Health authority seeing progress on offload times, but patient flow remains a challenge

Nova Scotia is making progress on ambulance offload times, but a health authority executive is warning that wait-lists for care in other parts of the system continue to be a problem.

Tim Guest, vice-president of health services, told the authority's board meeting in Antigonish on Thursday that patient numbers recently grew to levels rarely seen outside of the "winter surge" — typically the busiest time of the year for hospitals. Capacity protocols were triggered at some sites in all four of the authority's zones last month.

Guest admitted the situation has him concerned as winter looms. He said the problem is tied to some areas where wait-lists for home-care support or long-term care placements have gotten longer. Patients in need of those services occupy hospital beds while they wait. 

One of Guest's chief duties has been working to find ways to reduce the time ambulance crews must wait before they can turn patients over to the care of hospital staff and to improve the flow of patients once they get inside the hospital. Those efforts intensified following a directive earlier this year from Health Minister Randy Delorey.

Targeted efforts at the regional hospitals in Dartmouth, Kentville, Truro and Sydney and the Halifax Infirmary have all produced positive results month-over-month since May, said Guest. But those results only go so far if staff cannot get patients in and out of acute care beds as required.

Along with getting patients admitted in a timely way, staff are also working to discharge them as soon as they're ready to leave.

"This is a systemic issue and it requires a systemic response to have long-term sustainable impacts," Guest said in an interview.

One challenge identified in the past has been delays getting patients transferred back to long-term care homes after they're ready to be discharged from hospital. Guest said the health authority has had positive meetings with members of the continuing care sector and they're facing similar issues: staff are seeing more patients with challenging and complex health issues than they have in the past.

That means there will be a need for more education and training for providers, he said.

"But it also means that we need to look at different ways of caring for individuals that have needs that the system wasn't necessarily designed to provide."

Guest said the health authority and continuing care officials are in talks with the Health Department about what might be required to expand services to fill gaps that exist in some parts of the province, particularly as winter approaches.