March 04, 2012 at 11:47 AM
Ambulances and patients were backed up at Royal Jubilee Hospital’s emergency department again Friday as Vancouver Island Health Authority officials activated their highest-level emergency procedures to deal with the backlog.
Around noon Friday, about seven ambulances were lined up in the hospital’s emergency bay, with 28 patients admitted and waiting for a bed.
The B.C. Ambulance Service advised paramedics that Royal Jubilee was not the best option, but there was no official order redirecting them to Victoria General Hospital. That decision was left to patients and ambulance crews.
VIHA, which is preparing to roll out two major initiatives to aid better “patient flow,” confirmed it has had more patients admitted through the ER than beds most days over the last few months — a challenge it said is facing hospitals across the province.
“It’s fair to say the vast majority of the time we’ve had a significant number of admitted patients in the ER department waiting for in-patient beds,” said Elin Bjarnason, VIHA’s executive director of patient flow and care transition.
“We do take it very seriously and we really are working very hard to improve the situation,” Bjarnason said. Almost 60 more beds have been opened, and plans enacted, but more sustainable solutions are needed, she said.
Bjarnason said two major strategies rolling out in the next few months are expected to be fully up and running by September. Home First, a provincial strategy with its roots in Ontario, aims to get patients from hospital quicker with appropriate home supports.
The second strategy involves a major review and redesign of post-acute rehabilitation services to “streamline” access to those services and again, get patients home quicker with appropriate services at home and in the community.
On Friday, the hospital moved to its highest level of procedures for dealing with over-crowding, called Stage 5; every department was scoured for possible bed availability. These days, there are almost daily teleconferences on how to “decompress” the ER, confirmed VIHA spokeswoman Shannon Marshall. The over-crowding procedures are implemented when more than 20 patients are admitted in the emergency room.
Royal Jubilee’s emergency department has 17 stretchers and as many as 12 overflow beds, according to the union.
On Feb. 20, John Waterman, 91, a British war veteran whose leg has been amputated, waited in Royal Jubilee’s crowded ER from Monday through Wednesday afternoon before getting a room.
Having fallen out of his bed in his Cadboro Bay home and suffering from a bladder infection, Waterman was taken by ambulance to the ER where he was “shuffled from one corner of the hospital to another” — alternating between his wheelchair and a stretcher as they were available.
“The nurses and doctors seem to be doing a good job, but they didn’t seem to have any accommodation,” Waterman said.
Dazed and confused by his infection, the drugs, and the merry-go-round in the ER, when Waterman was finally admitted to a bed in the hospital’s new $349-million Patient Care Centre, he thought he was in a hotel and ordered tea and a wider bed to accommodate himself and his wife.
Wife Beryl, 88, also a war vet, admitted the new room was so nice it resembled a hotel. “Staff do the best they can but they’re very stressed and there’s not enough of them.”
Registered nurse Margo Wilton, who represents the south Island for the B.C. Nurses Union, said she visited the ER Friday because of the overcrowding. Among other things, she saw a woman stomping out of the ER complaining about the wait for her family member, too few staff and beds, and where exactly her taxes were going.
“The nurses are distraught, and I’m not using that word lightly” said Wilton. “Yes there are issues with workload, long hours and no breaks, but what’s really upsetting them is that they are not caring for the patients in the way they should be looked after. They are horrified at the level of care they are providing.”
Bjarnason said she appreciates how the staff are feeling despite the number of strategies put in place. “I don’t think we’re in a crisis in the emergency but I support the nurses in their call for improved flow,” Bjarnason said.
Lorne McGruer, 60, living with terminal colon cancer for two years, is no stranger to the hospital and confesses to loving his time with nurses and patients on the oncology ward and at the B.C. Cancer Agency. However, even he was taken aback by his ER wait on Feb. 21.
With a fever and his immune system significantly compromised by chemotherapy, McGruer, who arrived Tuesday morning, didn’t get a bed on the oncology ward until the next day at 4 p.m.
“The waiting room was packed, there was seven of us in the hallway, and I had no white blood cells,” McGruer said. “They are doing wonders with the paper and string they have but ...”
There are 136 beds sitting empty in the care centre with no funding to operate them — 68 beds on the fifth floor, as well as 34 beds on both the fourth and seventh floors, according to the BCNU.
VIHA said there are more beds at Royal Jubilee now since the care centre opened and the extra beds are reserved for future capacity.
McGruer said they should be opened now.
“Opening up additional in-patient beds hasn’t solved the issue,” Bjarnason said. “We need to work around sustainable solutions around patients moving back to the community in a timely way and supporting people in the community and in residential facilities so they don’t have to come to the hospital.”