Hospital re-admission rates debated - Infomart - 0 views
www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|pgsf|20151008|230920202
from heather Ontario cupe hospital readmissions campaign rural cuts
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Smiths Falls EMC Thu Oct 8 2015
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A union representing employees at the Perth and Smiths Falls District Hospital (PSFDH) is charging that re-admission rates have risen 16.5 per cent over the past several years. Hospital management, however, is disputing this, pegging the number much lower, at about seven per cent. During a press conference at the Smiths Falls branch of the Royal Canadian Legion on Tuesday, Sept. 29, Michael Hurley, president of the Ontario Council of Hospital Unions (OCHU), said that their statistics were drawn from information stretching from 2009 to 2014 from the Canadian Institute for Health Information, and focused specifically on the PSFDH but also the Brockville General Hospital too.
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"A re-admission is a system failure," said Hurley. "People who were discharged were coming back in...in significant numbers." John Jackson, president of CUPE (Canadian Union of Public Employees) local 2119, who works at the Perth and Smiths Falls District Hospital, agreed.
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"Where beds have been cut in the community, there has been a spike in re-admission rates," said Jackson. His own hospital saw 12 beds, six at each site, cut back in 2013. "I can't speak about individual cases," he added, but Mike Rodrigues, vice president of CUPE local 1974, who works at the Kingston General Hospital (KGH), has seen, first-hand, patients being sent home to free up beds at his workplace. "There are two huddles a day," said Rodrigues, where upper management and the hospital's chief executive officer confer at 9:15 a.m. and 2:15 p.m. to discuss "Who can go today? Who can we get out?" when there is "gridlock," at the hospital, such as long waiting room times. "It's difficult," Rodrigues said. But, "you tow the party line. They do what they are told."
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He conceded that the doctors and nurses likely do a triage of who is best able, of all of the patients on the floor, to go home, but he has seen, in the last 10 years alone, women being sent home 10 to 12 hours after giving birth to a child, whereas, in 2005, that mother could have stayed three to four days in the hospital. Hurley said he has heard of patients who "are not well enough to be sent home...fighting with their doctors," who are trying to discharge them. "A lot of pressure is put on the family," from the hospital administration and doctors, Hurley added, with the hospital threatening to charge families as much as $300 to $1,000 a day for each additional day their loved one remains in hospital - something he says is illegal. He saw such a scenario with his own mother.
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"She can't stay here," he was told. "'What're you going to do with her?' She died in hospital." Very often, according to Hurley, a patient may acquire a hospital-borne virus while recovering from a surgery, but "people are being moved through the system much more quickly," than they used to be, sometimes without sufficient recovery periods, and then, "the system has a second go at making them better." But this not only causes distress for the family and the health system, but also in the workforce too. "A huge number of people in Ontario do not have paid sick leave," said Hurley. "The personal cost to me (as a returning patient) is significant...It's a health setback, it's a psychological setback."
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Hurley added that hospitals in both Kingston and Ottawa were experiencing similar re-admission rates. He added that he did not think that it was "entirely valid," to dismiss re-admission rates on the rising number of older people in the area, as Baby Boomers reach their retirement years. "They will try to downplay this," said Hurley, before adding that it was not a problem created at the Smiths Falls or Perth hospital sites themselves. "This is a system problem because they have been starved of funding." As for blaming the issue on the elderly, Hurley said that that was ageism.
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Jackson lamented that while the hospital administration has tried its best to be as kind as it can with its cuts - with only one outright layoff - getting 12 beds cut from the local hospital system seems to be "how you get rewarded for efficiency." "It's time for the province to start funding the hospitals properly," said Hurley. One way that this could be addressed would be to raise the corporate tax rate. Administration response Later that week, in her office at the Great War Memorial Hospital site of the Perth and Smiths Falls District Hospital, president and chief administrative officer Bev McFarlane held a mini press conference of her own, alongside board chair Richard Schooley, to refute some of the union's allegations, starting with some of their numbers. "There is often another aspect of re-admissions," said Schooley during the interview on Thursday, Oct. 1. A patient could be, theoretically, discharged from hospital after recovering from heart surgery, then be re-admitted two weeks later after falling on some ice while shoveling snow from his driveway. Any admission to hospital within 30 days after a discharge would be counted as a re-admission - even if the cause was not directly related to the initial admission.
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She hastened to add that her hospital was recently awarded the distinction of being one of the top five hospitals in the province for quick-time responses, for getting patients seen to and into an in-patient bed. According to the hospital's numbers, the occupancy rate for acute care hospital beds was as low as the high 60s per cent over the summer, and in the high 70s per cent this past spring. "You have to look at all of the other indicators," said Mc-Farlane. Schooley also noted that the hospital's admissions have gone up from more than 31,000 in 2009 to more than 37,000 in 2014-15, and that they estimate the real re-admission rate at about seven per cent.
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How can you deal with more admissions with fewer beds?" asked McFarlane. "We are able to make you feel better in a shorter period of time." Gall bladder surgery used to require a seven-day stay in hospital, she said. Now, it is considered day surgery. "You aren't even admitted," she said. "The business of hospital care has changed over the years. The worst thing you can do is keep someone in an acute care bed when they don't need to be there." As for charging patients who refuse to leave the hospital because they do not believe that they are fully healed yet, Mc-Farlane did admit that "there is a rate that is charged, if there is a reasonable discharge plan and people refuse to leave," but she added that "I don't think we've ever done that here."
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As for the union's assertion that the hospital had less money on hand, Schooley pointed out that gross hospital revenues rose from $43 million in 2010 to $51 million in 2015. In fact, the LHIN is giving the hospital more money as a type of efficiency bonus, having wrestled five years worth of deficits into a $1.2 million surplus in 2014, with a projected surplus of $1.6 million for 2015. "That's the cushion we are building," said Schooley, in anticipation of the LHIN providing them with less money in the coming years. "In case some of these funding change realities manifest themselves."