Tuesday, February 17, 2009

hospital visits & appointments


I have written previously about Alternate Levels of Care (ALC) patients. This can be termed bed blockers: patient who require a different level of service than a hospital offers. We require services that range from ICU, hospital beds, chronic care facilities, long-term care, retirement homes) for some seniors. We are short spaces in many of these facilties. Another issue arises in patients required to be in a specific hospital at a specific time for an appointment for tests, evaluation, or consultation. Discharging a frail, senior patient to home requires much in the way or preparation and assessment.

The statistics come from a joint study by U of T., Ornge Transport Medicine, Sunnybrook Hospital and ICES, 80% of patient transfer are non-urgent nature. This would imply that we need a different level of transportation. Those requiring trips to other health care facilities (larger hopsitals for MRIs, tests, to see cardiologists, diagnostic imaging ( e.g., MRI), ongoing therapy (e.g., dialysis).

This study looks at who is using ambulance crews, (see more details here) how much time it took, and how it affects missed appointments, and compromising patient care. Certainly, in the great concentration and reorganization of services in Ontario Health Care, patients are forced to go to particular institutions that deliver the specific care they need. This issue requires some examination.

They wondered why highly-trained paramedics are diverted to deliver non-urgent patients. Of course, urgent calls take priority. I know that when my father needed to go from Gravenhurst to Toronto to have an MRI, we had to take him in an ambulance - he wasn't ambulatory. Then, a week later, we had to go back and visit the oncologist, who by now had read the report and simply wanted to meet my father and let him know that his tumour was now fatal and we would not continue the radiation treatments that had so decreased his quality of life.

We sat there in the morning, and waited more than an hour until an ambulance was available, despite having booked it two weeks before. My poor father, in his dementia, could not understand what we were waiting for. In many cases, such trips waste the time of the ambulance, and concern everyone involved. It is rather an expensive taxi to drive two hours into downtown Toronto. As many of the media articles claim, politicians must examine this issue. This is a colossal waste of time, money and expertise for very poor service for these frail seniors.

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"Inter-facility Patient Transfers in Ontario: Do You Know What Your Local Ambulance Is Being Used For?" Victoria Robinson, Vivek Goel, Russell D. MacDonald and Doug Manuel, Healthcare Policy, Vol .4 No.3, 2009 (www.longwoods.com)

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