Measuring Up 2018: Complex Challenges
Hospital overcrowding and hallway health care are realities facing today’s health care system in Ontario. The fact that they represent both a source and a symptom of the pressures that patients and frontline clinicians face underscores the complexity of the challenges to improve the situation.
This is one of the main messages to come from Measuring Up 2018, Health Quality Ontario’s yearly report on the performance of the province’s health system.
The report documents the cascading effects of hospital overcrowding such as longer wait times for admission to hospital from the emergency room; longer wait times to transfer out of hospital to other types of care – such as long-term care, home care; and insufficient access to mental health and addictions care. At a time when more and more patients have complex health needs, these stressors on the system are also contributing to rising levels of distress among unpaid caregivers.
One of the most visible effects of all of this is hallway health care where emergency department patients requiring hospital admission sometimes must be accommodated on stretchers in hallways. Wait times from emergency to inpatient wards are now at 16 hours, on average (2017-2018) – the longest they have been in recent years. It’s nearly 45 minutes longer than the previous year, and more than two hours longer than two years ago.
But Measuring Up is more than just numbers and statistics. It also demonstrates the impact on the frontline health care professionals who deliver care and the patients who receive it. For example, it tells the story of Karen, an emergency room (ER) physician who found herself apologizing to patients and having to practice hallway medicine when trying to accommodate up to 170 people with only eight beds in the ER available. The report also tells the stories of Jeff, Craig and Farrah – patients and family members – and their experiences dealing with the consequences of hospital overcrowding and other challenges facing the health system.
One particular challenge highlighted in the report is that of patients in hospital beds who are waiting for care in another setting. The most recently available data indicates the number of such patients is at its highest in five years and the equivalent of more than 10 large hospitals being occupied every day by patients waiting for care elsewhere.
This means that the system has less capacity to manage additional pressure, such as a challenging flu season or the opioid crisis. Visits to the emergency department due to opioids more than tripled to 54.6 per 100,000 people in 2017, from 15.2 per 100,000 in 2003.
With many hospitals across the province already operating at over 100% capacity, the sheer magnitude and complexity of the challenge cannot be understated. To address it requires innovation and effort from those on the frontlines, supported by concentrated and sustained system-wide initiatives all informed by meaningful and useful data.
But the picture of the health care system provided by Measuring Up is not entirely a gloomy one as the report also contains good news in how the health and health care of Ontarians has improved. People are living longer and are less likely to die before the age of 75. Wait-time targets are mostly being met for cancer and general surgeries and among people near the end of life, an increasing percentage are receiving home visits from a doctor or palliative home care services.
These more positive system trends demonstrate that large-scale improvement is possible with sustained focus and effort.
The variability of results within the report’s findings demonstrates the importance of measuring a focused and meaningful set of indicators of quality care across the health care continuum – and that’s exactly what Measuring Up and Health Quality Ontario do.
Want to learn more about hallway health care and what Measuring Up tells us about the challenges our health care system is facing? Listen to our podcast with Health Quality Ontario interim President and CEO Anna Greenberg.
Read the transcript.