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Archive for July, 2015
Tuesday, July 14, 2015

Enhancing the Delivery of Care


Enhancing the Delivery of Care
Hospital beds can be a scarce resource.  When it comes to availability of beds, we often hear that hospitals are “bursting at the seams” and there are times when Prairie Mountain Health (PMH) is no exception to this reality.

Regardless of how you enter the health care system, through the emergency department or for scheduled surgery, a bed to meet your care needs may be required.  No matter when or where patients are admitted – Prairie Mountain Health  wants to make sure that they  will receive quality, safe care in the right place, at the right time, and by the right provider.  There are times when some acute care facilities reach bed capacity, causing backlogs and affecting other areas of the health system.  This can mean acutely ill patients cannot be admitted or surgeries that have been scheduled for months in advance may have to be postponed because there is not an inpatient bed available.

To ensure that beds are available in the right place for those who require them PMH has developed a policy to assist in managing the appropriate use of hospital beds.  When beds in a hospital are nearing capacity, the health care team will review all current inpatients to determine if there are alternative locations/ options for care.  The goal is to have the patients cared for as close to where they live as possible, but the priority will be safe, quality care in the beds that are available.  “We understand the inconvenience patients and their families may feel as a result of a transfer out of their community – however, it is important to realize that there are acutely ill patients needing these beds,” says Penny Gilson, Chief Executive Officer of Prairie Mountain Health region.  “We need to be able to ensure that cancer patients can get their surgeries; that cardiac patients can be admitted; and that trauma victims have access to a level of care needed for their recovery.”

LARGEST REFERRAL CENTRE OF PMH
The Brandon Regional Health Centre (BRHC) is the largest referral centre for high care needs in Prairie Mountain Health.  BRHC provides speciality services to the region and in order to maintain that level of service beds need to be available.  The “bed” is not simply a place for the patient to sleep.  Other factors must be considered. Patients with specific needs have to be placed in areas designed to care for those needs, meaning special equipment and specialized staff.   Brian Schoonbaert is the Chief Operating Officer of the BRHC.  He says the public needs to understand this will not happen all the time only when it is absolutely necessary.  “Sometimes acute care beds are occupied by patients waiting to be placed in a personal care home or by patients who are “stable” and do not require the specialized or more intensive care offered by the larger health care sites.   If beds are needed in these specialized centers, there are other places within the region where other patients can get excellent quality, safe care.”
Schoonbaert says BRHC has faced a shortage of beds for some time, and it continues to be a problem for a number of reasons.  Canada’s aging population means people are living longer and often their long term care becomes more complex.  The Prairie Mountain Health region has a growing population.  As well, the addition of the Western Manitoba Cancer Centre in Brandon means that some of these patients may need beds during treatment.

RIVERS REHABILITATION CENTRE
The practice of moving patients to another facility to improve patient flow and provide the best possible care is not new to the region.  Several years ago BRHC faced a shortage of beds for rehabilitation for orthopedic patients getting procedures such as hip and knee replacements. A pilot project was implemented in Rivers where the health centre became a rehabilitation centre for these types of surgeries.  Without this additional rehabilitation capacity, Brandon would not have been able to do more surgeries to address wait times.  The Rivers Health Centre has staff who specialize in care for (orthopedic) rehabilitation patients e.g. physiotherapist, occupational therapist, rehab aides, nurses.  This program has been evaluated as being very successful.  The patients are very satisfied with their care. One patient provided the following feedback, “There are simply not words strong enough or unique enough to describe how impressed and thankful I am for this unit and this staff. Thank you seems so inadequate.”

TRANSITIONAL CARE SITES
Another way Prairie Mountain Health addresses bed use is by designating some facilities as transitional care sites. Transitional care sites came about as a result of some rural hospitals not having the necessary resources to sustain the facility operating as an acute care centre with emergency services.  It was determined that these facilities could still serve a valuable purpose by operating as a transitional care site.   Transitional care is the care of a patient who does not require 24/7 medical supervision by a physician but still requires some 24/7 nursing care.  There is a variety of different circumstances where this type of care is appropriate
- Patients who are waiting to be placed in a personal care home, when a bed is not yet available for them at the facility of their choice.  These patients are no longer able to manage at home, even with home care supports, so require admission to a health care facility for nursing support (or 24/7 nursing care) but do not require the 24/7 medical care.
- Patients who need to be admitted to provide their caregiver a break (respite care).
 - Patients who are recovering -  who have been acutely  ill and hospitalized at an acute care centre but no longer require the 24/7 medical care only available at acute care sites.

Pat Cockburn is the Senior Advisor Acute Care and Nursing for Prairie Mountain Health, “For example someone comes into the Brandon emergency department and they have pneumonia and they need a bed because they are frail and elderly.  They could be admitted to Souris or Minnedosa or another PMH facility where their needs can still be met in a safe environment.  We need to try and admit people to the appropriate place and ensure the beds in Brandon are available for those who need that level of care.”  Cockburn sited an example when the Swan Valley Health Centre had no acute beds open going into a weekend.  An assessment was done on some inpatients resulting in transfers to Grandview and Gilbert Plains so that there were acute care beds available in Swan River. 

In another situation, an elderly couple was admitted to two separate hospitals one in the rural area and the other to the Brandon Regional Health Centre.  Due to their medical conditions they were not able to return home and the process began to have them moved to a personal care home.  Their first choice home would have seen them wait for a long time and no guarantee they could be placed in the same home.  During this time, two beds became available in another rural personal care home not located in their home community.  After touring the facility with family, they decided to move into that care home.

Today they are together and happy which may not have happened if they had waited for their first choice.  In turn, this move opened up to two acute care beds in two facilities that are often full to capacity.

It is now policy that anytime someone is admitted to a PMH facility a staff member will go over an interim placement transfer notification letter.  It is to make sure that the patient and their family if possible, are aware of the possibility that a transfer may occur.  Before any transfer takes place many factors will be looked at; how medically stable a patient is; can the receiving facility manage that patient’s care needs; what available location would result in the least amount of inconvenience for family/social supports; are there other options for care – can family take the patient home; would additional home care supports, if available, facilitate discharge home; etc.  If a transfer needs to happen, every effort will be made to try and move to a location as close as possible to the patient’s community of residence.  

PMH recognizes that admission to hospital is often a stressful time for not only the patient but their family.  It would never be anyone’s intent to make this time more stressful, but it is important to note that there are not always the exact right resources in the exact right location to meet all demands.  Prairie Mountain Health hopes that people will understand that no one ever knows if they might need lifesaving surgery or intensive care but if one day they do having a bed available at the right time could make all the difference.  PMH asks for people’s cooperation and understanding that if one day that someone is you or your family member, then a bed with the right care will be available at the time you need it.  Thank you for your anticipated patience as we try to ensure all Prairie Mountain Health residents get the care they need.

Posted by Regional Health Authority @ 17:17 | E-mail this blog entry to a friend | PermaLink


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