Hospitals are deemed to be at “overcapacity” when they have more patients than available beds on a specific unit. It restricts patient movement from one care department to another (patient flow) and can result in an increased length of stay for patients in the Emergency Department.
Quinte Health Care, like many other hospitals at some point, has had its struggles with overcapacity. However, a recent reduction in overcapacity is being attributed to QHC’s new team approach to patient care and staff taking ownership to make improvements.
Tracy Jordan, Manager of Patient Flow said that we’ve taken a step in a positive direction in reducing overcapacity by implementing the new Interprofessional Patient Care Team (IPCT) approach. “We’re seeing a decrease in functional decline. With hourly rounding, patients are being checked on more frequently than before and the staff are working as a team to ensure the patient’s needs are being met,” she said. As part of QHC’s Senior Strategy, patients are encouraged to normalize their routine which includes getting out of bed more frequently, sitting up with visitors and doing exercises while in bed whenever possible. “Staff are taking ownership of our Senior Strategy and with less functional decline, patients are able to be discharged as planned.” She said that patient flow has improved significantly and referrals to the Complex Continuing Care (CCC) for slow stream rehab unit have dropped. “This is exactly the outcome we have been looking for."
Graph represents the approximate number of patients who have converted to Alternate Level of Care, Long Term Care (ALC LTC). When patients become ALC, they remain in hospital longer which can contribute to overcapacity issues. As shown in the graph, there were approximately 10 patients convert to ALC in June 2015, compared to just 3 patients in June 2016.
“When I look at the graph, it speaks volumes to me,” said Tracy. “Our overcapacity challenges have improved significantly and we’re seeing a reduction in Length of Stay. Not to say we won’t see capacity challenges in the future, but we’re definitely on the right path and that should be celebrated. Patients who are converting to Alternate Level of Care/Long Term Care (ALC LTC) are primarily people who cannot be supported in the community and those who truly need to remain in hospital to wait for a LTC bed to become available. We have the occasional conversion related to hospital acquired functional decline, but it’s nothing like before.”
What are we doing at QHC to continue to reduce overcapacity?
Mobilizing patients - Encouraging patients to move as much as possible, to get out of bed, to sit up with visitors, to dress themselves and exercise as often as possible in order to prevent functional decline. When patients have functional decline, they remain in hospital longer which can lead to overcapacity.
Encouraging patients to maintain their functional and cognitive status – Normalizing their routines as much as possible. Ensuring patients are drinking plenty of fluids and encouraging toileting over the use of a bedpan. Encouraging patients to perform activities of daily living as they did prior to admit.
Planning for discharge on admission – Attempting to address any concerns that family members have when patients are first admitted.
Notifying the patient and family 24 hours in advance of discharge whenever possible – Notifying patients and their family members of the planned time of discharge so that the person picking them can ensure they're on time.
Admitting appropriately – A greater consideration on determining if it’s necessary for a patient to be admitted to hospital or if they could receive the care they require from a service within the community.
Educating patients on why it’s important to tell the Unit Care Clerk (UCC) before they leave the unit to go home – As soon as we know that a patient has been discharged and they've gone home, we can have the room cleaned and get it ready for the next patient.