What Happens When There Are No Beds Available?
Most hospitals try to run at approximately 90% occupancy. This allows some "wiggle room" for the placement of patients who need to be admitted to the hospital as a result of an emergency. The Credit Valley Hospital hasn't had the luxury of running at 90% occupancy for several years.
Due to the high volume of patients as a result of rapidly expanding population growth in the Region of Peel, the hospital is running at approximately 98% occupancy most days. Many days during the Fall and Winter months, the hospital is running with no vacancy. In other words, all of its inpatient beds on the nursing units are full and there is literally no place to put any patients whose condition requires that they be admitted to hospital.
On any given day during the Fall and Winter months, there will be at least 10 to 12 patients who have arrived at the hospital, usually during the evening or overnight, who will be waiting for placement in an inpatient bed. We refer to these patients as Emergency Room Admissions or ERAs.
Early each morning the physicians make the rounds of the nursing units visiting their patients. Several beds "open up" as the physicians discharge the patients they determine are well enough to go home. After those patients are discharged, we're able to prepare the vacated inpatient rooms for the ERAs waiting for a bed in the emergency department.
The real problems arise in the emergency department when there are more than a dozen ERAs requiring an inpatient bed. Because of the severity of their medical condition, these patients are cared for on the stretchers in the emergency department.
When the situation is less than ideal new patients arriving in the emergency department will wait longer for treatment because there is literally no room for them to be seen.
We provide an hourly notice of the number of emergency room admissions (ERAs) to keep staff, patients and visitors informed of the inpatient bed situation in the emergency department on the hospital website and on our internal television program, Credit Valley Current. .
RAZ Providing Faster Treatment in Emergency Department
Patients classed as Level 1 and 2…those with life threatening or urgent conditions, are highest on the priority list and seen almost immediately. The Level 4 and 5 patients, loosely called the “lumps and bumps”, those who need to be seen but not urgently, are triaged to what we call the fast track. These patients need to be seen by a doctor, but their condition is easily diagnosed without time consuming tests. It’s the Level 3 patients – the ones who require a “workup” – bloodwork and x-rays for example – who bear the brunt of the wait time. Many of these patients are feeling so unwell that they need to lay down. But as anyone who has visited our emergency department in the last few years knows, treatment rooms and stretchers are at a premium and usually filled with the level one and two patients. As a result, it has been up to a four to twelve hour wait for this level of patient. And that’s not something we’re proud of.
However, in the Spring 2006, Credit Valley implemented a new protocol for the treatment of level three patients. They are now moved into a “sub holding area” now called the Rapid Assessment Zone (RAZ) specifically for these patients. This area has a few recliner chairs for those patients who are too ill to sit up comfortably. As soon as possible a group of level threes are moved into a new treatment area for assessment. Six spaces in Care Centre Three have been allocated for level three patients. Their bloodwork is completed and x-rays ordered. Some are given intravenous fluids. Then they are moved back into the sub-holding area and another group of level threes are moved into this treatment area. As soon as their test results are completed, the patient is called back into the treatment area to see the physician. If they require admission, they are moved into the main emergency department area and their condition is medically managed until a bed becomes available on the nursing unit.