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Govind Rao

Rural ERs better in Quebec than Ontario - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246200|ntnp|20150506|219898181

from heather rural emerg Ontario Quebec hospital cuts

shared by Govind Rao on 06 May 15 - No Cached
  • National Post Wed May 6 2015
  • Rural emergency departments in Ontario have dramatically fewer CT scans, specialists and nearby intensive-care units than those in Quebec, suggests a new study that adds to evidence of wide quality gaps in Canada's emergency health care. The findings parallel a similar disparity the researchers discovered earlier between rural ERs in British Columbia and Quebec.
  • They are now studying whether that lack of specialists and equipment affects the number of non-urban Canadians who die from trauma, stroke, heart attack and severe infection. The early results are "concerning," said Richard Fleet, a Laval University emergency-medicine professor who co-authored the newest research. "In a rural emergency department, people actually save lives by working as teams," said Dr. Fleet, who practised in a small-town B.C. emergency department before heading to Quebec. "For emergencies ... it's really good to have these backup systems in house."
  • ...4 more annotations...
  • One prominent rural ER physician in Ontario rejected the notion that his province's departments are inferior, saying the focus is more on sending the sickest patients to big trauma centres. Across the country, however, wide variations in emergencydepartment standards definitely do exit, said Alan Drummond, a spokesman for the Canadian Association of Emergency Physicians. "It's a crapshoot, when you go to any hospital in this country, in terms of what you're going to get in the type and quality of care," he said. "We have national variability and for 23 per cent of Canadians (who live outside cities), that's unacceptable." About 6 million Canadians live in rural areas, tend to be older on average, have greater health needs, and are more likely to suffer traumatic injury, partly due to the prominence of dangerous professions like farming and logging.
  • Fleet became interested in the relative quality of emergency service after cutbacks meant his former hospital in Nelson, B.C., could offer only "bare-bones services to a high-risk population." He lobbied for additional funding, but realized there were no published data comparing different Canadian emergency departments. In the most recent study, just published in the journal PlosOne, he and colleagues looked at rural departments with 24/7 service and an ability to admit patients to acute-care beds in their hospitals - 26 facilities in Quebec and 62 in Ontario. If anything, the Ontario ERs appeared more isolated on average, with a greater percentage of them being at least 300 kilometres from a trauma centre.
  • Yet 92 per cent of the Quebec emergency departments had a local intensive-care unit, compared to 31 per cent of the Ontario ones. Just over 80 per cent of the Quebec ERs had a general surgeon available on call, versus a third of the Ontario emergency departments. Fleet said he is not sure why Quebec's rural ERs are better equipped, given the provinces' spending on health care is similar per capita. It may relate to the fact its rural hospitals have fewer foreign-trained doctors, who may feel less empowered to demand better facilities. But Drummond said Ontario has a different protocol that ensures rural ER physicians are well-trained to provide basic emergency services - such as treating shock and blocked airways - and emphasizes funnelling critically ill patients to trauma centres in larger cities. The province's CritiCall system helps rural hospitals find facilities that can take their patients.
  • However, he agreed that having a CT scanner is now crucial to emergency departments anywhere making accurate diagnoses; the one his hospital in Perth, Ont., acquired five years ago "changed the way we practice." Just nine of 62 full-time rural Ontario departments had a CT scanner, according to the new study.
Irene Jansen

New rural emergency centres rely on nurses and paramedics at night | Canada | News | Na... - 0 views

news.nationalpost.com/...nurses-and-paramedics-at-night

rural hospital emerg ems

shared by Irene Jansen on 28 Jan 13 - No Cached
  • a revolution in emergency health care for rural Canada.
  • emergency rooms without doctors
  • Nova Scotia, which now has six of what the province calls “CECs,” or collaborative emergency centres
  • ...10 more annotations...
  • P.E.I
  • Saskatchewan
  • Now, it’s spreading to other provinces
  • For Nova Scotia, this began in 2009, when the government sent Dr. John Ross — its advisor on emergency care and a respected emergency room physician — to tour the province’s ERs. His 2010 plan, “Better Care Sooner” found only about 2% of patients going to rural ERs had real emergencies.
  • Cutting the night shifts in some hospitals, he said, would allow doctors to run more clinic hours.
  • If you lost the physician, you lost the coverage, so the emergency room just closed.
  • Now, Mr. Wilson said, patients can get appointments on 48 hours notice, when previously some had to wait five weeks to see a general practitioner.
  • at the CECs, a doctor, or group of doctors, still cover the busy 12 hours a day. At night, paramedics and nurses are able to treat many of the patients, and are able to quickly transport anyone critical to the nearest full-service ER.
  • “[If] it’s simply because of a doctor shortage, I really don’t think this is acceptable at all,” Dr. Affleck said. “You need to find the appropriate doctors to staff a true emergency department, if that is what the issue is.”
  • Mr. Wilson, though, said he is confident in the province-wide paramedic dispatch, which can quickly triage the call and determine whether a CEC or full ER is required.
Irene Jansen

Senate Social Affairs Committee review of the health accord, Evidence, September 29, 2011 - 0 views

