Dr. Chris Cunningham and I co-authored a recent paper looking at funding inequalities among hospitals in the Interior Health Authority. This prompted a meeting between Health Minister George Abbot and Vernon city council. The minister’s response to our paper was that it focused too much on acute care beds and not enough on community care beds that the IHA plans to open.
He did not comment on the fact that Vernon Jubilee is the only regional hospital without an on-site MRI scanner, though, we perform the highest number of CT scans. He also did not comment on the fact that we have only four operating rooms, though Trail, for example, serves half the population and has five ORs.
Absent from the discussion was the fact that in addition to the 80,000 people in the North Okanagan, VJH serves as the main referral hospital for an additional 50,000 people in the Shuswap as Salmon Arm and Revelstoke do not have specialist services such as pathology, pediatrics, spine surgery, urology, ENT, gynecology, pacemaker surgery, and orthopedics. I will not be addressing theses issues in this essay and will instead focus on acute care beds.
One of the premises of our paper was based on the following logical argument: an elderly population requires acute care hospital services; acute care services require acute care beds; the elderly populations in Vernon is growing; therefore, the requirement for acute care beds in Vernon will also grow. Follow me?
Let me rephrase using specific examples:
The two top reasons for admission to hospital for the elderly people (where elderly is defined as 65 or older - no offence to readers) are cardiovascular disease and cancer. So if you or your family suffer a heart attack, a life-threatening arrhythmia, a stroke or severe heart failure from metastic spread of cancer , you will require admission to an acute hospital bed.
If you were sent to a community bed such as a nursing home for any of these problems, you would simply die.
Now as a population needs a certain number of acute care beds to properly treat patients for all these problems is it not logical that a greater population would require a greater number of care beds?
Is it true that community beds would improve the care for patients with chronic illnesses but not necessarily patients with acute illnesses. The additional volume of acutely ill patients would not be well served by simply increasing the number of community care beds unless the intent was not to treat hem and have them simply die.
The elderly population of Vernon has been projected by the IHA to increase by 52.6 per cent by 2022.
For the past four years, Vernon Jubilee has been operating at 110 per cent capacity. That means that, on average, there are 10 per cent more patients in the hospital then there are funded beds. The recommended level of hospital capacity for optimum safety is 85 to 90 per cent. No other regional hospital in the IHA is on average over-capacity every single day. Not even Royal Inland and Kelowna General are in the same situation, according to IHA statistics.
It is a regular occurrence that surgeries are performed on patients who depend on a bed being vacated by another patient while their surgery is in progress.
This means that if for some reason grandpa is not quite ready to be discharged after his hip replacement, he might have to be put in a bed in the hallway or in a wheelchair in the waiting room so his bed can be given to a “fresh” post-operative patient. Imagine if the Vernon Lodge operated at 110 per cent capacity. You check in and your room is not ready so you are asked to have a meal at the restaurant. While you eat, someone is still sleeping in your room.
When you are finished your meal, the person in the bed is given the choice to either sleep in the hallway or take their stuff and stay at the bar for another few hours before they are ready to go to the airport so the room can be quickly cleaned for you to sleep in.
Two days later, the same thing happens to you when someone else needs the room. Would this be acceptable even once? What about every day for four years straight?
Would you be upset if there was no plan to change and there was no other hotel in town?
What it means for a hospital to run at 110 per cent capacity is that every person who works at the hospital, from the physicians to the nurses to porters and cleaning staff has to work at 110 per cent to keep patients moving through the system. By and large patients receive excellent medical care at Vernon Jubilee because staff working there really care about the patients and take pride in providing excellent care. But the hospital is at a breaking point. Disaster lurks on a daily basis. All it takes is an unexpected event such as an abnormal blood test that suggests that a patient who is supposed to be discharged may be having a heart attack or a pacemaker that malfunctions after being inserted meaning that the patient has to stay in the ICU another day, or a patient develops a blood clot in the lung after a hip fracture that now needs to be monitored on blood thinners for a few more days.
The physicians at VJH are concerned about the level of safety and the quality of care that is provided to their patients. We would prefer to work at a 85 to 90 per cent capacity environment as is recommended. This would require 160 acute care beds. We currently have 125.
Even though there is a new facility being planned at VJH, there is no plan to provide funding to increase the number of beds or operating rooms when it opens.
