Tackling the challenge of hallway medicine

An aging population, and a city population that now tops one million people, were both contributing factors to the busiest year in Queensway Carleton Hospital’s history.

“West-end Ottawa and its surrounding region has a population that is both growing and aging,” said Leah Levesque, interim Chief Executive Officer. “QCH has needed to be agile and responsive to the changing needs of our community.”

The biggest challenge is the difficulty for patients to find appropriate living arrangements – those who are well enough to be discharged from hospital, but cannot yet return home. On average, there were 60 patients each day waiting for “Alternate Level of Care (ALC),” which is about a third of the hospital’s medical beds.

“This is tough on the ALC patients – having to wait in the hospital for a more appropriate care setting in the community. It is especially tough on other patients who are required to receive care on stretchers in Emergency because no beds are available,” said Levesque.

Over the last year, the hospital was more than completely full 100% of the time – with admitted patients overflowing into Emergency and other “unconventional spaces.” In fact, there were more than 3,100 patient days spent overnight in these areas while waiting for an in-patient bed – a 26% increase over the previous year.

This past year the hospital also managed the additional challenge of a pair of unfortunate events in the city. A tornado in September, followed by the OC Transpo bus crash in January, which added additional strain to the already-full hospital. Despite the unexpected and tragic circumstances surrounding both events, they showcased the commitment and dedication to care that the QCH team provides to our patients each and every day.

“They’ve not only been incredible dealing with the unexpected, they’ve also shown a resilience and adaptability to a constantly changing healthcare environment,” added Levesque. To help deal with the capacity challenge, the hospital took on dozens of initiatives, including:

• Opened unfunded beds in unconventional spaces

• Formed partnership with community hospitals to move ALC patients to a more appropriate setting

• Reduced length of stay and readmissions in key areas

• “CTAS 1,2,3 project” to reduce wait times in Emergency

• Surgical smoothing project to reduce cancellations

• Added special patient navigator for elderly patients

• Added more mental health crisis nurses in Emergency

• Implemented a Surge policy and Internal Code Orange policy

• Worked with small hospital partners to accept ALC patients who are waiting for alternative levels of care