcrowding had led to patients being cared for in "unconventional spaces" such as hallways and closets. A report, officially released Thursday, from the Ontario Premier Doug Ford's Council on Improving Health Care and Ending Hallway Medicine looks at ways of modernizing the health care system to alleviate such problems. (CBC)

While hospital overcrowding is acknowledged as bad, how the Ministry of Health and Long-Term Care captures the number of beds occupied across the province doesn't show quite how bad the situation really is.

Ontario hospitals contribute to the so-called Daily Bed Census — an inventory that calculates occupancy as the number of patients recorded at each midnight divided by the number of beds staffed and in operation province-wide.

The problem is, not all the beds being tallied can accommodate the patients being counted.

"Not all beds are equal, because not all patients can access all hospital beds universally," says Anthony Dale, President and CEO of the Ontario Hospital Association. 

"There are specialty programs like obstetrics and gynecology or cancer and those are for very specific services and purposes. So general medicine is where the congestion is at its worst."

Barbara Garratt, 60, has stage four cancer. Her daughter Amber Garratt says she was taken to Southlake Hospital in Newmarket with an infection Tuesday evening and could not get a bed until Friday afternoon. (Submitted)

For example, a hospital may have a 99 per cent overall occupancy rate, but when you only look at the beds suitable for patients waiting in the Emergency Department — then occupancy rate is actually more like 130 per cent or above capacity.

That's because there may be a bed in the pediatric ward available, but that would be unsuitable for an adult surgical patient who must wait in the Emergency Department for a bed or worse — receive care in an "unconventional space" like a hallway.

Some hospitals exclude ICU or CCU from their occupancy reports and only include medical or surgical units, but the reporting is far from uniform.

Southlake Regional Health Centre doesn't include specialized units like birthing, NICU, cardiac care or our ICU, because those beds are only occupied by patients who require that specialized care.

"For example, when we are over capacity we can't put an adult in an NICU Isollette (incubator), nor would we place an adult in the child mental health unit, and a birthing unit bed would only be used by a women giving birth," said Matthew Haggerty of Southlake in an email to CBC.

Amber Garratt's 60-year-old mother Barbara Garratt — a stage four cancer patient — went to the Emergency Department at Southlake Hospital with an infection on Tuesday evening and didn't get a bed until Friday afternoon.

"My mother is in so much pain, sleep-deprived and needs to be given the medical attention she deserves and a place to get some proper rest," said Garratt, whose father even reached out to Premier Doug Ford, but didn't get a response.

A screen capture of a message sent to Premier Doug Ford asking him to intervene to get Barbara Garratt a hospital bed. (Submitted)

Southlake could not comment on a specific patient's care, but did say: "This has been one of our busiest weeks for the winter surge period. We always try to place all patients as quickly as we can. We have been very public about our capacity challenges."

Southlake's Emergency Department was designed for 70,000 visits per year, but saw 113,000 patients last year, said a spokesperson.

On the day Barbara Garratt finally got a bed, 25 admitted patients in the hospital's Emergency Department were still waiting.

"We had to mobilize so much to help get my mom what she needs especially being a stage four cancer patient, sitting around so many germs is not good for her health," said Amber Garratt, who is glad her mom now has a bed. "It's in the Cardiac Ward which doesn't make so much sense to us, but at least it's a bed."

Anthony Dale, President and CEO of the Ontario Hospital Association says the Daily Bed Census treats all beds the same when they, in fact, cannot accommodate all patients. (Submitted)

While the Ministry of Health's Daily Bed Census is not as accurate as it could be, Anthony Dale of the OHA says it's still useful.

"There's different ways of measuring the performance of the health system and the bed census is one very powerful one, mostly because it's done on a daily basis," says Dale.

Dale points to Dr. Rueben Devlin's 32-page report called: "Hallway Health Care: A System Under Strain" released Thursday. It estimates that 1,000 patients at any given time at any given day in a hospital in Ontario receive care in a hallway or other unconventional space.

"I think we always want to be doing everything we can to measure and evaluate hospital and health system performance and if more work needs to be done on that on the bed census then we should do it," said Dale. "But what you're getting directionally is a clear indication of the problem and it's deteriorating."

The most recent data shows there are approximately 5,000 alternate level of care patients of about 30,000 beds in the province overall. That means one in six hospital beds is occupied by somebody who really should be in another, more appropriate setting, said Dale.


Philip Lee-Shanok

Senior Reporter, CBC Toronto

From small town Ontario to Washington D.C., Philip has covered stories big and small. An award-winning reporter with more than two decades of experience in Ontario and Alberta, he's now a Senior Reporter for the National Network based in Toronto. His stories are on CBC Radio's World Report, World This Hour, World at Six and The World This Weekend as well as CBC TV's The National and CBC News Online. Follow him on Twitter @CBCPLS.


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