Hospital bed tie-ups drive long waits

About one in six hospital beds is occupied by patients who should be receiving care elsewhere, a new report finds.

About one in six hospital beds is occupied by patients who should be receiving care elsewhere, a new report finds.

Tuesday's sixth annual report card from the Wait Time Alliance highlights how these stays lengthen wait times to the detriment of patients in both emergency and elective or scheduled care. 
Patients who don't need to be in hospital beds would receive more appropriate and cost-effective care outside hospital, says ophthalmologist Dr. Lorne Bellan, chair of the Wait Time Alliance. (Richard Lam/Canadian Press)

"A myriad of factors lead to long waits for care, but the high number of hospital patients waiting for alternative levels of care such as rehabilitative or long-term care is likely the single-biggest cause of wait times," said Dr. Lorne Bellan, chair of the alliance.

"Even more important is the fact that these patients would receive more appropriate and cost-effective care outside of the hospital," he added in a statement.

The patients occupying hospital beds that could be cared for somewhere else tended to be older, with an average age of 80. They often have dementia and other chronic conditions.

They often stay in hospital for about 26 days, and usually come in through the emergency department, the report showed.

When one of these patients takes up an acute-care bed, about four patients per hour are denied access to emergency, the report estimated.

'Interesting alternatives'

Investing in home care and offering more support for family caregivers are "interesting alternatives" that need to be explored, Bellan told reporters.

As an example, Ottawa Hospital was above 100 per cent occupancy on Tuesday, in part because of people taking up acute-care beds unnecessarily, said Dr. Jeff Turnbull, the hospital's chief of staff.

About 25 people have been admitted and are waiting in the emergency bed for a bed, but they'll have to wait on average for more than 24 hours, Turnbull said. 

"We have ambulances waiting to offload, we have patients waiting to get into the hospital, and we have cancelled surgery as a consequence of patients waiting to get into long-term care," said Turnbull, who is also the president of the Canadian Medical Association.

Doctors, hospitals and health groups, including the Health Council of Canada, have cited the same backlog — beds taken up by people who no longer need hospital care but can’t look after themselves at home and are waiting to get into long-term care or other homes.

The report card comes as governments prepare for the expiry of the 10-year accord on health care in 2014.

Health minister Leona Aglukkaq remained optimistic, saying there are still a few years left in the agreement. Aglukkaq said there are still a few years left in this agreement, and that she'll continue to work with the provinces and the territories to address their health care accord priorities. 

"In our discussions to renew the accord we will stress the importance of accountability and results, to ensure that the needs of Canadians come first, and that wait times for medically necessary procedures continue to get shorter," Aglukkaq said in an e-mailed statement to the Canadian Press.

There has been a slight improvement over the last year for the original five benchmarks that governments agreed to, namely diagnostic imaging, joint replacement, radiation oncology, cataract surgery and bypass surgery, according to the report card.

This year, Ontario, Quebec and British Columbia performed strongly, the alliance said, while Nova Scotia and Alberta were lagging. The overall national grade for the five priority areas was a grade of "B."

"If I think back to what my goals and dreams were seven years ago … I would have said, 'Well, OK, at this point, or even a couple of years ago, we should've had A's across the board for the five priority areas,' because the 'A' grade just means that everybody is getting care and in a time frame they're supposed to get it in," Bellan said. 

Other benchmarks

The group also assigned grades beyond the five priority areas, noting governments are reporting on just over 10 per cent of benchmarks that include:

  • Radiation therapy and curative care for breast, prostate and lung cancer.
  • Gastroenterology, such as colonoscopy following a positive fecal occult blood test.
  • Emergency department waits for both admitted and non-admitted patients.
  • Total hip and knee replacements.
  • Cardiac care such as cardiac rehabilitation.
  • Scheduled tests in nuclear medicines like whole body bone scans.

Ontario, Alberta, Nova Scotia, B.C. and Saskatchewan provide wait-time data on the most treatments, the group said.

The report's authors also graded provincial wait-times websites on how comprehensive they were.

In the report, an "A" grade means that 80 per cent of all people are being treated within the time set in the benchmark. This falls to 70 per cent to 79 per cent for "B," and 60 per cent to 69 per cent for "C."

The Wait Time Alliance was created in 2004 to provide governments with advice from the physicians' perspective on medically acceptable wait-time benchmarks.

It includes the Canadian Medical Association, and other national organizations representing experts such as radiation oncologists and cardiovascular specialists.

With files from CBC's Susan Lunn and The Canadian Press