It may come as a surprise to everyone else in Northern Ontario's health-care community, but the hospital with the busiest ER in the province is Thunder Bay Regional Health Sciences Centre.
"Our patient volume was 101,785 in 2009 – 2010," said Lisa Beck, director of critical care and emergency services. "To the end of September, we saw 53,000 patients and we're projecting this year to exceed 105,000."
By mid-November, another hospital in southern Ontario was slightly ahead, "but we have been the busiest for several years," added Rhonda Crocker-Ellacott, vice-president, emergency room, critical care, trauma & surgery and chief nursing executive.
There are several reasons for the high volume of patients.
For one thing, "we have a shortage of family physicians in Thunder Bay, so we're pretty much the only show in town," said Dr. David Wood, medical director, emergency and trauma. "It's also because we've become so efficient that we're a victim of our own success. If someone feels it's going to take them a month and a half to get an ultrasound that's important to them, they'll come to us for expedited care."
Despite being one of the busiest ER's in Ontario, Thunder Bay Regional's Emergency Department exceeds Ministry of Health wait time standards in two out of the three patient categories and performs well above provincial averages.
For high acuity, non-admitted patients, the department achieves the eight-hour standard 95 per cent of the time, while for low acuity, non-admitted patients, it achieves the four-hour standard 93 per cent of the time. It's the third category of high acuity admitted patients where Thunder Bay Regional falls short, but that's due to the hospital's high volume of alternate level of care (ALC) patients taking up acute care beds and causing backups in the ER.
"There are days when we've had 34 in-patients in the Emergency Department and that's not mentioning the other 60, 80 or 100 patients coming through at any given time," said Crocker-Ellacott.
"We get 300 patients a day in the ER and have 51 stretchers, so having 34 admitted patients in the department is very challenging. At our peak, we had 87 ALC patients occupying inpatient beds. When you consider that the hospital has a total of 375 beds, of which only 261 are medical-surgical beds, having 87 of them occupied by patients waiting for other levels of care compromises our ability to admit and flow through.
"It's taking up physician time, it's taking up nurse time and interprofessional care time while we're still trying to operate one of the busiest emergency departments in the province."
In mid-November, Thunder Bay Regional had 50 ALC patients waiting for long-term care beds to be freed up in the community.
Hospital management is working with St. Joseph's Care Group, the Community Care Access Centre, the Local Health Integration Unit and other agencies to resolve the problem, but it's "slow-going," said Crocker-Ellacott.
"It's a system problem. It's not something that our hospital can address in isolation. It requires all of the players in the health-care system to work together to provide our patients with the right care, at the right time, by the right provider."
Initiatives
In the meantime, the department is moving ahead with a number of initiatives funded by the Ministry's Pay for Results program. They include the hiring of dedicated ECG technicians, phlebotomists, nurses and clerical staff, additional housekeeping coverage on the midnight shift and support workers to stock supplies and transport patients.
To reduce overcrowding in the ER, the hospital has also opened a six-bed unit for admitted patients on the third floor.
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