The building is merely a replacement not an expansion. If you think the hospital that your tax dollars pays for should provide a safe level of medical care at least equal to other facilities in Penticton and the Kootenays by providing adequate acute beds, sufficient operating rooms, equal access to MRIs and other modern imaging, please write to:
Health Minister George Abbott, Room 337, Parliament Buildings, Victoria, B.C. V8V 1X4
Dr. Hamish Hwang
He did not comment on the fact that Vernon Jubilee is the only regional hospital without an on-site MRI scanner, though, we perform the highest number of CT scans. He also did not comment on the fact that we have only four operating rooms, though Trail, for example, serves half the population and has five ORs.
Absent from the discussion was the fact that in addition to the 80,000 people in the North Okanagan, VJH serves as the main referral hospital for an additional 50,000 people in the Shuswap as Salmon Arm and Revelstoke do not have specialist services such as pathology, pediatrics, spine surgery, urology, ENT, gynecology, pacemaker surgery, and orthopedics. I will not be addressing theses issues in this essay and will instead focus on acute care beds.
One of the premises of our paper was based on the following logical argument: an elderly population requires acute care hospital services; acute care services require acute care beds; the elderly populations in Vernon is growing; therefore, the requirement for acute care beds in Vernon will also grow. Follow me?
Let me rephrase using specific examples:
The two top reasons for admission to hospital for the elderly people (where elderly is defined as 65 or older - no offence to readers) are cardiovascular disease and cancer. So if you or your family suffer a heart attack, a life-threatening arrhythmia, a stroke or severe heart failure from metastic spread of cancer , you will require admission to an acute hospital bed.
If you were sent to a community bed such as a nursing home for any of these problems, you would simply die.
Now as a population needs a certain number of acute care beds to properly treat patients for all these problems is it not logical that a greater population would require a greater number of care beds?
Is it true that community beds would improve the care for patients with chronic illnesses but not necessarily patients with acute illnesses. The additional volume of acutely ill patients would not be well served by simply increasing the number of community care beds unless the intent was not to treat hem and have them simply die.
The elderly population of Vernon has been projected by the IHA to increase by 52.6 per cent by 2022.
For the past four years, Vernon Jubilee has been operating at 110 per cent capacity. That means that, on average, there are 10 per cent more patients in the hospital then there are funded beds. The recommended level of hospital capacity for optimum safety is 85 to 90 per cent. No other regional hospital in the IHA is on average over-capacity every single day. Not even Royal Inland and Kelowna General are in the same situation, according to IHA statistics.
It is a regular occurrence that surgeries are performed on patients who depend on a bed being vacated by another patient while their surgery is in progress.
This means that if for some reason grandpa is not quite ready to be discharged after his hip replacement, he might have to be put in a bed in the hallway or in a wheelchair in the waiting room so his bed can be given to a “fresh” post-operative patient. Imagine if the Vernon Lodge operated at 110 per cent capacity. You check in and your room is not ready so you are asked to have a meal at the restaurant. While you eat, someone is still sleeping in your room.
When you are finished your meal, the person in the bed is given the choice to either sleep in the hallway or take their stuff and stay at the bar for another few hours before they are ready to go to the airport so the room can be quickly cleaned for you to sleep in.
Two days later, the same thing happens to you when someone else needs the room. Would this be acceptable even once? What about every day for four years straight?
Would you be upset if there was no plan to change and there was no other hotel in town?
What it means for a hospital to run at 110 per cent capacity is that every person who works at the hospital, from the physicians to the nurses to porters and cleaning staff has to work at 110 per cent to keep patients moving through the system. By and large patients receive excellent medical care at Vernon Jubilee because staff working there really care about the patients and take pride in providing excellent care. But the hospital is at a breaking point. Disaster lurks on a daily basis. All it takes is an unexpected event such as an abnormal blood test that suggests that a patient who is supposed to be discharged may be having a heart attack or a pacemaker that malfunctions after being inserted meaning that the patient has to stay in the ICU another day, or a patient develops a blood clot in the lung after a hip fracture that now needs to be monitored on blood thinners for a few more days.
The physicians at VJH are concerned about the level of safety and the quality of care that is provided to their patients. We would prefer to work at a 85 to 90 per cent capacity environment as is recommended. This would require 160 acute care beds. We currently have 125.
Even though there is a new facility being planned at VJH, there is no plan to provide funding to increase the number of beds or operating rooms when it opens.
The building is merely a replacement not an expansion. If you think the hospital that your tax dollars pays for should provide a safe level of medical care at least equal to other facilities in Penticton and the Kootenays by providing adequate acute beds, sufficient operating rooms, equal access to MRIs and other modern imaging, please write to:
Health Minister George Abbott, Room 337, Parliament Buildings, Victoria, B.C. V8V 1X4
Dr. Hamish Hwang
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