In early 2017, the Winnipeg Regional Health Authority (WRHA) was dealing with a situation common in cities across Canada; 78 of the city’s hospital beds were occupied by people waiting for spaces to open up in nursing homes.
The entire service-delivery chain was clogged, and the results were predictable. New arrivals at the city’s emergency departments (EDs) and urgent-care centres were waiting for an average of 1.8 hours before they could be seen. Patients scheduled to have non-emergency surgeries and other procedures were told their appointments had to be delayed.
Fast forward 12 months, and the situation was quite different. Just nine elderly Winnipeggers were in acute-care beds awaiting transfer to long-term care. ED wait times had dropped to 1.5 hours, and the city’s hospitals were coping well with a virulent flu outbreak.
What led to the 88% drop in demand for acute-care beds was a determined focus on increasing the resources to help elderly patients make the transition to home care. Several changes were made: 65 new transition beds, introduced with the goal of getting patients into a situation where they can live independently with home-care support; a new initiative to rapidly dispatch nurses to assist patients with complex medical issues; and a shift in attitude among health officials, which saw them commit to a “home first” philosophy for elderly patients and their families.
Overall, the WRHA has adopted a holistic approach that takes the focus off the circumstances at individual hospitals and concentrates on improving the capacity of the entire system.
The startling results seem to reinforce the CMA’s recommendation that the federal government undertake a study of the appropriate use of acute care for seniors and examine ways to mitigate the inappropriate use of acute care for elderly persons and provide support for caregivers.