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Exploring Reasons for Bed Pressures in Winnipeg Acute Care Hospitals*

Published online by Cambridge University Press:  31 March 2010

Verena H. Menec ,
Sharon Bruce  and
Leonard MacWilliam
Verena H. Menec*
Affiliation:
University of Manitoba
Sharon Bruce
Affiliation:
University of Manitoba
Leonard MacWilliam
Affiliation:
University of Manitoba
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être addressées à : Verena H. Menec, Ph.D., Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E ON3. (menec@cc.umanitoba.ca)
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Abstract

Hospital overcrowding has plagued Winnipeg and other Canadian cities for years. This study explored factors related to overcrowding. Hospital files were used to examine patterns of hospital use from fiscal years 1996/1997 to 1999/2000. Chart reviews were conducted to examine appropriateness of admissions and hospital stays during one pressure week. Results indicate that pressure periods in the hospital system were driven by an influx of older adults with influenza-associated respiratory illnesses. Moreover, examination of one specific pressure week showed that at least 100 beds were occupied by patients who likely did not require acute care. The chart review revealed that a substantial proportion of non-acute patient-days were spent awaiting home care, long-term care, or diagnostic testing services. These findings suggest future bed pressures might be prevented through influenza vaccination and an increase in the availability of – and timely transfer to – alternative levels of care.

Résumé

La surpopulation des hôpitaux constitue un fléau à Winnipeg et dans d'autres villes canadiennes depuis des années. Cette étude aborde divers facteurs liés à cette surpopulation. Les dossiers des hôpitaux ont servi à l'évaluation des fluctuations relativement à l'utilisation des hôpitaux pour les exercices 1996/1997 à 1999/2000. Un examen des dossiers a été mené afin de déterminer la pertinence des admissions et des séjours à l'hô pital pendant une semaine de forte affluence. Les résultats réve`lent que les périodes d'affluence du système hospitalier étaient dues à l'afflux de personnes âgées souffrant de maladies respiratoires associées à la grippe. Par ailleurs, l'examen d'une semaine de forte affluence en particulier a révélé qu'au moins une centaine de lits étaient occupés par des patients qui n'avaient probablement pas besoin de soins de courte durée. L'examen des dossiers a révélé qu'une proportion substantielle de jours-patients qui n'étaient pas de courte durée ont été passés à attendre des soins à domicile, des soins de longue durée ou des examens paracliniques. Ces conclusions semblent indiquer que l'on pourrait éviter d'éventuelles périodes de forte affluence au moyen de vaccinations contre la grippe ainsi que d'une augmentation de la disponibilité des autres niveaux de soins et de transferts rapides vers ceux-ci.

Keywords

agingalternative levels of carehospital overcrowdinginfluenza-associated illnessesagingalternative levels of carehospital overcrowdinginfluenza-associated illnesses
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 24 , Issue S1: Health and Health Care Use Among Older Adults: Using Population-Based Information Systems to Inform Policy in Manitoba , Spring/Printemps 2005 , pp. 121 - 131
Copyright
Copyright © Canadian Association on Gerontology 2005

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Footnotes

*

This research resulted from projects undertaken by the Manitoba Centre for Health Policy under contract to Manitoba Health. The results and conclusions are those of the authors, and no official endorsement by Manitoba Health was intended or should be inferred. Dr. Menec holds a New Investigator Career Award from the Canadian Institutes of Health Research.

