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Code Gridlock

I am reminded of the urgent need for a national seniors strategy in Canada every time I see or hear the words “Code Gridlock’’ at Kingston General Hospital where I am on staff.

Code Gridlock is every bit as ominous as it sounds. When a hospital reaches and exceeds its capacity, these two words go out on pagers and smart phones to physicians, administrators, nurses and support staff in hospitals all over Canada, or over the PA system as is the case at my hospital.

It means the hospital is so full that patients can’t move. Patients in emergency can’t go upstairs to beds because they are full. Sometimes ambulances can’t offload patients into ER because it is packed – even in the hallways. Elective surgeries are cancelled. Transfers from the region are put on hold.  Patient flow, has ground to a halt.

To those outside the medical world, the two words probably won’t be heard over the white noise of a busy hospital. But to everybody else in the building they work like a dog whistle — start freeing up beds immediately. My hospital has been in Code Gridlock for the past three months.

The home care folks go into overdrive to try to get already-stretched services into place for patients nearing discharge. The social workers call in favours to try to get long-term care facilities to squeeze in one or two more people.

All hospitals in the region are told that we can’t take any patients other than “life and limb” problems. All physicians, nurses and other health care professionals are urged to do whatever they can to expedite discharges.

Code Gridlock was developed to deal with the inevitable surges in activity we see — a way to raise awareness acutely and thereby squeeze extraordinary performance out of the system for a few days in order to overcome the congestion. But increasingly, Gridlock is becoming the norm.

So what does Code Gridlock have to do with a national seniors strategy involving all levels of government with Ottawa taking the lead?

In the hospital world we have another code – ALC. It stands for alternate level care (as opposed to acute care).

These are patients who no longer require acute care and for all intents and purposes are able to leave the hospital. More to the point, they should be leaving the hospital not only because the beds are needed by others but because the hospital is, ironically, a dangerous environment for patients who have chronic but not acute disease.

Hospitals are not set up to look after people with chronic diseases. Patients get deconditioned, they fall, they suffer hospital-acquired infections. They don’t get the care they need and deserve.

ALC patients are almost always seniors who should be in long-term care or at home with assistance from home care, or with community-based solutions.

Fifteen per cent of acute-care hospital beds in Canada are occupied by ALC patients. The CMA estimates $2.3 billion a year that could be used elsewhere in the health system if we could just break the habit of warehousing our seniors in hospitals.

As an intermediate measure, we need to step up investment as a society in long-term care. We must also develop and invest in a plan that recognizes people want more support and services that will help them stay in their homes and communities. The need to dehospitalize the system and deal with Canada’s aging population should be priorities in a national seniors strategy.

Canadians over 65 currently account for half of all health costs. By 2031 seniors will present 21 per cent of the populations and 59 per cent of the health costs.

The European Commission takes independent living seriously enough to have the SILVR project. That stands for Supporting Independent Living for the Elderly Through Robotics. That’s right, robotics.

In an age of wearable technology we can now think what used to be unthinkable. Google Glass has developed a contact lens that reads glucose levels from tear duct emissions. It is now possible to monitor blood pressure through a bandage.

Think of how much more viable home care would be with this emerging technology.

All this is doable if our governments are prepared to sit down and develop a national strategy dedicated to the principle of aging well and quality care for all.

Fifty years ago Tommy Douglas showed us a better way. Fixing seniors care will go a long way in renewing the entire health system.

Dr. Christopher Simpson

President, Canadian Medical Association

 

This op-ed ran in the Winnipeg Free Press on January 14, 2015.