Been a long time since I’ve been here…
Work has been interesting, sometimes in the literal and sometimes in the sarcastic sense of the word. My current facility is getting ready to move lock, stock and barrel to a new hospital in about 6 weeks or so. This has been a long time coming, and naturally has many of us both excited and dreading it at the same time. The place is definitely more spacious, the ER is expanded in both beds and footprint, but it appears there isn’t much of a change in overall bed census on the wards, something that keeps us a bit clogged up. As this is supposed to be a regional health care centre, I think there may be a lot of expectation management that needs to happen for the residents of our health region.
While we’re getting a new hospital, some in the urban area just south of us are facing closures of 3 major emergency depts., centralizing care at 3 others for high acuity problems and turning two of the other three ER’s into urgent care centres. Other wards in those facilities will be repurposed and care of certain conditions will be centralized as well (orthopedics in one, rehab and mental health in others, etc). These closures, ironically, were to decrease ER wait times – some places had patients stagnating in the depts. because of, surprise surprise, no discharge or movement on the wards. The thought process is that people of certain triage acuity will only be seen in certain facilities, as these are generally where the most appropriate staff are situated – those of lower acuity levels will be sent/told to go elsewhere (in theory).
I’m expecting/almost hoping similar things to occur here in our region – there are certain, little town hospitals/ER’s that are hit or miss if they’re open, as the docs there are getting a bit burnt out or simply don’t want to cover the ER for one reason or another. First thing I check coming on shift in the morning is our status board and the second is “The Wall of Shame” – the area where we have the diversion notices up from our area of the health region. More often than not, there are three plus out of eight up there – since that’s the norm now, I suppose we’d be just as well off closing some of them, since patients tend to migrate to us anyway, as they get used to their own place being close. Cut out the middle man and close them OR set up a group that’s controlled at a regional level to make sure they’re open if it’s deemed necessary that they are, based on population and distance from higher care facilities. Some of these places really ought to be re-roled into long term care facilities instead of acute care anyway, as one of the biggest bed blocking problems is waiting for personal care home beds anyway – the larger places can be kept for acute care or step down care so that the sick people don’t spend their entire hospital stay in the ER.
There has been talk of expanding PA roles here in our region and others to keep some of these ER’s open, using a remote coverage model much like I was used to in the military and what I did in my rural primary care practice when I left the military. There will need to be some training and flushing out periods to ensure that the supervising physicians are satisfied with the folks going out to these facilities. but it is a reasonable solution – many PA’s in the US do solo coverage in rural ER’s and Canadian military PA’s are quite used to it as it’s their norm. A role like this will be an exciting step forward in for our profession here in Canada and certainly benefit some patients here in my province.
Watch and see what happens next for now.