Your hospital gateway - emergency care in Niagara
- June 2001
For many Niagara patients, Emergency Departments are their gateway into the hospital system. What happens when the entry point is congested? The past several years have shown us the results, as Critical Care Bypass (CCB) and Redirect Consideration (RCD) numbers have skyrocketed in Niagara and across the province due to numerous factors.
To develop solutions, Niagara received provincial funding in Fall 2000 to make new initiatives a priority. An Emergency Services Co-ordinator was hired to improve communication and co-operation among Ambulance Dispatchers, Niagara Emergency Medical Services, Community Care Access Centre Niagara, Nursing Homes/ Long-Term Care (LTC) Facilities and all Emergency Departments throughout Niagara.
Several new initiatives have since been implemented, including a new approach to reduce the number of long-term care residents transferred to hospital for minor health concerns. Two Advance Practice nurses have connected with Niagara’s 27 LTC facilities and, from January to early May, saved an amazing 288 days in hospital for the frail elderly as well as 200 ambulance trips. That translates into $208,400 health care dollars saved!
New funding to open additional flex beds has helped reduce the backup of patients awaiting acute care beds in the Emergency Department. By reducing that number, Critical Care Bypass (CCB) hours have dropped substantially over the last year. The change from 1999 to 2000 is impressive – CCB hours reduced by 44.2% and RDC hours dropped by 26.7%. A monthly comparison shows that from January to March 2001, Niagara Emergency Departments (including Hotel Dieu and West Lincoln Memorial Hospitals) were on CCB a total of just 89 hours, compared to a whopping 307 hours the previous year.
This reduction is certainly a step in the right direction, however, there are still too many patients for the number of acute care hospital beds available. An ongoing issue is the number of Alternate Level of Care (ALC) patients who no longer require hospital care but cannot be discharged because of a shortage of long-term or nursing home beds in the community. It is not unusual for Greater Niagara General, St. Catharines General, and Welland Hospital Sites to each have between 20 and 30 ALC patients every day.
The strong efforts made over the past winter by providers of health care services in Niagara have carved a significant dent in our Emergency issues. By integrating our systems, Niagara can indeed become healthier and an excellent start has already been made.
ER Staffing Increases for Greater Niagara General Site
An added relief to ER pressures is the March 2001 announcement (click HERE for press release) of $500,000 for Greater Niagara General. The MOHLTC has stated that this funding will be recurring, based on an evaluation of the pilot project. The designated funds are to be used for the following:
- Add one full-time equivalent RN on all shifts to address volume pressures
- Add one dedicated Clinical Nurse Specialist or nursing clinical teacher as practice consultant/quality practice development leader to the Emergency Department
- Add a Nurse Practitioner to provide primary care for non-urgent patients arriving at the Emergency Department
- Provide coverage for nurses attending continuing education classes and/or participating in quality improvement initiatives
- Provide incentives for on-site delivery of community college courses in emergency and/or critical care nursing.