www.parl.gc.ca/...49055-e.htm

accord waits senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Christine Power, Chair, Board of Directors, Association of Canadian Academic Healthcare Organizations
  • eight policy challenges that can be grouped across the headers of community-based and primary health care, health system capacity building and research and applied health system innovation
  • Given that we are seven plus years into the 2004 health accord, we believe it is time to open a dialogue on what a 2014 health accord might look like. Noting the recent comments by the Prime Minister and Minister of Health, how can we improve accountability in overall system performance in terms of value for money?
  • ...97 more annotations...
  • While the access agenda has been the central focal point of the 2004 health accord, it is time to have the 2014 health accord focus on quality, of which access is one important dimension, with the others being effectiveness, safety, efficiency, appropriateness, provider competence and acceptability.
  • we also propose three specific funds that are strategically focused in areas that can contribute to improved access and wait time
  • Can the 2014 health accord act as a catalyst to ensure appropriate post-hospital supportive and preventive care strategies, facilitate integration of primary health care with the rest of the health care system and enable innovative approaches to health care delivery? Is there an opportunity to move forward with new models of primary health care that focus on personal accountability for health, encouraging citizens to work in partnership with their primary care providers and thereby alleviating some of the stress on emergency departments?
  • one in five hospital beds are being occupied by those who do not require hospital care — these are known as alternative level of care patients, or ALC patients
  • the creation of an issue-specific strategically targeted fund designed to move beyond pilot projects and accelerate the creation of primary health care teams — for example, team-based primary health care funds could be established — and the creation of an infrastructure fund, which we call a community-based health infrastructure fund to assist in the development of post-hospital care capacity, coupled with tax policies designed to defray expenses associated with home care
  • consider establishing a national health innovation fund, of which one of its stated objectives would be to promote the sharing of applied health system innovations across the country with the goal of improving the delivery of quality health services. This concept would be closely aligned with the work of the Canadian Institutes of Health Research in developing a strategy on patient oriented research.
  • focus the discussion on what is needed to ensure that Canada is a high performing system with an unshakable focus on quality
  • of the Wait Time Alliance
  • Dr. Simpson
  • the commitment of governments to improve timely access to care is far from being fulfilled. Canadians are still waiting too long to access necessary medical care.
  • Table 1 of our 2011 report card shows how provinces have performed in addressing wait times in the 10-year plan's five priority areas. Of note is the fact that we found no overall change in letter grades this year over last.
  • We believe that addressing the gap in long-term care is the single more important action that could be taken to improve timely access to specialty care for Canadians.
  • The WTA has developed benchmarks and targets for an additional seven specialties and uses them to grade progress.
  • the lack of attention given to timely access to care beyond the initial five priority areas
  • all indications are that wait times for most specialty areas beyond the five priority areas are well beyond the WTA benchmarks
  • we are somewhat encouraged by the progress towards standardized measuring and public reporting on wait times
  • how the wait times agenda could be supported by a new health accord
  • governments must improve timely access to care beyond the initial five priority areas, as a start, by adopting benchmarks for all areas of specialty care
  • look at the total wait time experience
  • The measurements we use now do not include the time it takes to see a family physician
  • a patient charter with access commitments
  • Efficiency strategies, such as the use of referral guidelines and computerized clinical support systems, can contribute significantly to improving access
  • In Ontario, for example, ALC patients occupy one in six hospital beds
  • Our biggest fear is government complacency in the mistaken belief that wait times in Canada largely have been addressed. It is time for our country to catch up to the other OECD countries with universal, publicly funded health care systems that have much timelier access to medical care than we do.
  • The progress that has been made varies by province and by region within provinces.
  • Dr. Michael Schull, Senior Scientist, Institute for Clinical Evaluative Sciences
  • Many provinces in Canada, and Ontario in particular, have made progress since the 2004 health accord following large investments in health system performance that targeted the following: linking more people with family doctors; organizational changes in primary care, such as the creation of inter-professional teams and important changes to remuneration models for physicians, for example, having a roster of patients; access to select key procedures like total hip replacement and better access to diagnostic tests like computer tomography. As well, we have seen progress in reducing waiting times in emergency departments in some jurisdictions in Canada and improving access to community-based alternatives like home care for seniors in place of long-term care. These have been achieved through new investments such as pay for performance incentives and policy change. They have had some important successes, but the work is incomplete.
  • Examples of the ongoing challenges that we face include substantial proportions of the population who do not have easy access to a family doctor when needed, even if they have a family doctor; little progress on improving rates of eligible patients receiving important preventive care measures such as pap smears and mammograms; continued high utilization of emergency departments and walk-in clinics compared to other countries; long waits, which remain a problem for many types of care. For example, in emergency departments, long waits have been shown to result in poor patient experience and increased risk of adverse outcomes, including deaths.
  • Another example is unclear accountability and antiquated mechanisms to ensure smooth transitions in care between providers and provider organizations. An example of a care transition problem is the frequent lack of adequate follow-up with a family doctor or a specialist after an emergency department visit because of exacerbation of a chronic disease.
  • A similar problem exists following discharge from hospital.
  • Poorly integrated and coordinated care leads to readmission to hospital
  • This happens despite having tools to predict which patients are at higher risk and could benefit from more intensive follow-up.
  • Perverse incentives and disincentives exist, such as no adjustment in primary care remuneration to care for the sickest patients, thereby disincenting doctors to roster patients with chronic illnesses.
  • Critical reforms needed to achieve health system integration include governance, information enablers and incentives.
  • we need an engaged federal government investing in the development and implementation of a national health system integration agenda
  • complete absence of any mention of Canada as a place where innovative health system reform was happening
  • Dr. Brian Postl, Dean of Medicine, University of Manitoba, as an individual
  • the five key areas of interest were hips and knees, radiology, cancer care, cataracts and cardiac
  • no one is quite sure where those five areas came from
  • There was no scientific base or evidence to support any of the benchmarks that were put in place.
  • I think there is much less than meets the eye when we talk about what appropriate benchmarks are.
  • The one issue that was added was hip fractures in the process, not just hip and knee replacement.
  • in some areas, when wait-lists were centralized and grasped systematically, the list was reduced by 30 per cent by the act of going through it with any rigour
  • When we started, wait-lists were used by most physicians as evidence that they were best of breed
  • That continues, not in all areas, but in many areas, to be a key issue.
  • The capacity of physicians to give up waiting lists into more of a pool was difficult because they saw it very much, understandably, as their future income.
  • There were almost no efforts in the country at the time to use basic queuing theory
  • We made a series of recommendations, including much more work on the research about benchmarks. Can we actually define a legitimate benchmark where, if missed, the evidence would be that morbidity or mortality is increasing? There remains very little work done in that area, and that becomes a major problem in moving forward into other benchmarks.
  • the whole process needed to be much more multidisciplinary in its focus and nature, much more team-based
  • the issue of appropriateness
  • Some research suggests the number of cataracts being performed in some jurisdictions is way beyond what would be expected to be needed
  • the accord did a very good job with what we do, but a much poorer job around how we do it
  • Most importantly, the use of single lists is needed. This is still not in place in most jurisdictions.
  • the accord has bought a large amount of volume and a little bit of change. I think any future accords need to lever any purchase of volume or anything else with some capacity to purchase change.
  • We have seen volumes increase substantially across all provinces, without major detriment to other surgical or health care areas. I think it is a mediocre performance. Volume has increased, but we have not changed how we do business very much. I think that has to be the focus of any future change.
  • with the last accord. Monies have gone into provinces and there has not really been accountability. Has it made a difference? We have not always been able to tell that.
  • There is no doubt that the 2004-14 health accord has had a positive influence on health care delivery across the country. It has not been an unqualified success, but nonetheless a positive force.
  • It is at these transition points, between the emergency room and being admitted to hospital or back to the family physician, where the efficiencies are lost and where the expectations are not met. That is where medical errors are generated. The target for improvement is at these transitions of care.
  • I am not saying to turn off the tap.
  • the government has announced, for example, a 6 per cent increase over the next two or three years. Is that a sufficient financial framework to deal with?
  • Canada currently spends about the same amount as OECD countries
  • All of those countries are increasing their spending annually above inflation, and Canada will have to continue to do that.
  • Many of our physicians are saying these five are not the most important anymore.
  • they are not our top five priority areas anymore and frankly never were
  • this group of surgeons became wealthy in a short period of time because of the $5.5 billion being spent, and the envy that caused in every other surgical group escalated the costs of paying physicians because they all went back to the market saying, "You have left us out," and that became the focus of negotiation and the next fee settlements across the country. It was an unintended consequence but a very real one.
  • if the focus were to shift more towards system integration and accountability, I believe we are not going to lose the focus on wait times. We have seen in some jurisdictions, like Ontario, that the attention to wait times has gone beyond those top five.
  • people in hospital beds who do not need to be there, because a hospital bed is so expensive compared to the alternatives
  • There has been a huge infusion of funds and nursing home beds in Ontario, Nova Scotia and many places.
  • Ontario is leading the way here with their home first program
  • There is a need for some nursing home beds, but I think our attention needs to switch to the community resources
  • they wind up coming to the emergency room for lack of anywhere else to go. We then admit them to hospital to get the test faster. The weekend goes by, and they are in bed. No one is getting them up because the physiotherapists are not working on the weekend. Before you know it, this person who is just functioning on the edge is now institutionalized. We have done this to them. Then they get C. difficile and, before you know, it is a one-way trip and they become ALC.
  • I was on the Kirby committee when we studied the health care system, and Canadians were not nearly as open to changes at that time as I think they are in 2011.
  • there is no accountability in terms of the long-term care home to take those patients in with any sort of performance metric
  • We are not all working on the same team
  • One thing I heard on the Aging Committee was that we should really have in place something like the Veterans Independence Program
  • some people just need someone to make a meal or, as someone mentioned earlier, shovel the driveway or mow the lawn, housekeeping types of things
  • I think the risks of trying to tie every change into innovation, if we know the change needs to happen — and there is lots of evidence to support it — it stops being an innovation at that point and it really is a change. The more we pretend everything is an innovation, the more we start pilot projects we test in one or two places and they stay as pilot projects.
  • the PATH program. It is meant to be palliative and therapeutic harmonization
  • has been wildly successful and has cut down incredibly on lengths of stay and inappropriate care
  • Where you see patient safety issues come to bear is often in transition points
  • When you are not patient focused, you are moving patients as entities, not as patients, between units, between activities or between functions. If we focus on the patient in that movement, in that journey they have through the health system, patient safety starts improving very dramatically.
  • If you require a lot of home care that is where the gap is
  • in terms of emergency room wait times, Quebec is certainly among the worst
  • Ontario has been quite successful over the past few years in terms of emergency wait times. Ontario’s target is that, on average, 90 per cent of patients with serious problems spend a maximum of eight hours in the emergency room.
  • One of the real opportunities, building up to the accord, are for governments to define the six or ten or twelve questions they want answered, and then ensure that research is done so that when we head into an accord, there is evidence to support potential change, that we actually have some ideas of what will work in moving forward future changes.
  • We are all trained in silos and then expected to work together after we are done training. We are now starting to train them together too.
  • The physician does not work for you. The physician does not work for the health system. The physician is a private practitioner who bills directly to the health care system. He does not work for the CEO of the hospital or for the local health region. Therefore, your control and the levers you have with that individual are limited.
  • the customer is always right, the person who is getting the health care
  • It is refreshing to hear something other than the usual "we need more money, we absolutely need more money for that". Without denying the fact that, since the population and the demographics are going to require it, we have to continue making significant investments in health, I think we have to be realistic and come up with new ways of doing things.
  • The cuts in the 1990s certainly had something to do with the decision to cut support staff because they were not a priority and cuts had to be made. I think we now know it was a mistake and we are starting to reinvest in those basic services.
  • How do you help patients navigate a system that is so complex? How do you coordinate appointments, ensure the appointments are necessary and make sure that the consultants are communicating with each other so one is not taking care of the renal problem and the other the cardiac problem, but they are not communicating about the patient? That is frankly a frequent issue in the health system.
  • There may be a patient who requires Test Y, X, and Z, and most patients require that package. It is possible to create a one-stop shop kind of model for patient convenience and to shorten overall wait times for a lot of patients that we do not see. There are some who are very complicated and who have to be navigated through the system. This is where patient navigators can perhaps assist.
  • There have been some good studies that have looked at CT and MRI utilization in Ontario and have found there are substantial portions where at least the decision to initiate the test was questionable, if not inappropriate, by virtue of the fact that the results are normal, it was a repeat of prior tests that have already been done or the clinical indication was not there.
  • Designing a system to implement gates, so to speak, so that you only perform tests when appropriate, is a challenge. We know that in some instances those sorts of systems, where you are dealing with limited access to, say, CT, and so someone has to review the requisition and decide on its appropriateness, actually acts as a further obstacle and can delay what are important tests.
  • The simple answer is that we do not have a good approach to determining the appropriateness of the tests that are done. This is a critical issue with respect to not just diagnostic tests but even operative procedures.
  • the federal government has very little information about how the provinces spend money, other than what the provinces report
  • should the money be conditional? I would say absolutely yes.
Govind Rao

