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Overcapacity in our hospitals

Dr. John Dornan, Chief of Staff, Horizon Health Network

Dornan Congestion Blog Photo"Why do I have to wait for four hours in the emergency department to see someone?" The answer is far from simple or easily answered. There is great interest in understanding why wait times in Emergency Departments (EDs) can be so long. Perhaps I can share my perspective.

 We are getting older. As we age, our needs increase, and at some point, it becomes harder to care for ourselves adequately at home. As a society, in Canada, our hospitals have become a safe place for seniors that can't go home. Yet the demands on our acute care beds has not diminished by an equal volume. 

At any point in time, across Horizon, approximately one in four of our beds are occupied by patients requiring alternate levels of care (ALC), meaning these patients no longer require in-hospital care but are too unwell to return to their home without certain support services. These patients would always be better cared for in their community rather than hospitals. The reality is that New Brunswick does not have enough nursing homes to receive these patients, and finding staff for home care is also a challenge. Therefore, these patients remain in our hospitals, and the number of ALC patients in Horizon facilities continues to grow each year.

We are not alone. Every province in our country is facing similar challenges relating to overcapacity, particularly during flu season. On any given day, Horizon is working with about 75 per cent of its acute care beds to look after ED admissions, surgeries, cancer treatments, etc. At times, we are obliged to cancel surgeries due to a lack of inpatient beds, and patients admitted from the ED experience a longer wait in the ED.  Fewer ED beds means a smaller number of beds with which to cycle through our waiting room.  Each Horizon facility explores and implements unique solutions in the face of inadequate staff or beds, or both.

In instances of overcapacity patients may experience long wait times in our emergency departments. We understand this is upsetting. People don't like it when they're waiting for a long time and see others being called before them who may have waited less time. We follow a triage practice (CTAS) so that people with more critical problems are seen quicker. Patients requiring the most urgent medical attention are always seen first.

For this reason, it's always important to consider alternatives to the emergency department.  Patients are encouraged to contact their family physician, nurse practitioner or walk-in clinic for non-urgent medical needs. Your local pharmacist can also be a wealth of health care knowledge as well. For more information, visit,

For patients that are admitted into one of our facilities, it may take us some time to find a bed, which may result in our patients staying in non-traditional hospital rooms while we find an available bed. We know this isn't ideal for patients, families or staff. Horizon works hard to ensure the safety and quality of care for all our patients regardless of whether they're in a bed or in the ED. Horizon staff meet daily to discuss admissions and discharges and work to find solutions and appropriate space for all of our patients.

What else are we doing? Horizon is placing more emphasis on improving primary care within the community so patients will have better access to the services they need, stay in their own homes longer, and possibly bypass the hospital system altogether. We're working with our key partners to find solutions on how to care for our patients that are waiting for a nursing home, and are strengthening our relationship with the Department of Social Development. Social workers now come to the hospital to assess the patient and work to find a suitable solution to ensure quality care.

We at Horizon continue to advocate for more long-term beds and work directly with communities to find solutions. Overcapacity is not only a New Brunswick issue, it is felt across Canada, and is something that needs to be addressed.  There is an undeniable imbalance between hospital beds and beds available in the community which could best care for seniors. Until this is resolved, it's important for everyone involved to optimize the resources we have available today.

The best way to not experience a long wait in the ED, is to not require care! Accidents happen, and much of what precipitates a visit to the ED is beyond our control. However we can collectively improve our health, get an annual flu shot, make small changes for healthier lifestyle and take advantage of different services within our community, whether it be an exercise class or a social club. Simple things can go a long way.

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