Sault Area Hospital Update to Our Community
July 27, 2022 – With so much well-deserved media attention currently being given to the ongoing fragility of our provincial and national health care system, this update is shared with our community to affirm that we continue to be at the ready to implement the plans necessary to provide and support the delivery of safe, quality, and sustainable care at Sault Area Hospital and in our community.
The health system is facing significant health human resource challenges while dealing with the seventh wave of COVID-19, ongoing and related staffing impacts, and, particularly for SAH, a return to pre-pandemic patient visits to our Emergency Department, increased number of alternate level of care (ALC) patients in hospital, and an increase in surgical demands.
Our Emergency Department is seeing a return to pre-pandemic patient volumes as individuals who delayed accessing care address their health care needs, and individuals who are unable to access urgent care with their primary care providers or are without a family care provider come to the Emergency Department for care. Additionally, our Emergency Department is seeing an increase in substance use and patients presenting with mental health concerns. Like Emergency Departments across the country, we are impacted by increased patient visits coupled with staffing constraints. We are seeing increased patient wait times, ambulance offload delays, and increased admissions to the hospital.
Overall, we continue to provide safe, quality care at SAH. We recognize that we are fortunate compared to many other communities – larger and smaller, northern and southern – but also recognize that our ongoing stability continues to be uncertain during this time of heightened risk to our health, human resources and increased system pressures. We recognize and fully appreciate that our staff, physicians and volunteers contribute to this stability on every shift in every department. We are paying close attention to every link in the health care delivery chain. In addition to our work, we maintain close contact with our community health care partners and our senior health system partners at Ontario Health North.
Our community can be assured that we are working together to investigate solutions aimed at protecting our community’s access to health care. We will share updates such as today’s with our community on a regular basis. We ask our community for their continued support on behalf of everyone working hard to deliver safe, sustainable care to our patients, clients, and their caregivers and families that we are privileged to serve.
Stay safe and be well,
Ila Watson, President and Chief Executive Officer – Sault Area Hospital
Dr. Silvana Spadafora, Chief of Staff – Sault Area Hospital
Emergency Department Update
Our Emergency Department team is working to meet our community’s urgent and emergent health care needs. Our Emergency Department has a full slate of physicians, lessening the risk of physician shortages as seen elsewhere. We are reassured by this stable component of our care team. However, like many communities across Canada, our nursing and clinical support services teams have experienced shortages impacting care delivery. To lessen this impact, as our Emergency Department provides many levels of care, we redeploy staff and physicians within the department to address the most critical patient care needs. Additionally, we are working to address these shortages with recruitment initiatives, focused attention on efficiency improvements in the ED, such as our new ‘Fit to Sit’ pilot initiative with our EMS partners, and work with our EMS partners on ambulation offload.
We are asking our community to support their Emergency Department by when able seeking alternative care options by visiting a walk-in clinic, contacting Health811 at 811 (formerly Telehealth), or using a virtual care option. If you have an emergency, please call 9-1-1 or proceed to the Emergency Department. Do not delay care.
Like hospitals across Ontario, SAH is being impacted by the broader health system’s capacity pressures which have a domino effect across the system. Health human resource challenges combined with the finite number of beds have increased pressure on our hospital. Due to these capacity challenges across the health care system, we are seeing an increase in the number of patients waiting for an alternate level of care. Patients designated as alternate level of care (ALC) refer to patients receiving care in a hospital who do not require the intensity of resources and services provided in a hospital care setting and are awaiting transfer to another care setting, often in the community (community-based services, long-term care, home care, etc.).
Alternate Level of Care Update
As of May 31, 2022, Sault Area Hospital’s alternate level of care rate is 29.3%; this equates to 61 patient cases. May’s ALC rate is SAH’s highest alternate level of care rate over the past twelve months. With the increase in alternate level of care patients in the hospital, SAH is operating at a constant over 100% capacity in acute adult beds, when we would expect and plan to operate at a 90% occupancy to allow for surge capacity readiness
Every day our team works to address the care needs of our community by supporting safe patient discharges, working with our broader health care system partners to support patients being transferred to facilities or home with supports that address their needs and being innovative with staffing models such as by assessing the care requirements of each patient and ensuring that the right provider is caring for them each shift.
Surgical Services Update
We managed our procedure and surgical waitlists well as we resumed surgical services following the COVID-19 shutdowns. We are seeing some increases in our wait times; as individuals who may have delayed care are now seeking care, health human resource staff constraints with anaesthesia and trained operating room staff in high demand, and interrupted supply chain – particularly for critical or specialized supplies.
We currently have an increase in individuals experiencing a wait time longer than 182 days to receive their surgery. Approximately 10% of our elective surgical patients have been waiting longer than 180 days, an increase from 9% in February. We have cancelled less than ten cases over the past six months, given the restrictions and COVID-19 impacts. Cancelled surgeries are given priority as soon as possible, and patients often have their surgery completed within two weeks of cancellation. Anyone who experienced a delay in their surgery due to supply chain issues had their surgery completed within the same week.
To address this increase in wait time and lessen the possibility of additional surgical cancellation, we are taking the following measures: a daily review of the inpatient needs for the operating room and cardiac catheterization lab and, when possible, proactively reducing bookings to match health human resource levels and hospital capacity, rescheduling surgeries to align with supply availability, and implementing a new evidence-based standard of practice for some surgeries. Over the past two years, some surgeries have changed; for example, more than 80% of patients that undergo a total joint replacement (hips or knees) can go home the same day and do not require admission to the hospital. These patients are seen by physiotherapy post-surgery and resume their therapy in an outpatient setting within several days. Our Seamless MD team is supporting this evidence-based approach. SeamlessMD enables us to engage, monitor and connect remotely with surgical patients with the information they need to prepare for and recover from their surgery.
Additionally, we continue to work as a strong health system partner with our regional health care partners and Ontario Health North to support the consistent prioritization of surgical patients across the region. Sometimes, patients may be referred to other communities for more urgent care if required. At this time, SAH is receiving and not sending patients.
We are committed to performing cancer surgeries and all urgent/emergent surgeries.
Health Human Resources Update
Health human resource shortages are an issue facing SAH. We know that other hospitals and industries are experiencing the same challenges. Health human resource shortages impact our community with longer wait times, the potential for the reduction or cancellation of programs or services, overall added pressure on the health care system, and reduced work/life balance for our healthcare workers. We have a higher than usual number of open job postings, with the majority being temporary or permanent part-time.
We have also experienced higher than usual attrition over the past two years at SAH. The primary driver of our attrition is resignations. Our hiring has kept up with attrition, but we have not been able to get ahead, maintaining an ongoing need for further recruitment to meet the staffing needs of our hospital. Additionally, we are pressured by alternative employment opportunities for individuals such as travelling nursing and enticements from other communities here and abroad.
We are working to address our health human resource needs by deploying and reassigning staff as needed across the hospital, ongoing recruitment and retention efforts by working with educational community partners to explore opportunities, and we have also developed opportunities for in-community training for some of our challenging to recruit for positions. Our intensive care team has developed an extensive orientation and education program for novice and experienced RNs. It provides all their training at SAH with a cross-over to Durham College certification. This reduces the need for our staff to travel to receive this specialized education. We have also developed and maintained our cardiac catheterization lab education and ongoing education for our Cardiology Team.
We are working collaboratively with Sault College and other partners to hire as many new grads as possible. We are also very excited about the upcoming cohort of internationally educated nurses that will be ready to practice in the spring of 2023.