Seniors-on-stretchers: a health care disgrace; Long waits in the ER are not the fault o... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|243387|ntgm|20140923|204615819

from heather waits hospital emerg continuing care privatization

shared by Govind Rao on 23 Sep 14 - No Cached
  • The Globe and Mail Tue Sep 23 2014
  • apicard@globeandmail.com Can we truly claim to have a modern, humane health system when we leave frail, frightened, elderly people for hours, even days, on gurneys in hospital emergency departments? It's an uncivilized, disrespectful and disgraceful practice. Yet, it's been going on, to varying degrees, since the 1970s and, as the population ages, it's getting worse, not better. The most recent evidence we have comes from Quebec, where Robert Salois, the provincial health and welfare commissioner, has just released a new report in which he traces the "evolution" of emergency care in the province over the past 10 years. It makes for chilling reading, especially if you have a loved one like a frail elderly parent or grandparent who routinely needs medical care. There are two types of patients in hospital emergency departments: 1) The ambulatory who are able to move about and sit to wait for care, and; 2) the nonambulatory, meaning they need a bed or stretcher, and usually come in by ambulance.
  • These patients, in their 70s, 80s and 90s, are essentially living on a gurney for days with little or no access to meals, toilets or privacy, and they are often alone. In fact, the seniors-on-stretchers meme is so commonplace that we take it for granted. The media coverage only tends to start once someone's grandmother has been in the ER for 72 hours or more. Mr. Salois calls the situation "preoccupying" - an understatement if there ever was one - and says policy-makers should be compelled to act, for humanitarian as much as economic reasons. The commissioner makes the point that waits in the ER are not the fault of the ER. The endless bottlenecks are due to problems upstream and downstream. In other words, it's an engineering issue, not a medical one.
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  • In Quebec last year there were 3.4 million ER visits, including 2.3 million ambulatory and 1.1 million non-ambulatory patients. (Canada-wide, it's 14 million visits, with roughly the same two-thirds, one-third split.) According to Quebec's health and welfare commissioner, the ambulatory spend, on average, 4.6 hours in the ER. Almost all are discharged home, none the worse for wear (and waiting). The non-ambulatory are a different story. The true emergencies, the trauma cases that are a mainstay of prime-time TV, have an average wait time of fewer than 10 minutes from the time they hit the ambulance bay. Perhaps we should take some comfort in that, but these "code blue" cases make up fewer than 1 per cent of patients. Most people who come to a hospital emergency department by ambulance will be triaged and treated relatively quickly, but then they will wait. These non-ambulatory patients, most of them frail seniors with chronic conditions like COPD or heart disease, wait, on average, 18.4 hours in the ER. Remember, that's an average; waits of 24 to 48 hours are not uncommon. We stick them in hallways, behind curtains or in transformed broom closets.
  • The commissioner estimates that 60 per cent of patients who go to the emergency room should not be there at all. They should be treated in primary care, by physicians or nurse practitioners. But lots of people don't have a regular doctor and very few of those who do can get same-day appointments for urgent (but not emergency) problems. Healthy people wasting a few hours in the ER waiting room is not, in the grand scheme of things, a big deal, though it doesn't make for good continuity of care. The real worrisome situation is that of the non-ambulatory patients stuck in ER purgatory. Some of the gurney-bound are waiting for a hospital bed, but only about one-third are admitted to hospital. Beds are in short supply because there are many frail seniors already stuck living in hospital with nowhere to go for lack of home care or longterm care beds. The majority of elderly ER patients have the same dilemma: They're not sick enough to be hospitalized, but too sick to go home alone, or back to a nursing home where there is no medical care.
  • It's a perverse scenario that plays out daily and with increasing frequency. But we know the solution. We don't need bigger ERs. We need to shift resources from hospitals into primary care for the ambulatory and home care and community care for the non-ambulatory. Until we do, our parents and grandparents will continue to fill emergency departments and fester in hospital hallways, gasping for care.
CPAS RECHERCHE