References

Anderson, G., Sheps, S., & Cardiff, K. (1993). Evaluation of Vi-Care: A utilization management program of the Greater Victoria Hospital Society. Vancouver: University of British Columbia.Google Scholar
Barker, W.H. (1986). Excess pneumonia and influenza associated hospitalization during influenza epidemics in the Unites States, 1970–78. American Journal of Public Health, 6, 761–765.CrossRefGoogle Scholar
Brownell, M.D., Roos, N.P., & Burchill, C. (1999). Monitoring the impact of hospital downsizing on access to care and quality of care. Medical Care, 6(Suppl.), JS135–JS150.Google Scholar
Bruce, S., De Coster, C., Trumble Waddell, J., Burchill, C., & De Haney, S. (2001). Acuity of patients hospitalized for medical conditions at Winnipeg acute care hospitals. Winnipeg: Manitoba Centre for Health Policy.Google Scholar
Bruce, S., De Coster, C., Trumble Waddell, J., Burchill, C., & De Haney, S. (2002). Patients hospitalized for medical conditions in Winnipeg, Canada: Appropriateness and level of care. Health Care Management Forum, Winter(Suppl.), 53–57.CrossRefGoogle Scholar
Canadian Association of Emergency Physicians. (2000). Position statement: Emergency department overcrowding. Retrieved December 17, 2004, from http://www.caep.ca/002.policies/002-1.guidelines/overcrowding.htmGoogle Scholar
Canadian Institute for Health Information. (2002). Health care in Canada. Ottawa: Statistics Canada.Google Scholar
De Coster, C., Peterson, S., Carrière, K.C., & Kasian, P. (1999). Assessing the extent to which hospitals are used for acute care purposes. Medical Care, 37(Suppl.), JS151–JS166.Google ScholarPubMed
De Coster, C., Roos, N.P., Carrière, K.C., & Peterson, S. (1997). Inappropriate hospital use by patients receiving care for medical conditions: Targeting utilization review. Canadian Medical Association Journal, 157, 889–896.Google ScholarPubMed
Derlet, R.W., & Richards, J.R. (2000). Overcrowding in the nation's emergency departments: Complex causes and disturbing effects. Annals of Emergency Medicine, 35, 63–68.CrossRefGoogle ScholarPubMed
Dickinson, G. (1989). Emergency department overcrowding. Canadian Medical Association Journal, 140, 270–271.Google ScholarPubMed
Espinosa, G., Miro, O., Sanchez, M., Coll-vinent, B., & Milla, J. (2002). Effects of external and internal factors on emergency department overcrowding. Annals of Emergency Medicine, 39, 693–695.CrossRefGoogle ScholarPubMed
Fatovich, D.M. (2002). Emergency medicine. British Medical Journal, 324, 958–962.CrossRefGoogle ScholarPubMed
Fayerman, P. (1999, February 11). Hospital squeeze puts patients in linen closets, storage areas. Vancouver Sun, p.A1.Google Scholar
Feferman, I., & Cornell, C. (1989). How we solved the overcrowding problem in our emergency department. Canadian Medical Association Journal, 140, 273–276.Google ScholarPubMed
Fetter, R., & Freeman, J. (1989). DRG refinement with diagnostic specific comorbidities and complications: A synthesis of current approaches to patient classification (Final report: The Health Care Financing Administration Cooperative Agreement, No. 15-C-98930/1-01 and 17-C-98930/1-0251). New Haven: Health Systems Management Group.Google Scholar
Fleiss, J.L. (1981). Statistical methods for rates and proportions. New York: John Wiley & Sons.Google Scholar
Graff, L. (1999). Overcrowding in the ED: An international symptom of health care system failure. American Journal of Emergency Medicine, 17, 208–209.CrossRefGoogle ScholarPubMed
Gray, C. (2000). Hospital crisis? What crisis? Canadian Medical Association Journal, 162, 1043.Google Scholar
Gross, P.A., Hermogenes, A.W., Sacks, H.S., Lau, J., & Levandowski, R.A. (1995). The efficacy of influenza vaccine in elderly persons: A meta-analysis and review of the literature. Annals of Internal Medicine, 123, 518–527.CrossRefGoogle Scholar
Hanratty, B., & Robinson, M. (1999). Coping with winter bed crises. British Medical Journal, 319, 1511–1512.CrossRefGoogle ScholarPubMed
