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Name
Simon Jackson

Fri, 07/29/2016 - 02:58

Stephen, Your tale of congestion rings loud and clear in Nova Scotia. Our inpatient medical services are experiencing a similar congestion. Over the past 5 years our MTU admissions have grown, our LOS for typical patients has reached the expected data, our "bed turns" increased, yet our ED continues on "code census" as we struggle to find inpatient capacity for newly admitted "medicine" patients. ALC, and "ALC like" or ALC destined" patients comprise about 20% of our census, yet compromise almost all of our excess LOS. These patients (if they are still patients?) need care. They do not need an acute medical service. We are wasting limited health care dollars providing suboptimal long term housing which does not meet the persons needs. I have often wondered about a trial randomizing immediate LTC placement to "usual" placement, and would hypothesize that in addition to being more expensive, residing in a hospital is inherently more dangerous (infection, medication error, falls secondary to suboptimal physical environments) than a LTC facility! It is highly probable that the ongoing hospitalization is both more expensive and worse, yet we do no have a systemic plan of attack. We have made some inroads. House-staff are forbidden to mention of placement on admission, home first, home again, an increased willingness to expand services to "keep people home" while waiting for care and a team change to tolerate increased risk. We have dedicated services for the rehabilitation of post surgical and post medical admissions for patients in needed of reconditioning, who work diligently to ensure return to home if at all possible. We don't admit "can't go homes", instead push for urgent placement from the ED, or expanded supports to allow discharge from the ED. We have made some progress. It has come at a cost, with a doubling or our readmission rate from 4-5% to 8%, but this still exceeds CIHI predictions. We are working to try and develop a region wide integrated frailty strategy, to better support patients and families and prevent institutionalization that we unfortunately create with aggressive medical procedures in patients with limited opportunity for improvement. It is the lace of a long term solution that is worrisome. We are at the start of a population bubble that will cripple our hospitals and LTC facilities unless system wide changes in hospital and social policy are implemented. Talking about this is a start, but it is true action that is needed. Simon Jackson, Interim Head, Department of Medicine, Dalhousie

Name
Simon Jackson
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