Top A&E doctors warn: 'We cannot guarantee safe care for patients anymore' - UK Politic... - 0 views

www.independent.co.uk/...-patients-anymore-8624513.html

UK safety ER

shared by CPAS RECHERCHE on 21 May 13 - No Cached
  • // div.slideshow img { display: none; } 1 / 2Top A&E doctors have warned 'We cannot guarantee safe care for patients anymore'Rex //
  • A combination of “toxic overcrowding” and “institutional exhaustion” is putting lives at risk, according to the letter to senior NHS managers from the leaders of 18 emergency departments.
  • Last week, figures showed that the number of patients attending casualty units in England has increased by a million in the 12 months leading up to January 2013.
  • ...8 more annotations...
  • Speaking before his appearance at the Health Select Committee, he conceded that urgent care services were “getting closer to the cliff edge,” with A&E admission increasing by 51 per cent over the past 10 years
  • The letter from the 20 A&E leaders talks of the “institutional exhaustion” of the nursing, medical and even clerical staff who being pushed ever harder by the growing volume of work with little outside support
  • . It also describes how doctors and nurses are being forced to work in what are verging on dangerous environments
  • They further warn that overcrowding is likely to lead to more deaths in hospitals and reveal that standards of care are deteriorating as serious clinical incidents and delays are rising.
  • The letter states: “The aforementioned issues have led to us routinely substituting quality care with merely safe care; while this is not acceptable to us, what is entirely unacceptable is the delivery of unsafe care; but this is now the prospect we find ourselves facing on too frequent a basis
  • Recent developments such as the introduction of 111 and financial penalties for holding ambulance crews in ED are touted as solutions to the crisis: however we as ED physicians recognise that these measures will actually make the problem worse instead of better, and evidence is already emerging to support our opinions.
  • Furthermore, we firmly believe and strongly recommend that ED leads should be intimately involved with and consulted on the commissioning of Emergency services in the region, as well as other related emergency care changes-such as 111.
  • There is toxic ED overcrowding, the likes of which we have never seen before.
Doug Allan

New thinking needed on emergency medical services for Canada's aging population | Toron... - 0 views

www.thestar.com/..._canadas_aging_population.html

EMS

shared by Doug Allan on 12 Mar 13 - No Cached
  • Details emerged last month about the case of an 87-year-old Toronto woman who lost her life in December. This shocking incident raises difficult questions that need to be answered if a similar tragedy is to be avoided.
  • Worse still, paramedics would have reached the scene when she was still alive but were redirected no less than seven times to other emergencies considered to be more critical.
  • Emergency medical services throughout Canada are struggling to cope with the demands placed on them by an aging population. Because they so often find themselves alone, many elderly citizens often rely on paramedics for help when something goes wrong,
  • ...10 more annotations...
  • Yet there is no guarantee that a hiring blitz will improve things, particularly because hospitals are releasing elderly patients faster than ever.
  • This is why Halifax, and its Extended Care Paramedic (ECP)Extended Care Paramedic (ECP) program, is so important.
  • Here, a paramedic — trained in the health needs of seniors — is assigned to a nursing home.
  • The presence of a paramedic onsite means that calls which once led to emergency rooms visits — falls, wounds and issues relating to palliative care are prime examples — are now dealt with at the nursing home
  • What is also important is that the ECP program has not required an extra infusion of money. Instead, the system was simply reorganized to give existing paramedics a new responsibility.
  • While impressive, this is only a pilot project, one that is based on a long-standing policy used in the United Kingdom, and the city of Sheffield in particular
  • The results proved so successful that an expanded program is now used throughout the U.K.
  • As a result, well over half of those seen are not sent to the emergency room or even the hospital.
  • And because of this, in the areas it is practised, ambulances are able to meet the U.K. standard call response time of eight minutes in the vast majority of cases. In Canada, nine minutes is the benchmark for cities but this is often missed.
  • As for costs, here, too, reorganizing the system rather than hiring a vast number of new staff has helped keep expenses in check. In fact, because emergency room and hospital admittances are down, money has actually been saved.
  • Doug Allan on 12 Mar 13
     
    Placing paramedics in nursing homes as a way to reduce ER pressures and hiring more paramedics
Doug Allan

South West Local Health Integration Network | Innovative Non-Emergency Transportation A... - 1 views

www.newswire.ca/...ansportation-approach-launched

EMS privatization

shared by Doug Allan on 28 Jun 13 - No Cached
  • This LHIN-wide approach, a first in the province, was developed with the collaboration and support of all hospital organizations in the South West LHIN.
  • Standards have now been developed for non-emergency transportation vehicles, including their on-board equipment and qualifications of drivers.
  • Prior to the implementation of this LHIN-wide approach to non-emergency transportation service delivery, there were no established standards to follow, and various transportation providers, including ambulances (EMS), were called upon to transport patients.
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  • "This non-emergency transportation approach is precisely the type of collaborative effort that will help transform the health care system in Ontario. Standardized equipment and qualifications will lead to enhanced quality of care and safety for all the people hospitalized in the South West LHIN." - The Honourable Deb Matthews, Minister of Health and Long-Term Care
  • These service standards will also help meet infection control requirements.
  • Their goals for this initiative were to: Develop transportation standards for vehicles and transportation staff; Create a standardized decision making guide to assist hospital staff to determine the most appropriate services based on the needs of the patient; and Educate users on the appropriate way to use Non Emergency and EMS transport services Select a common supplier to provide the service across the South West LHIN geography.
  • EMS services fully support this development.
  • Neal Roberts, EMS Executive Chief, Middlesex-London Emergency Medical Services Authority and Ontario Association of Paramedic Chiefs Vice President.
  • Doug Allan on 28 Jun 13
     
    Standardized qualifications for drivers.  Response to the scandal of privatized patient transfers uncovered by CBC.  But still no legislation as promised by government. 
Heather Farrow

