Kgh_crisis

Jeff Green | Oct 11, 2007

KGH in Crisis: but Not for the First Timeby Jeff Green

The image that springs to mind when Joe de Mora, CEO of Kingston General Hospital, and Dr. Peter Munt, the head physician, described the current state of the institution at a recent media day, is that of the daily traffic jam on the Don Valley Parkway in Toronto.

Every morning the parkway fills up at about the same time, and eventually a backlog develops. Only when a sufficient number of cars have gone through does the bottleneck lessen.

At KGH, the bottleneck is represented by the emergency room. “The emergency room is a barometer of the whole hospital,” said Dr. Paul Dungey, the program director of emergency medicine at KGH.

Until a couple of years ago, there was a delay of about 3-4 hours for patients to move out of the emergency room to a hospital room once the emergency team had determined they needed to be admitted to the hospital.

“Now it takes an average of 16 hours,” said Dungey.

On some mornings, there are patients lined up in emergency waiting for space in the hospital, and if they are not cleared before the daytime rush of ambulances and walk-in traffic, people can get stacked up waiting for treatment. “We don’t have ambulances lined up six deep like they do in some larger urban centres,” said Dungey, “but we are getting there.”

The backlog at emergency is due to many factors, according to hospital officials. For one thing, there are patients staying in some of the 454 beds at KGH who should be in long-term care facilities, but there is a shortage of beds in those facilities, leaving some patients ‘parked’ in expensive hospital beds that are needed for other patients.

As the tertiary care centre for Eastern Ontario, KGH serves a large geographic region, 500,000 to 600,000 people, well beyond the City of Kingston, Frontenac County and the surrounding region. This population is older and sicker than other populations in the province. This leads to pressures on many parts of the hospital.

The intensive care unit at the hospital contains 21 beds. At about 11 o’clock in the morning on the day the media visited, all but two of those beds were occupied.

Down at the Cancer Care Centre of Eastern Ontario, staff struggle to juggle patients in the 15 chemotherapy chairs, and nursing staff struggle to make up correct dosages in a miniscule pharmacy as the patient load keeps growing.

Alastair Lamb, the program operational director for Oncology, said the “Cancer Care Centre was built in the 1970’s. At the time, the patient load was several hundred per year. It is now 3,500 and is growing by 3% per year.”

The 21-bed paediatric unit was established in 1999 when the department was moved over from Hotel Dieu hospital as part of a restructuring program. It has occupied temporary quarters since that time, leading to inefficiencies.

For example, the unit contains mostly 4-bed hospital rooms. With a patient population of boys and girls aged from very young all the way to 17, it is a challenge not only to ensure that boys and girls are separated, but also that teenagers are kept apart from very young children.

The media day at the hospital was part of an advocacy campaign the hospital administration initiated aimed partially at gaining public support in KGH’s attempts to secure more government funding.

“It appears now that we are in a crisis,” said CEO Joe de Mora, “but this is not the first time this has happened in the 160-year history of the hospital.”

De Mora said that in looking at some of the administrative archives of the hospital, he has seen minutes of meetings from 30 and 60 years ago that read “as if they could have been taken from meetings held six months ago. So we have faced financial problems in the past.”

The situation is a bit different now, however. The hospital is in need of some major redevelopment, and the good news is that approvals are now being given for major renovations.

The Cancer Care Centre will be undergoing a $50 million upgrade. The dingy basement, with no natural light, that holds the chemo-room and pharmacy will be replaced by a spacious 39-person capacity second floor room. As people undergo chemotherapy they will have a view of Lake Ontario. The new centre will take five years to build, but construction is scheduled to start soon.

Approvals have been secured for seven more intensive care unit beds, and the paediatric ward will be replaced with a proper paediatric centre, with construction starting next spring.

These new facilities are designed to be able to handle more patients, more efficiently, and should cut down on the per-patient costs.

“We are happy that the redevelopment is now underway,” de Mora said. “We would have been in a better situation if it had been done ten years ago, because we are now facing a large increase in patient load, which we will be dealing with while undergoing construction. If the work had already been done, we would be able to deal with the load more easily. But we are now facing an operational crisis as we undergo redevelopment.”

The solution seems to be more money, according to the hospital administration.

“By all efficiency measures we are doing very well,” de Mora said, “but we are in a budget deficit and we need more operating funds.”

The hospital is seeking an increase in annual operating funds in the range of $40 million.

“We are not asking for money at the expense of other parts of the healthcare system, however,” Joe de Mora said. “The hospital is the location of last resort for patients. Improved funding for Family Health Teams and Community Support Services in rural areas is just as important. We are certainly not saying give us all the money and ignore those other services which help keep people out of hospital, which is better for them and for the healthcare system.”