BY NORM TOLLINSKY
A dramatic change in health caredelivery is quietly underway at SudburyRegional Hospital. Having consolidated acute care services at its main Paris St. site last year, the hospital is now centralizing chronic care services at its Memorial site several blocks away.
Very little thought was given to what would become of the Memorial site leading up to the completion of the so-called one-site hospital, said Sudbury Regional president and CEO Dr. Denis Roy. At one point, management considered using it for physician offices. Then, as Alternate Level of Care patients began clogging the Paris St. site, it was used to temporarily house long-term care patients awaiting transfer to the new 128-bed St. Gabriel’s Villa in Chelmsford and 24 new beds at the city-owned Pioneer Manor.
The idea of a day hospital specializing in chronic care made sense, said Roy, because “there won’t be new acute care beds opened up in the foreseeable future. The financial situation of the province doesn’t allow that, so we have to find ways to take care of as many patients as possible outside the hospital.”
The Ontario Breast Screening Program was one of the first clinics to move to the Memorial site. It was followed by a diabetes clinic and, by the end of the summer, the site will house clinics for heart failure and chronic obstructive pulmonary disease (COPD), as well as a pain clinic and bariatric assessment clinic.
The diabetes clinic was previously located at the YMCA downtown and focused primarily on education and self-management. The new clinic at the Memorial site also provides more complex care, including laser surgery for diabetic retinopathy and foot care.
“Before we decided on the clinics for the Memorial site, we asked ourselves what kind of patients show up in Emergency,” said Roy. “Twenty-five per cent of our admissions have diabetes and 40 per cent of patients with heart failure get admitted all the time.”
Heart failure patients who show up in Emergency will be referred to the heart failure clinic for stabilization. Once stabilized, it will be up to their family physician to provide follow-up care. However, if their family physician feels they need more specialized attention, they can be referred back to the clinic. The idea is to provide heart failure patients with more intensive monitoring to keep them from returning to Emergency and taking up acute care beds.
The clinic will also provide follow-up service to patients using pacemakers and defibrillators and could, in future, use electronic technologies to monitor weight gain and fluid retention.
Day surgeries and any procedures requiring anesthetic, diagnostic imaging or pathology services will continue to be performed at the acute care site.
The goal is to use the Memorial site exclusively for chronic care clinics, but it’s still too early to pull the plug on the 75-bed surge capacity for ALC patients, said Roy.
“Until there is availability of other services like supportive housing and assisted living in the community, we don’t want to take the risk of closing those beds. I am not so sure at the present time that all of those patients at Memorial will be able to transfer to either St. Gabriel’s or Pioneer Manor, so there will be a certain number of patients remaining at the Memorial site. It’s not an ideal place. Our priority is to use it for outpatient activities. We’re only keeping the beds open because there are no other alternatives in the community.”
Down the road, Roy also sees the possibility of virtual wards, whereby patients are discharged after two or three days in hospital and then supervised at home through the use of remote monitoring and two-way video.
“We did it for the virtual Intensive Care Unit. Why couldn’t we do it for a patient who doesn’t require ICU?” he asked.
Still to be determined is how the new focus on chronic care service will impact on the hospital’s funding from the Ministry of Health and Long-Term Care. Funding levels won’t change if patients waiting for surgery or other acute care patients fill beds freed up by heart failure and COPD patients. However, there’s also the risk that keeping chronic disease patients out of hospital could negatively impact funding if admissions decrease.
Other initiatives hospital management is keen to move forward with are a Learner Centre for students and staff, and a Pediatric Centre of Excellence.
“At present,” said Roy, “pediatric activities are all over the place. We have children being treated for cancer at the Cancer Centre. We have post-natal follow-up and the botox clinic here. Pediatric diabetes is at the Memorial site and the current Centre of Excellence is on Bancroft Drive, but it’s not big enough.”
A funding request for both initiatives is in the hands of the Ministry.
Plans for a research institute are still in the works and options for relieving a critical shortage of parking are under evaluation.