Angus, Bennett to fly to Attiwapiskat, MPs get emotional during late-night debate on su... - 0 views

www.hilltimes.com/...58531

aboriginal suicide

shared by Heather Farrow on 18 Apr 16 - No Cached
  • More funds and youth involvement are crucial for a long-term solution for remote First Nations communities, says NDP MP Charlie Angus.
  • Monday, April 18, 2016
  • PARLIAMENT HILL—NDP MP Charlie Angus, who is flying to Attawapiskat First Nation on Monday with Indigenous Affairs Minister Carolyn Bennett to meet with Chief Bruce Shisheesh, is calling for immediate action to provide critical services to the 2,000 residents of this northern Ontario community located in his riding.
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  • We need to stabilize the situation in Attawapiskat in terms of making sure they have the health support they need,” Mr. Angus (Timmins-James-Bay, Ont.) told The Hill Times last week. “We need a plan to get people who are needing help in any of the communities to get that help.”
  • A rash of attempted suicides prompted Mr. Angus, who’s also the NDP critic for indigenous and northern affairs, to call for an emergency debate on the ongoing suicide crisis in the James Bay community of about 2,000. As a result, the House of Commons convened until midnight last Tuesday for an emotionally charged discussion on mental health services following a string of incidents in northern reserves in recent months. Several MPs choked up during their statements, recounting suicide incidents in their ridings and personal lives.
  • Sometimes partisan politics need to be put aside and members need to come together to find solutions to prevent another unnecessary loss of life,” Conservative MP Todd Doherty (Cariboo-Prince George, B.C.) said during the debate. NDP MP Georgina Jolibois (Desnethé-Missinippi-Churchill River, Sask.) said the suicide rate went up in her home community of La Loche in northern Saskatchewan after a shooting spree that killed four people last January.
  • Liberal MP Robert-Falcon Ouellette (Winnipeg Centre, Man.) recalled visiting the northern Manitoba Pimicikamak Cree Nation, which declared a state of emergency over a series of suicide attempts last month.
  • Mr. Angus made an emotional appeal to action in his opening remarks during the emergency debate. “We have to end the culture of deniability whereby children and young people are denied mental health services on a routine basis, as a matter of course, by the federal government,” he said. Eleven people attempted to take their lives in Attawapiskat two Saturdays ago, prompting the First Nation to declare a state of emergency—the fourth one since 2006. There has been more than 100 suicide attempts in the reserve since the month of September, many of which involved children. The community has been plagued by flooding and several housing crises in recent years.
  • Eighteen mental health workers were dispatched to Attawapiskat on Tuesday, including two counsellors, one crisis worker, two youth support workers, and one psychologist. While there is no set timeline, they’re not expected to leave for at least two weeks, said Health Canada assistant deputy minister Keith Conn during a teleconference last week.
  • Some of the people treated for mental health problems last week had previously been airlifted out of the community for assessment before being sent back after their examination, according to Mr. Conn. This past Tuesday, at least 13 people, including a nine-year-old child, had made plans to overdose on prescription pills as part of a suicide pact. The Nishnawbe-Aski Police Service apprehended them before sending them to the local hospital for a mental health assessment.
  • Mr. Conn said he’s heard criticism of the mental health assessment process from Attawapiskat First Nation Chief Bruce Shisheesh. Individuals who are identified as likely to commit suicide are typically sent to a hospital in Moose Factory, Ont., to be psychologically evaluated by a psychologist or psychiatrist. They are then discharged and sent back to the community, where some try to take their life again. Mr. Conn said Health Canada does not “control the process,” but he personally committed to review the mental health assessment effectiveness.
  • No federally funded psychiatrists were present in the region prior to the crisis, despite reserve health-care falling under the purview of the federal government. Mr. Conn said the Weeneebayko Area Health Authority (WAHA), a provincial health unit servicing communities on the James Bay coastline, is usually responsible for the Attawapiskat First Nation following an agreement struck with the federal government about 10 years ago.
  • A mental health worker position for the reserve has been vacant since last summer, in part because there’s a lack of housing for such staff. The community has been left without permanent, on-site mental health care services. Since then, the position has been filled by someone already living on reserve. During the emergency debate in the House last week, Health Minister Jane Philpott (Markham-Stouffville, Ont.) emphasized the need for short- and long-term responses to the crisis.
  • We need to address the socio-economic conditions that will improve indigenous people’s wellness in addition to ensuring that First Nations and Inuit have the health care they need and deserve,” she said. Ms. Philpott pointed to the Liberal government’s budget, which includes $8.4-billion for “better schools and housing, cleaner water, and improvements for nursing stations.”
  • “Our department and our government are ensuring that all the necessary services and programs are in place,” she said during the debate. “We are currently investing over $300-million per year in mental wellness programs in these communities.” Yet, Mr. Angus said the budget includes “no new mental health dollars” for First Nations communities. In addition to allocating more funds for mental health services to indigenous communities, Mr. Angus said there needs to be a concerted effort to bring in the aboriginal youth in the conversation.
  • We need to bring a special youth council together,” he told The Hill Times on Wednesday. “We need to have them be able to come and talk to Parliament about their concerns, so we’re looking at those options now.” Emotion was audible in Mr. Angus’ voice when he read letters he received from Aboriginal youth during the emergency debate, which expressed a desire to work with the federal government to solve the crisis.
  • The greatest resource we have in this country is not the gold and it is not the oil; it is the children,” he said. “The day we recognize that is the day that we will be the nation we were meant to be.” Mr. Angus met with Indigenous and Northern Affairs Minister Carolyn Bennett (Toronto—St. Paul’s, Ont.) earlier in the week to discuss potential long-term solutions to the suicide crisis. “I’ve always had an excellent relationship with Carolyn Bennett, and as minister we’re trying to find ways to work together on this, to take the tension down, to start finding solutions,” Mr. Angus said. Mr. Angus criticized “Band-Aid” solutions that have been thrown at First Nations issues over the years and said there needs to be a “transformative change” this time.
  • That’s where we have to move beyond the positive language to actually the brass tacks,” he said. During the emergency debate, Mr. Angus supported the idea of giving more resources to frontline workers such as on-reserve police, and health and treatment centres. 0eMr. Angus’ riding sprawls from shores of the Hudson Bay to the Timiskaming district on the border with Quebec, an area roughly equivalent in land size to that of Guinea. He holds two constituency offices in Timmins and Kirkland Lake.
Govind Rao

Surrey hospital sees 'unprecedented' crowding, multiple infections - Infomart - 0 views

www.fpinfomart.ca/...212716467

from heather hai bc hospital health and safety infectious disease

shared by Govind Rao on 19 Jan 15 - No Cached
  • The Globe and Mail Mon Jan 19 2015
  • Surrey Memorial Hospital is grappling with its highest-ever volumes of emergency patients and an outbreak of the potentially deadly C. difficile, according to an internal bulletin. The bulletin obtained by The Canadian Press informed staff on Friday that the hospital is experiencing "unprecedented" congestion. A Fraser Health Authority spokesman said the emergency room is seeing up to 500 people a day - a significant spike that he attributed to a high number of flu cases in the community.
  • "It's an extremely busy time," said Ken Donohue. "We obviously appreciate the patience that the public has and our staff work hard to see patients as soon as they can." He said the hospital has also declared a C. difficile outbreak, meaning there are three or more cases and staff are taking extra steps to stop the infection from spreading. C. difficile is a bacterium that often spreads through poor handwashing and occurs after antibiotic treatment. The infection and ensuing diarrhea can cause death in the very ill and elderly.
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  • There are also infections of influenza, CPE bacteria and respiratory conditions throughout the facility, but Mr. Donohue said they are not being declared outbreaks. He said the emergency room has a triage system ensuring those with serious illness and injury are seen first, and that patient levels have already fallen over the past 24 hours.
  • But Gayle Duteil, president of the B.C. Nurses' Union, said her members are calling the "chaotic" conditions inside the hospital the worst they've ever seen. "While Fraser Health is describing it as unprecedented, it's certainly not unanticipated," she said, adding that patients are waiting up to 45 minutes to be looked at. Ms. Duteil said the hospital has reopened its old emergency department, that emergency room patients are lining the halls and that there are multiple admitted patients who require hospital care sitting in chairs waiting for beds.
  • "Nurses are professionals and they'll continue to care for any number of patients that come through the door. But it is a very difficult time," she said. Ms. Duteil said the health authority must hire more nurses.
  • Many nurses at the hospital are already on overtime shifts, and the emergency department, intensive care unit and family birthing units are short-staffed. "I certainly feel for the nurses in Surrey, across Fraser Health, the whole health authority today, because this should be prevented," she said. The health authority has set up a "command centre" at the hospital, consisting of a team of staff and leadership that meet regularly to ensure that everyone is working together.
  • The Fraser Health Authority opened Surrey Memorial's new emergency department at a cost of $500-million in October, 2013, but the nurses' union has said it's still too small for the growing population.
Doug Allan

