Severe staff shortages, a lack of hospital beds, and deferred care due to pandemic restrictions have created a perfect storm in Canada’s health-care sector, and the Kingston area is feeling the ill effects.
Ontario Health’s overview, taken from National Ambulatory Care Reporting System (NACRS), Canadian Institute for Health Information (CIHI), and Cancer Care Ontario (CCO) provides a clear picture of the Emergency Department (ED), diagnostic imaging, and surgical wait times locally and across the province.
According to its data, provincially, the average wait time to see an ED doctor for assessment is about 1.9 hours. For Kingston General Hospital (KGH), the average is 2 hours, while for Hotel Dieu Hospital (HDH) it is 1.1 hours, with the smaller Lennox and Addington County General Hospital (LACGH) in Napanee averaging 2.5 hours. The total ED stay for non-urgent patients averages three hours, with KGH at 4.6 hours, HDH at 2.4 hours, and LACGH at 3.9 hours. The total stay for a “high urgency” patient who is not admitted to the hospital is 4.5 hours provincially, 6.5 hours at KGH, 3.1 hours at HDH, and 5.1 hours at LACGH.
However, when it comes to ED patients who need to be admitted to the hospital, the provincial average skyrockets above the provincial target of 8 hours. It takes an average of 20.7 hours to be admitted to a hospital bed in the province of Ontario. A patient can expect an average wait of 19.4 hours in Kingston or 17 hours in Napanee.
Asked why, Dr. Renate Ilse, Chief Operating Officer at Kingston Health Sciences Centre (KHSC) said, “I wish I could give you better news.”
”The reality,” she explained, “is that Kingston Health Sciences Centre, like most of the hospitals in the country right now, is operating at capacity… A variety of hospitals are closing their emergency departments or asking people to go elsewhere… to help with capacity. We’re not able to do that because we’re the only game in town, so that means we have to see everybody that comes in, and the reality is that we’re really, really busy.”
Dr. Ilse puts this down to “tremendous staff shortages” and “post-pandemic deferred care.” And the slowdowns aren’t just in the Emergency Department, she said: “We’re just full. The hospital is permanently full and has patients in the hallways quite often. And that means that we can’t admit patients until we discharge patients.”
Despite creative ways of looping patients quickly through the queue, such as creating “discharge lounges and doing things that might speed things up,” Dr. Ilse explained, “There’s a lot of patients, a full hospital, and too little staff.”
Staff shortages explained
Why are so many nurses and physicians missing from Ontario’s health-care system? Dr. Ilse said, “That’s a very complicated question… but in general, health care has changed a lot… There have been lots of attempts to reform the health-care system in Ontario over the last 30 years, and most of them have been aimed at reducing hospital beds and decreasing the cost of care, which certainly discourages some people from going into the profession.”
She observed, “When I was a nurse many years ago on the front line, it was a different job from what it is today. The pandemic hasn’t made people nicer to each other, is the best way I can put it.”
Along with this, Dr. Ilse said hospital jobs are difficult on individuals and families. “In 2022 , there are just so many other opportunities for people, especially in nursing… there are so many things you can do with your nursing degree. So if you have an option that allows you to work Monday to Friday and still see your family, I think a lot of people take that.”
It is clear to her that systemic change is needed in the profession “to try to make it more attractive for people to want to do hospital nursing.”
Change is coming. Will it help?
On Oct. 27, 2022, the provincial government announced additional changes that it says “will break down barriers so that more health professionals can work in Ontario” as part of the provincial Plan to Stay Open: Health System Stability and Recovery.
Proposed by the Ontario Ministry of Health, the College of Nurses of Ontario, and the College of Physicians and Surgeons of Ontario, the changes are meant to “support recruitment efforts and make it faster and easier for health care professionals trained in Ontario, other provinces, and internationally to register and practice in Ontario,” according to a media release.
Dr. Ilse said this may help “in the short run” to alleviate some of the staffing issues. However, she went on, “There just aren’t nurses out there to hire… There are a lot of international graduates who are not working… [The provincial government] has said that they’re going to fast track some interim registrations while people are going through the system and getting registered. It is probably the only way to get people into the system quickly; otherwise, you’d have to wait for them to graduate two, three, four years down the road.”
What happens when patients need diagnostic imaging tests or surgery?
Dr. Ilse explained that “MRI (magnetic resonance imaging) machines and CT (computerized tomography) machines are actually controlled by the government… So [a health care provider such as KHSC] would get awarded a CT or MRI [machine]; sometimes you would have two or three. And then [the Ontario government] controls the amount of work that you can do by allocating operating hours.”
This means that, every year, KHSC gets a certain number of operating hours determined through provincial allocations. And, Dr. Ilse said, in order to maximize the efficiency of the diagnostic imaging teams at both KGH and HDH, KHSC has had staff undertake performance improvement programs, so as to get as much out of those operating hours as possible.
The next thing to consider about diagnostic imaging wait times is that the government and Cancer Care Ontario (CCO) actually issue a list of how to assess the priority of someone who needs either an MRI or CT scan. Each patient is given a priority level of one through four.
“A priority one,” explained Ilse, “would be somebody who is in a life-threatening condition and needs [imaging] right away to assess what’s going on.” She gave the example of someone who had a head injury from a car accident, a situation where doctors need to know what to do in order to save a life.
KGH demonstrates excellent priority one wait times, but unfortunately, priority four patients can wait several months for imaging. Non-urgent imaging is still important, however, and Dr. Ilse expressed sympathy for people who have to wait.
”If you’re the person who’s waiting, yes, it’s very frustrating, because you don’t know what’s going on and you wonder what’s happened to you,” she said. ”I wish we could do more and help more, but the reality is that the system isn’t funded that way.”
Surgery wait times are complicated even further by the type of surgery and the general health of the person requiring surgery, Dr. Ilse explained. Once a doctor advises a surgery, that doctor will tell the patient approximately how long they will wait for their surgery. Closer to the surgical date, the patient goes through surgical screening, then gets booked for a pre-operative assessment. And depending on general health (colds, illnesses, chronic disease), the patient might need more tests.
”If you’re somebody who is otherwise not well, [for example] if you’re a diabetic or if you’ve got high blood pressure, it wouldn’t be surprising that you would need to be monitored prior to your surgery,” Dr. Ilse said, noting that fluctuations in a patient’s health could lead to retesting and longer waits.
Dr. Ilse said she feels for people experiencing the wait times right now, and she hopes that knowing why they must wait will give them some relief: ”I feel really bad for the public. I think it’s very difficult when you don’t know why you have to wait.”
But, she concludes, ”The reality is, in a public funded system, there have to be some some constraints and some limits. Otherwise, it would run out of money… It’s a bit of a trade off… All of us are really lucky that we don’t have to bankrupt our families because we need health care. That’s the pro. The con is that sometimes we have to wait a little longer and, through the pandemic and more recently, that’s just become more of a critical problem than it has ever been previously.”