Health Canada. (2002). Influenza in Canada: 2000–2001 season. Canada Communicable Disease Report, 28, 17–28.Google Scholar
Health Services Utilization and Research Commission. (1994). Barriers to community care. Saskatoon: Author.Google Scholar
Hensher, M., Fulop, N., Coast, J., & Jefferys, E. (1999). Better out than in? Alternatives to acute hospital care. British Medical Journal, 319, 1127–1130.CrossRefGoogle ScholarPubMed
InterQual. (1999a). ISD-AC Instensity of Service Severity of Illness Discharge Services. Marlborough, MA: InterQual, Division of Access Health, Inc.Google Scholar
InterQual. (1999b). ISD-AC Instensity of Service Severity of Illness Discharge Services. Marlborough, MA: InterQual, Division of Access Health, Inc.Google Scholar
Joint Policy and Planning Committee. (1997). Non-acute hospitalization report (adult). Toronto.Google Scholar
Kendrick, S., Frame, S., & Povey, C. (1997). Beds occupied by emergency patients: Long term trends in patterns of short term fluctuations in Scotland. Health Bulletin, 55, 167–175.Google ScholarPubMed
Lui, K., & Kendal, A.P. (1987). Impact of influenza epidemics on mortality in the United States from October 1972 to May 1985. American Journal of Public Health, 77, 712–716.CrossRefGoogle ScholarPubMed
McBean, A.M., Babish, J.D., & Warren, J.L. (1993). The impact and cost of influenza in the elderly. Archives of Internal Medicine, 153, 2105–2111.CrossRefGoogle ScholarPubMed
Menec, V.H., MacWilliam, L., Black, C., & Aoki, F. (2003). The impact of influenza-associated respiratory illnesses on hospitalizations, physician visits, emergency room visits, and mortality. Canadian Journal of Public Health, 94, 59–63.CrossRefGoogle ScholarPubMed
Menec, V.H., Roos, N.P., & MacWilliam, L. (2002). Seasonal patterns of hospital use in Winnipeg: Implications for managing winter bed crises. Health Care Management Forum, Winter(Suppl.), 58–64.CrossRefGoogle Scholar
Mitchell, C. (1998, February 19). No room for dignity in ERs hallways. Winnipeg Free Press, p.A1.Google Scholar
Nichol, K.L. (1998). Efficacy/clinical effectiveness of inactivated influenza virus vaccines in adults. In Nicholson, K.A., Webster, R.G., & Hay, A.J. (Eds.), Textbook of influenza. Oxford: Backwell Science, 358–372.Google Scholar
Nichol, K.L., Margolis, K.L., Wuorenma, J., & Von Sternberg, T. (1994). The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. New England Journal of Medicine, 331, 778–784.CrossRefGoogle ScholarPubMed
No Room for Dignity in ERs Hallways. (1999, January 8). Winnipeg Free Press, p.A1.Google Scholar
Roos, L.L., & Nicol, J.P. (1999). A research registry: Uses, development, and accuracy. Journal of Clinical Epidemiology, 52, 39–47.CrossRefGoogle ScholarPubMed
Schneider, S., Zwemer, F., Doniger, A., Dick, R., Czapranski, T., & Davis, E. (2001). Rochester, NY: A decade of emergency department overcrowding. Academic Emergency Medicine, 8, 1044–1050.CrossRefGoogle Scholar
Schull, M.J., Szalai, J.P., Schwartz, B., & Redelmeier, D.A. (2001). Emergency department overcrowding following systematic hospital restructuring: Trends at twenty hospitals over ten years. Academic Emergency Medicine, 8, 1037–1043.CrossRefGoogle ScholarPubMed
Sheps, S.B., Reid, R.J., Barer, M.L., Krueger, H., McGrail, K.M., Green, B., Evans, R.G., & Hertzman, C. (2000). Hospital downsizing and trends in health care use among elderly people in British Columbia. Canadian Medical Association Journal, 163, 397–401.Google ScholarPubMed
Simonson, L., & Fukuda, K. (2000). The impact of influenza epidemics on hospitalizations. Journal of Infectious Disease, 181, 831–837.CrossRefGoogle Scholar
Trerise, B., Dodek, P., Leung, A., & Spinelli, J.J. (1999). Inappropriate underutilization of services in an acute care hospital. Vancouver: Centre for Health Evaluation and Outcome Sciences.Google Scholar
Wright, C.J., & Cardiff, K. (1998). The utilization of acute care medical beds in Prince Edward Island. Vancouver: Centre for Health Services and Policy Research.Google Scholar