Non-emergency ambulance transfers | Local | News | Kenora Daily Miner and News - 0 views

www.kenoradailyminerandnews.com/...e-transfers-now-being-reviewed

Kenora EMS

shared by Doug Allan on 14 May 13 - No Cached
  • Negotiations to find a solution for the conflict between the region’s hospitals and the Kenora District Services Board over who should pay for non-emergency transfers are ongoing, but there are signs progress is being made.
  • The conflict stems from the question of who should have to pay for ambulance service when it is used to transfer patients between hospitals in non-emergency situations. The district services board has argued the current setup where they have to pay those costs is not sustainable, both financially and from a service perspective.
  • The services board had been sending out bills to hospitals for the transfers, but all of the region’s hospitals refused to pay them, and the province warned the board they were violating the Ambulance Act by sending the invoices to the hospitals.
Irene Jansen

Canadian hospitals turn to Internet to fight emergency room wait times | News | Nationa... - 0 views

news.nationalpost.com/...ight-emergency-room-wait-times

report cards competition abf on hospital alberta

shared by Irene Jansen on 18 Apr 12 - No Cached
  • Patients who log on to the website for Calgary’s hospitals are offered a surprising choice these days: wait times for four emergency departments across the city, posted automatically, 24/7 in “real time.”
  • Kitchener has just become the first in that province to launch its own, enhanced version of the same idea
  • Administrators argue the online information should help patients better decide where to seek out medical aid, spur staff to improve service — and one day even fuel competition between hospitals under new, demand-based funding models.
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  • worry about doctors and nurses cutting corners to speed up the Internet clock, and critically ill patients staying clear of their local hospital because of long queues that might not even apply to them.
  • “It leads to the commercialization of the care we provide in emergency departments,” said Dr. Peter Toth, president of the Canadian Association of Emergency Physicians. “It’s a marketing strategy, perhaps. I’m not sure how it really adds to the overall quality of the experience.”
  • Ontario moves to so-called patient-based funding of hospitals, where the province pays hospitals per patient treated, rather than handing over money in annual lump sums.
  • it seems people are still largely choosing the hospital nearest them, not necessarily the one with the shortest wait time.
  • For the staff working in emergency departments, though, the online postings could have unwanted effects, pushing them to give short shrift to some patients to improve the numbers and satisfy superiors, said Dr. Brian Goldman
  • He also worries about patients choosing the hospital that posts the shortest wait times, potentially meaning a longer trip that could prove fatal for someone suffering a heart attack.
Govind Rao

Emergency room physicians sound the alarm - Infomart - 0 views

www.fpinfomart.ca/...182959983

from heather emerg waits cuts hospital

shared by Govind Rao on 20 Nov 13 - No Cached
  • The Telegram (St. John's) Wed Nov 20 2013
  • Brian Sinclair died waiting in a Winnipeg hospital's emergency room in 2008 after spending 34 hours without seeing a doctor. A double amputee, he had a bladder infection caused by a blocked catheter that could have been cured by antibiotics.
  • CAEP came out swinging this week, decrying overcrowded emergency rooms in Canadian hospitals as a public-health emergency.
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  • CAEP wants national benchmarks established for emergency department wait times, and it wants provincial governments to sign on and to publicly report that data.
Govind Rao

Herb Gray waited 48 hours for a bed: widow; Voted for medicare - Infomart - 0 views

www.fpinfomart.ca/...205019651

from heather conservatives private clinics privatization waits

shared by Govind Rao on 29 Sep 14 - No Cached
  • National Post Mon Sep 29 2014
  • Former deputy prime minister Herb Gray, who was a member of Parliament when medicare was adopted in 1966, was forced to wait in the emergency room at The Ottawa Hospital on a stretcher for 48 hours before being moved to a bed, his widow Sharon Sholzberg-Gray says. Mr. Gray, one of the longest-serving MPs in Canadian history, died at the Civic campus of The Ottawa Hospital in April. He was 82. Mr. Gray suffered from Parkinson's disease, which meant he had frequent falls. That and other chronic conditions sent him to hospital by ambulance four or five times, said Ms. Sholzberg-Gray, where he had to wait in the emergency department on a stretcher until a bed became available. Ms. Sholzberg-Gray, a lawyer who was president of the Canadian Healthcare Association in the late 1990s, said even a career as an advocate for changes that were needed in the health-care system didn't prepare her for the stress and anxiety of having a frail loved one on a stretcher in emergency for so long. Such a long wait without a real hospital bed worsens a patient's condition, she said. "You can't even get off the bed yourself." Spending days in the emergency room, she said, "does not create the best conditions for your future health status."
  • Ms. Sholzberg-Gray said the issues she had argued about as an advocate "became much more real when I faced them day to day." "I spent the last 25 years of my career as president and CEO of different health associations. I was the spokesperson for the publicly funded health system in this country, advocating for appropriate funding so Canadians could have equitable access to programs that met their needs," she said. "Still, I don't think I was prepared for the personal challenge of being the family caregiver and manager and the difficulties that one has to have a continuum of care that was seamless." Ms. Sholzberg-Gray said she doesn't blame the hospital, which provided good care, but she said the health system needs to better meet the needs of the elderly. "The real question is: Should frail elderly people lie behind a curtain for 48 hours? No." The plight of those frail elderly in emergency rooms was highlighted earlier this month when Quebec released a report that found nonambulatory patients - the majority of them seniors - wait an average of 18.4 hours in the emergency room. The Canadian Medical Association is calling for the federal government to take leadership in developing a national seniors strategy. Seniors, notes association president Dr. Chris Simpson, account for 45%-50% of health-care spending, and that will grow.
Govind Rao

