Photo by George Le Masurier
Despite Island Health’s efforts, overcapacity still plagues hospitals, stresses staff
This month, like last month, and the month before that and every month since the two new North Island Hospitals opened last year, they have been overcapacity.
So on most days, staff at the Courtenay and Campbell hospitals struggle to find space to put as many as 30-plus extra patients, and the peak hospitalization season that coincides with the influenza season is just getting started.
Overcapacity at the brand new hospitals is not the only critical health care need in the Comox Valley — see the sidebar story on long-term care beds — but it is a serious issue for overburdened hospital workers. And it does not bode well for communities with growing populations, and for whom the capacities of these hospitals were expected to be adequate until 2025.
The new Comox Valley Hospital opened on Oct. 1, 2017 with staff and patients budgeted for 129 beds. It was almost immediately plagued with overcapacity.
Patient numbers soared as high as 178 within a few months, a situation that has continued throughout the year and led to predictable consequences.
Staff trying to care for up to 49 extra Comox Valley patients became stressed and exhausted. They took sick days to recover, which created daily staff shortages and exacerbated the workload problems, according to sources.
Overcapacity also plagues Campbell River Hospital, where the maximum 95 beds were opened quickly and still runs overcapacity.
And it is not good for patients housed in makeshift accommodations at both hospitals.
Dermot Kelly, Island Health executive director for the region, told Decafnation that all hospitals across BC have overcapacity issues, and that the two North Island Hospitals are following an official Overcapacity Protocol.
Kelly said the protocol includes a number of steps to mitigate the overcapacity problems, including “working to reduce the length of stay within hospital, and improve access to care in the community.”
Community access measures include “increasing Home Support hours, implementation of Overnight Care Teams, new specialized services for those with Mental Health and Substance Use Challenges and improved supports for those who are medically frail,” he said.
And, he said the hospitals are working to increase access to Adult Day Programs and respite services “to better support the needs of patients and caregivers in the community.”
And the Comox Valley Hospital recently opened an additional 17 beds, for a total of 146 open beds (of the hospital’s maximum capacity of 153) with increased staffing levels, and moved out 21 long-term care patients, most of them going to a renovated floor at the former St. Joseph’s General Hospital.
Island Health has also increased the number of surgeries at the two hospitals, Kelly said. While that has reduced surgery wait times, it has also increased the number of hospital visits and stays.
But those efforts have so far not reduced patient levels to capacity or below.
The number of admitted patients ranged from 160 to 170 throughout October, reaching a high of 177 on Oct. 12. Those numbers are expected to increase significantly as the annual influenza season gets underway this month.
Sources have told Decafnation that extra patients at CVH have been housed in an unopened section of the emergency room. These patients are on stretchers, without standard beds or the same healing environment as regular rooms.
The Campbell River Hospital also remains dramatically overcapacity, but unlike the Comox Valley it has no unopened space to house them. Sources say patients are parked in hallways.
Overcapacity raises staff issues
A CVH source, who requested anonymity, said the overcapacity issues have kept staff morale low.
“We opened up a new ward and the morale is still not wonderful,” a source told Decafnation. “We are overcapacity everyday, and patients are getting discharged too early. I know this because the exact same patients that were discharged are back two days later.”
“People are without beds and there’s a full ward of aging population in the emergency overflow areas,” another source said. “We put elderly people in the pediatric ward sometimes. This causes so many issues.”
For some CVH workers, stress is caused by too many vacant positions, which forces staff into overtime, and because some departments didn’t get extra staff when the last hospital ward was opened.
Kelly said there were 91 vacant staff positions as of Dec. 6 between the two hospitals, which he blamed partly on the region’s rental and housing affordability issues that “directly impacted our ability to fill vacant positions and retain staff.”
Campbell River sources tell Decafnation that their hospital had more than 130 admitted patients last week. The hospital was designed for a maximum capacity of 95.
Campbell River staff are concerned that patient-to-nurse ratios are not being met. Overtime is rampant, they say, and staff is “being run off their feet.”
“Patients are now located in emergency rooms,” the source said. “Third floor sunrooms have been converted to bedrooms and two patients per room is common.
“There are rooms where one of the two patients has an infectious condition that should be in isolation.”
Our source said they feared this could cause a MRSA or similar infection alert.
But Kelly said Island Health’s Over Capacity Protocols ensure safe care in the hospitals.
“In cases of over census, guidelines for care have been developed to ensure we provide the best care possible. Our main goal is to provide safe and effective care in the most appropriate setting possible,” he said.
And he praised the hospitals’ staff as “incredibly passionate and dedicated, sometimes under challenging circumstances.”
NO WORD YET ON PROMISED 151 LONG-TERM CARE BEDS
As a strike by care workers at two Comox Valley assisted living facilities enters its sixth day, many people are wondering what happened to the 151 additional long-term care beds promised by Island Health last year?
The critical shortage of long-term care and respite beds in the Comox Valley continues to cause problems for at home caregivers, many of whom are exhausted and in crisis. And it causes overcapacity issues at the Comox Valley Hospital, where patient s who need long-term care are stuck in acute care beds.
The contract award for new beds is already three months late and, according to an Island Health spokesperson, no announcement is imminent.
Island Health issued a Request for Proposal for 70 new long-term care beds over three years ago, but cancelled it a year later, and issued a new RFP this year. The health authority said it would award contracts by Aug. 31 of this year.
When it missed that deadline, Island Health said the contracts would be announced later in the fall. Now, three months later, the contracts have still not been awarded.
Asked what is holding up the awarding of contracts, Island Health spokesperson Meribeth Burton said, “Awarding a long-term care contract is a complex, multi-stage process. We want to ensure we are thoughtful in our decision because this facility will serve the community for decades to come.”
Island Health could give no date when the awards would be announced.
“We understand the community needs these additional resources and is anxious to learn when the contract will be awarded. We will be able share more details with the community once a project development agreement is finalized with a proponent,” she said. “We don’t have a firm date, but we will let you know as soon as we can.”
Burton said Island Health still pins the timeline for opening the new long term care beds at 2020.
In the meantime, 21 long-term care patients were relocated back to the former St. Joe’s Hospital, which reopened and renovated its third floor to create an additional and temporary long-term care facility. St. Joe’s already operates The Views for about 120 long-term patients. The new facility in the old hospital is called Mountain View.
The move was planned in part to relieve overcapacity issue at the Comox Valley Hospital.
What was the capacity of St. joe’s? I recall in 2001, both my parents were taking up acute care beds because there was no room in Intermediate Care or Extended Care.
The high cost of keeping people in acute care facilities when they no longer need that kind or level of service is sickening.
I have to wonder how much of this is actually inadequate staffing. Like the mention of “unopened” rooms and beds. If the need is established over time, they should be raising the budget and opening more beds. It’s not rocket science, especially with a provincial “surplus.”
If there’s enough staff, people get treated more quickly and can return home faster. Then it wouldn’t clog up and they’d be able to retain staff.
The problem has less to do with the number of acute care beds, and more to do with the lack of capacity to discharge patients to safe recuperation beds once the acute crisis has passed. Not everyone needs long term care, there is a need to get people ready to return to their normal homes, and we are well below capacity in meeting that need.