Tuesday, December 20, 2005

Surrey plan, Alberta test offer health care models

VICTORIA - Anybody wondering about the future of their local hospital should pay close attention to the overhaul of medical services in Surrey.
The problem was crowding at the Surrey Memorial Hospital, in the emergency room and the wards.
But the solution backed by the province wasn't a bigger hospital, or even just a larger ER. Instead the services are being carved up into separate centres, with the aim of reserving acute care hospital beds and high-end emergency care for those who really need them.
So the health region has just opened a "minor treatment unit" for people who don't really need the full emergency service but show up there anyway. Instead of clogging the waiting room and sitting for hours - and creating more delays for people who really need emergency care - they get sent off to the minor treatment centre.
A massive ambulatory care centre is going to be built nearby, sort of a junior hospital. People who need outpatient care, day surgery and other activities that don't require the acute care support can be treated there. It will include a primary care clinic housing family doctors, and people to help with chronic disease management.
The idea is simply. Get every patient into the system where it makes sense. Increased specialization allows cost-efficiencies and wait time management, and you can avoid the high cost of having someone who only needs minor first aid clogging a busy emergency room.
Health Minister George Abbott is an enthusiastic backer of the approach, being tried for the first time in B.C. He expects a similar strategy any time hospitals are built or expanded. "What we're seeing is very much a model for the future," Abbott says.
Hospitals in Salmon Arm, Kamloops, Kelowna and Nanaimo are already under increasing pressure. Abbott says a similar approach will be taken in those communities, although changes will likely be incremental.
The Canadian Centre for Policy Alternatives released a study this month that advocated taking the concept farther. Dr. Michael Rachlis said governments should be building more specialized surgical clinics for minor procedures and low-risk surgery. A clinic that does only knee and hip replacements can deliver faster, better care at lower cost, just like a service station that does only oil changes.
Rachlis also wants governments to pay a lot more attention to "queue management," the science of moving people from start to finish smoothly and quickly. He argues people wait too long for surgery even when enough operations are being done, because the system is clunky. Patients move through a series of tests and specialists visits with little co-ordination and frequent long delays. Simply managing that process efficiently cuts waiting times.
A report on an Alberta experiment this week confirmed that the approach can work. In the first eight months of a new approach to hip and knee replacements, the wait from getting a referral to specialist to surgery was cut to three months. It had been averaging 20 months.
The project included money to keep operating rooms open. But many of the gains came from managing patients' progress through the system, and eliminating needless waits for tests or to see specialists or physiotherapists. A change as simple as scheduling all tests and consultations for each patient for one day cut out long delays.
Any increased costs were recovered. People who wait almost two years for surgery lose income and suffer, and their health deteriorates. Because patients got surgery before their health began to fail, the average hospital stay was cut from 6.2 days to 4.3 days - an enormous cost saving.
Some of the principles may be harder to apply in smaller centres, although the idea of clinics that are also "minor treatment units" may may good sense where a full emergency room can't be justified.
But the new approaches, in Surrey and across the mountains in Alberta, show that health care problems can be solved within the current system.
Footnote: B.C. needs to make improvements. The province is meeting most of the first handful of wait time standards agreed to by the provincial health ministers. But the province isn't close to providing knee and hip surgery within the required six months. More than half the patients wait longer than that. Many wait much longer.


Anonymous said...

It seems pretty clear to me that the hold up in those operations on hips and knees is at least partly because of the long time it takes to actually get to see a orthopedic surgeon. I've been asking around , and a year is not uncommon. If anyone can prove other wise let us all know! So no matter what the BC governemnt says about 15 weeks wait times, and the fed talk about 26 week wait times, it's all smoke and mirrors if you wait a year and then they start counting. Numbers can be twisted and they are being twisted here.

The Alberta model seems to be far more efficient with shorter wait times, the patients arn't hobbling around so their muscles don't shut down. They tend not so likely to fall down and break something, shorted recovery time. A win win all the way.

Anonymous said...

If this set up in Aberta is as good as it looks for reducing wait times for surgury, and if it's done inside the public system and , and is even liked by the NDP opposition in Alberta, why do we hear nothing about it either way from the NDP Official Opposition in BC?
Everyone knows the wait lists shown on the government web site are bogus, and the new improved 26 weeks doesn't cut it either. Wait times are closer in BC to one year and a half, and often greater.
Just ask anyone on a wait list and reality sets in. But maybe some folks don't like reality?

Politicians alway seem to slant things the way they want them to slant, and if necessary will bring out the old credit card to make things right , for themselves. What if you don't have a credit card. Tough, just wait.Probrably make you a better person if you spend some time with constant pains. That way you can always be thnakful your elected folks are working hard to make things right.

Anonymous said...

My God, the NDP health critic in Aberta and now even Jack Layton is reported to say that the Alberta new method of handling long wait lists works. Mind you on TV they only showed Layton threatening Good Ol Ralph.

Now maybe the leader of the offical opposition in BC might say something. But don't hold you collective breath

Anonymous said...

I was standing in a surgeons office in Victoria earlier today to clarify the time and date for first consulation with him. You really don't want to know!

The staff member was on the phone and somebody was being told to expect almost a years wait prior to getting into the office.

Seems the folks added last spring were coming up for their first visit in the next two months.

One has to wonder just why a wait of a year is needed to actually get to speak to a doctor who happens to do sugical work.
Or is it shortage of operating room time, associated staff time, or does the places work on reduced hours?

Our government is not helping by telling people that lists are getting shorter. The govenment list means nothing till the surgeon decides a potential patients risk factor, he then tries to book a bed, in the priority he feels is right for the patients, and the rest of them simply slip farther down the pile.

The Alberta model seems able to get the parties to the table much faster. How can they do that, and why doesn't in happen here in BC?

Maybe it's to encourage folks to go elsewhere for their medical procedure, preferrably to a private clinic. But that can't be because the federal minister says there is to be no two tier system. I got news for you Minister, there is one right now. Hire some more doctors and staff, open the opperating rooms, and cut those lists down or finally admit you guys dont have either the smarts to manage, or the desire to manage.

Anonymous said...

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