Ambulance fees unfair, dangerous obstacle to care - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|tost|20150327|217276859

from heather ems user fees Ontario ally

shared by Govind Rao on 27 Mar 15 - No Cached
  • Toronto Star Fri Mar 27 2015
  • Imagine you're a physician seeing a 6-month-old child in clinic. She has a fever and cough, she's working hard to breathe and her oxygen levels are falling. You know she needs assessment in the emergency room and requires transportation in an ambulance in case her condition worsens en route. Her family understands the urgency of the situation, but asks, "Could we take her there in our car?" Experiencing a medical emergency is an incredibly stressful experience for patients and their families. This stress should not be compounded by worries about getting an ambulance bill they can't afford. As physicians, we know the importance of the first few minutes of an emergency situation, and the crucial role of Emergency Medical Services (EMS) in saving lives. And yet ambulance fees remain a significant barrier to people receiving necessary care across Canada.
  • One young mother recently spoke to the Saskatchewan press about receiving a bill of $7,000 after several ambulance trips were required for her severely ill daughter. Connie Newman of the Manitoba Association of Seniors Centres recently described to reporters the plight of an elderly woman who walked to the hospital in -40 C because she could not afford an ambulance. How often are people forced to choose the unsafe option of driving themselves or their loved ones to hospital simply because they cannot afford to pay? A recent CBC Marketplace survey revealed that 19 per cent of Canadians did not call an ambulance due to cost. Clearly, this is an issue that our provincial and territorial health ministers need to address. A look across our provinces and territories reveals a patchwork system for financing ambulance services. New Brunswick has recently removed ambulance fees for anyone who does not have private insurance coverage. All other provinces and territories in Canada - with the exception of the Yukon - charge ambulance fees. The burden of cost to patients is highest in the prairies: Manitoba charges up to $530 per trip, and Saskatchewan tacks on fees for interhospital transfers on top of the $245-$325 fee for an ambulance pickup from home.
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  • In Ontario, the cost is typically much lower at $45 per trip, but increases to $240 if the receiving physician deems it unnecessary. The reality on the ground violates the spirit, if not the letter, of the Canada Health Act: Equal access to physician and hospital services means little if safe passage to them is anything but. There are a variety of options to reduce this inequity in access. One option is to follow New Brunswick's lead and offer full coverage. An alternative would be to only charge users if the ambulance ride is deemed medically unnecessary. However, differentiating "appropriate" from "inappropriate" ambulance use isn't straightforward, and can vary between providers. What's more, evidence suggests that institutions - schools, long-term care facilities, hospitals and police services - more often initiate potentially unnecessary ambulance services than do individuals, as a result of compliance with internal policy or protocol.
  • As with other areas of health care, user fees are a blunt tool: they reduce both necessary and unnecessary use of services. The risk of footing the bill could deter people, especially those living in poverty, from calling for help. This would deny them not only safe transport to hospital, but also the initial emergency interventions by paramedics that can mean the difference between life and death. Public education and enhanced availability of primary care are more effective ways to decrease unnecessary ambulance use. Ideally, ambulance services should be fully covered for everyone. This would, however, require provincial governments to take on more of the costs. In Nova Scotia, that cost is an estimated $9.7 million, according to the Nova Scotia Citizen's Health Care Network. This is a drop in the bucket of the $6.2-billion Nova Scotia health-care budget; a small investment to ensure everyone, regardless of income, has access to vital emergency care. The variety and inequity of ambulance charges in Canada is a policy mess. Canada's health ministers should work together to establish a consistent and compassionate approach that balances cost with the need to remove barriers to care. Ryan Meili is an expert adviser
  • with EvidenceNetwork.ca, a family physician in Saskatoon and founder of Upstream: Institute for a Healthy Society. @ryanmeili Carolyn Nowry is a family physician in Calgary. They are both board members with Canadian Doctors for Medicare.
Cheryl Stadnichuk

Health Reform In Ontario Must Include Oral Health Care | Jacquie Maund - 0 views

www.huffingtonpost.ca/...reform-ontario_b_10071550.html

dental Medicare Ontario

shared by Cheryl Stadnichuk on 25 May 16 - No Cached
  • 05/23/2016 1
  • The Ontario government's proposed reform of the provincial health-care system is going forward with a glaring omission: primary mouth care. To make this reform truly "Patients First," Dr. Eric Hoskins, Minister of Health and Long Term Care, must include primary care for the mouth.
  • Dentists are not part of the primary health-care system and physicians are not trained to deal with mouth diseases, such as those that affect teeth and gums. Primary mouth care is not covered under OHIP, and hospitals are not equipped to deliver dental care. Ontario only has public dental programs for low income children under 18, and a patchwork of basic services for people receiving social assistance.
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  • In 2014, there were almost 61,000 hospital emergency room visits for dental problems. The most common complaints were abscesses and dental pain. It is estimated that every nine minutes a person shows up in a hospital emergency room with a dental problem. The minimum cost of each hospital visit is $513. As a result, taxpayers spend approximately $31 million annually to have physicians acknowledge that patients have dental disease which they cannot treat.
  • The College of Dental Hygienists of Ontario estimates that two to three million Ontarians have not seen a dentist in the past year. The main reason is the cost.
Heather Farrow

Breaking News: Success! Patients, Residents Travel 700 kilometres to Ontario Legislatur... - 0 views

www.ontariohealthcoalition.ca/...hospitals-emergency-department

Ontario coalition hospital cuts victory

shared by Heather Farrow on 20 Apr 16 - No Cached
  • April 18, 2016
  • Toronto – At a press conference today at Queen’s Park, patients and concerned citizens from Wallaceburg issued an urgent plea to Ontario’s Minister of Health to stop the closure of the Wallaceburg Hospital’s Emergency Department. The residents, who are traveling more than 700 kilometres across the province and back to bring their message to Ontario’s Legislature, told their stories of how the Wallaceburg emergency department has saved the lives of their family members and friends. Their local MPP Monte McNaughton greeted them in the Legislature, wrote a letter to the Health Minister advocating to keep the Emergency Department open and delivered hundreds of personal letters from community members to the Premier today.
Heather Farrow

Paramedicine expands to rural communities in B.C. - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|bccp|20160427|245817592

