BY NORM TOLLINSKY
Patients requiring a transfer to one of northeastern Ontario’s four hub hospitals for urgent medical care won’t be kept waiting anymore while doctors and nurses call around in search of an empty bed.
Under the North East LHIN’s new Life or Limb Policy, “patients who need urgent care within four hours will never be refused transport,” said Dr. Derek Manchuck, the LHIN’s Critical Care Lead and chief of critical care at Sudbury Regional Hospital. “We’ll accept these patients no questions asked. They’ll come and be cared for, and we’ll sort things out later.”
The North East LHIN, the second adopter of a Life or Limb policy in the province, worked closely with the South West LHIN and London Health Sciences Centre, where it was first introduced.
“We modelled our policy on the work of the South West LHIN for essentially the same reasons,” said Manchuck. “People were coming to harm because transfers were delayed.”
Seriously ill or injured patients arriving at a smaller hospital would sometimes have to wait for doctors or nurses to call around in search of a hub hospital with an empty bed. Hospitals could refuse an emergency transfer if they didn’t have the resources to accommodate a patient.
“Then what would happen is they’d call surrounding hospitals,” said Manchuck. As a last resort, they’d have to rely on the province’s CritiCall service to find a hospital elsewhere in the province.
“So, you can see how there could be a delay in care and, unfortunately, there were some bad outcomes.”
The Life or Limb Policy is primarily “a change in mindset,” said Manchuck. “You have to be prepared to work on the fly and stretch the boundaries of your institution’s capacity. It results in overcrowding, but it’s in the best interests of patients to get the urgent care they need.”
The flip side of the policy is a repatriation agreement between the four hub hospitals in Sault Ste. Marie, Timmins, North Bay and Sudbury and all of the smaller hospitals in the region, according to which the latter have agreed to the return of patients once they have been stabilized and are no longer in need of specialized care.
An inventory of the specialized services provided by each of the hub hospitals in the northeast has been compiled to help hospital staff with emergency transfers.
Patients requiring thoracic surgery, vascular surgery, cardiac surgery or neurosurgery, for example, would be transferred to Sudbury Regional Hospital, but other patients would be transferred to hospitals in Timmins, Sault Ste. Marie or North Bay, depending on their location.
Manchuck estimates between four and six patients a week require an emergency transfer to a hub hospital in the northeast. They include victims of traffic accidents, strokes and heart attacks, and patients with head injuries, open fractures and gastrointestinal bleeding.
A hub hospital can only decline a transfer if it has declared a moderate surge, but that only happens during a SARS or H1N1 outbreak when a hospital exceeds its usual capacity by 15 per cent, which happens very rarely.
Manchuck, who took over as North East LHIN Critical Care Lead after the policy was developed and agreed to, predicts that more LHINs across the province will adopt Life or Limb policies.
“This is the way health care is moving,” he said. “There’s a provincial no refusal policy for neurosurgery that was signed off on last year. It’s a sign of the times. People are trying to make the existing system work better.”
Work on the development of the Life or Limb Policy was led by former North East LHIN Critical Care Lead Dr. David Boyle and Chris Bourdon, the LHIN’s Emergency Department Lead and Sudbury Regional’s Chief of Staff.
The policy took effect June 1 and applies to all 25 hospitals in the LHIN.
