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Patient flow

Too many waiting in hospitals after discharges

TORONTO – More than 50,000 patients in Ontario were hospitalized longer than necessary in 2009 because the necessary post-discharge care could not be arranged, Auditor General Jim McCarter says in his 2010 Annual Report, released earlier this month.

“We know that staying in hospital longer than medically necessary can be bad for a patient’s health,” McCarter said. “It can also mean someone else has to wait longer than necessary for hospital care, and it is needlessly expensive.

“Although a number of initiatives have been introduced to improve patient discharge processes, our hospitals and other health-care facilities need to do better with regard to the safe and timely discharge of patients.”

Ontario hospitals discharge more than 1 million patients a year. Freeing up hospital beds as soon as patients can be discharged has a critical impact on surgery wait-times, on the efficient operation of hospital emergency departments, and on the overall cost-effective operation of our health-care system.

Most patients simply go home, but more than 20% require varying levels of support – anything from home-care services to a bed in rehabilitation or long-term-care facilities. Hospitals often must keep these patients until such services can be found.

Changing demographics will put further strain on the system: in 2009, people aged 65 or over accounted for just 13% of Ontario’s population but almost 60% of patient-days in hospital. In the next 20 years, the number of seniors is expected to double, making the need for efficient discharge procedures all the more critical.

Among the more significant findings in the Auditor’s Report:

• Across the province, about 50% of patients who could have been discharged if home-care services had been available had to wait in hospital an average of six days for the services.

• Half of hospital patients waiting for long-term-care beds from November 2009 to February 2010 were placed within 30 days; 90% were placed within 128 days.

• Wait-times for post-hospital services varied significantly by region: for hospitals in the North West Local Health Integration Network (LHIN), 90% of discharged patients were placed within 27 days, while the comparable figure in the North East LHIN was 97 days.

• In one region, long-term-care homes rejected between 25% and 33% of applications for such reasons as the patient required too much care, was too heavy or had behavioural problems. Applicants who were accepted were often just added to a lengthy wait-list.

• In some cases, patients rejected the choice of a long-term care centre because of its location – too far from home, thereby discouraging family members from visiting.

Posted December 16, 2010