bc ems cupe rural

shared by Heather Farrow on 02 May 16 - No Cached
  • Williams Lake Tribune Wed Apr 27 2016
  • Alexis Creek, Anahim Lake, Bella Bella and Bella Coola have been named as remote B.C. communities that will welcome community paramedicine. Alexis Creek, Anahim Lake, Bella Bella and Bella Coola have been named as some of the 73 rural and remote B.C. communities that will welcome community paramedicine, a program that offers residents enhanced health services from paramedics. Health Minister Terry Lake made the announcement Wednesday.
  • "The Community Paramedicine Initiative is a key component of our plan to improve access to primary health-care services in rural B.C.," Lake said. "By building upon the skills and background of paramedics, we are empowering them to expand access to care for people who live in rural and remote communities, helping patients get the care they need closer to home." The program is just one way the Province is working to enhance the delivery of primary care services to British Columbians. The services provided may include checking blood pressure, assisting with diabetic care, helping to identify fall hazards, medication assessment, post-injury or illness evaluation, and assisting with respiratory conditions.
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  • Under this program, paramedics will provide basic health-care services, within their scope of practice, in partnership with local health-care providers. The enhanced role is not intended to replace care provided by health professionals such as nurses, but rather to complement and support the work these important professionals do each day, delivered in non-urgent settings, in patients' homes or in the community. "As a former BC Ambulance paramedic, I understand the potential benefits of community paramedicine," said Jordan Sturdy, MLA for West Vancouver-Sea to Sky. "Expanding the role of paramedics to help care for the health and well-being of British Columbians just makes sense." Community paramedicine broadens the traditional focus of paramedics on pre-hospital emergency care to include disease prevention, health promotion and basic health-care services. This means a paramedic will visit rural patients in their home or community, perform assessments requested by the referring health care professional, and record their findings to be included in the patient's file. They will also be able to teach skills such as CPR at community clinics.
  • "Community paramedics will focus on helping people stay healthy and the specific primary care needs of the people in these communities," said Linda Lupini, executive vice president, BC Emergency Health Services. "This program also allows us to enhance our ability to respond to medical emergencies by offering permanent employment to paramedics in rural and remote areas of the province." "Community paramedicine brings improved patient care and more career opportunities to rural and remote areas," said Bronwyn Barter, president, Ambulance Paramedics of BC (CUPE 873). "Paramedics are well-suited to take on this important role in health-care provision." Community paramedicine was initially introduced in the province in 2015 in nine prototype communities. The initiative is now expanding provincewide, and will be in place in 31 communities in the Interior, 18 communities in northern B.C., 19 communities on Vancouver Island, and five communities in the Vancouver coastal area this year.
  • At least 80 new full-time equivalent positions will support the implementation of community paramedicine, as well as augment emergency response capabilities. Positions will be posted across the regional health authorities. The selection, orientation and placement process is expected to take about four months. Community paramedics are expected to be delivering community health services in northern B.C. this fall, in the Interior in early 2017, on Vancouver Island and the Vancouver coastal area in the spring of 2017. BC Emergency Health Services has been co-ordinating the implementation of community paramedicine in B.C. with the Ministry of Health, regional health authorities, the Ambulance Paramedics of BC (CUPE 873), the First Nations Health Authority and others. Copyright 2016 Williams Lake Tribune
Irene Jansen

HCA, Giant Hospital Chain, Creates a Windfall for Private Equity - NYTimes.com - 0 views

www.nytimes.com/...ndfall-for-private-equity.html

us hospital hca fraud staffing quality corporation

shared by Irene Jansen on 22 Aug 12 - No Cached
  • profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California, have soared
  • The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.
  • only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion
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  • 35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms
  • HCA’s cardiac business is extremely lucrative, and the Justice Department has requested reviews that HCA conducted that indicate some of the heart procedures at some of its hospitals might not have been necessary and resulted in unjustified reimbursements from Medicare and other insurers.
  • HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance.
  • In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.
  • inadequate staffing in important areas like critical care
  • Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.
  • One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not documenting whether ordered tests had been performed.
  • Claiming he provided poor care, the other hospital did not renew Dr. Awwad’s privileges. Dr. Awwad is suing to have them reinstated.
  • “If you were a for-profit hospital with investors and shareholders,” said Paul Levy, a former nonprofit hospital executive in Boston unaffiliated with HCA, “there would be a natural tendency to be more aggressive and to seek more revenues.” Executives at profit-making hospitals are “judged in greater measure by profitability” than the administrators of nonprofit hospitals, he said.
  • some of HCA’s tactics are now under scrutiny by the Justice Department. Last week, HCA disclosed that the United States attorney’s office in Miami has requested information about cardiac procedures at 10 of its hospitals in Florida and elsewhere.
  • Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff
  • Small and nonprofit hospitals are closing or being gobbled up by medical conglomerates, many of which operate for a profit and therefore try to increase revenue and reduce costs even as they improve patient care. The trend toward consolidation is likely to accelerate under the Obama administration’s health care law as hospitals grapple with what are expected to be lower reimbursements from the federal and state governments and private insurers.
  • Columbia/HCA became the target of a widespread fraud investigation in the late 1990s, which led to one of the largest Medicare settlements ever.
  • HCA wanted to attract more patients to its emergency rooms, and it did. Annual visits climbed 20 percent from 2007 to 2011. But while emergency departments are often a critical source of patient admissions, they are frequently money-losers because many patients do not have insurance. HCA found a solution: it figured out how to be paid more for the patients it was seeing.
  • Nearly overnight, HCA’s patients appeared to be much, much sicker.
  • No one has accused HCA of up-coding, or billing for more expensive services that were not needed — one of the complaints made against it a decade ago.
  • The acting head of Medicare is Marilyn B. Tavenner, a former HCA executive who left there in 2005 to become the secretary of Health and Human Resources in Virginia.
  • Several former emergency department doctors at Lawnwood Regional Medical Center in Fort Pierce, Fla., said they frequently had felt compelled to override the screening system in order to treat patients.
  • When the doctors failed to meet the hospital’s goals for how many patients should be considered emergencies, “they really started putting pressure on.”
  • Regulators in several states have taken HCA hospitals to task over screening out patients too aggressively, including situations where the screening missed serious conditions.
  • “Staffing is critical,” said Courtney H. Lyder, the dean at the UCLA School of Nursing and an expert on wound care. “When you see high levels of wounds, you usually see a high level of dysfunctional staff,” he said.
  • HCA owned eight of the 15 worst hospitals for bedsores among 545 profit-making hospitals nationwide, each with more than 1,000 patient discharges, tracked by the Sunlight Foundation using Medicare data from October 2008 to June 2010.
  • an examination of lawsuits shows bedsore problems have been persistent at several HCA facilities
  • The hospital was cited twice by Florida regulators, in 2008 and 2010, for having inadequate numbers of nurses on its staff to oversee wound care for patients.
Irene Jansen

Length of stays for patients reduced - 0 views

www.edmontonjournal.com/...story.html

emerg waits hospitals lean tqm

shared by Irene Jansen on 23 Jan 12 - No Cached
  • A University Hospital pilot project has successfully made one unit work as intended: quickly accepting emergency patients and providing team care for twice as many patients who are able to return home twice as fast.
  • will see it expanded to other hospital wards at the University and Royal Alexandra hospitals, and, eventually, all Alberta hospitals.
  • The project was launched last October for emergency patients who need to be admitted for pneumonia, congestive heart failure or other general internal medicine issues. These are the sickest patients, often seniors, who need acute care or additional rehabilitation services for multiple chronic health problems before they're ready to return home.
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  • Under the project, four wards with 18 beds each were opened to quickly accept the general internal medicine patients from emergency. Instead of waiting one full day in emergency, patients now wait an average of 5.1 hours before being transferred to the new units
  • Once there, the medical professionals come to them
  • has reduced the average length of stay in hospital by about five days, from 10 for these specific patients.
Irene Jansen

Seniors at risk of catching infections in ER - Health - CBC News - 0 views

www.cbc.ca/...seniors-infection-er.html

hai emerg ltc

shared by Irene Jansen on 24 Jan 12 - No Cached
  • A new study suggests emergency departments may be a source of infections for seniors who turn to them for care, and a potential starting point for some of the infectious outbreaks that make their way through long-term care facilities.
  • those who had been to Emerg were nearly four times more likely to have a respiratory or gastrointestinal infection in the week after the hospital visit than seniors who had not been to the hospital
  • take additional precautions for the week upon their return to the long-term care facility — in particular during the winter months."
  • ...2 more annotations...
  • the risk in emergency departments themselves, even if you actually haven't been on a hospital ward
  • The paper suggests long-term care facilities might consider using infection control precautions for five to eight days after a resident has been to the emergency department.
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