Thread by @drdeepasoni

Anatomy of a winter surge
aka
CHF: congestive healthcare failure

This is what 🇨🇦 healthcare system looks like from the inside
#hallwaymedicine
#ONpoli #canadawaits
#surgeisthenewnormal

Several hour waits in emergency department (ED)

patients spilling into hallways, ICU beds full, precious ED beds full with admitted patients because no beds in hospital = no bed admit (NBA).

This scene plays out in hospitals all over ON and all over 🇨🇦. every.single.winter.

Patients repeatedly approach nursing station:
“how much longer?”
“when is it my turn?”
“how many doctors are working?”
“why is this taking so long?”, “why are you guys so slow?” “you call this an emergency?”

All of this cuts deep as you have been suppressing, hunger, thirst and the need to void for hours, trying to get everyone seen

They don’t know this. They don’t know you carry this moral distress with you: knowing the system is failing them and you can’t do much to change it

The critically ill get rushed in. Heart attack, stroke, heart failure, infections, trauma...we stabilize, treat and get them admitted. But soon into the winter, usually a few weeks into December, the supply of hospital beds is outstripped by the demand.

The number of sick patients coming through the ED doors overwhelms the resources a hospital has.

Soon, those sick patients have no bed to go to and so they wait, on an emergency stretcher for a hospital bed on a ward upstairs, to become available. It hardly ever does.

As winter wears on, you have more and more ED beds occupied by admitted patients. This leaves fewer and fewer for the ED docs to use to see new patients from the waiting room. It’s like an overflowing bathtub.

Water starts to spill everywhere. In the ED, the new patients coming through the doors, are the water. They seep into the halls and corridors, waiting.

They can’t see behind the walls.

They can’t see that the resources, rooms, staff, are partially taken up caring for patients who need a real bed, but won’t get it because 🇨🇦 has one of the lowest number of beds per population of any OECD country.

They won’t get a hospital bed because 🇨🇦 needs: a better home care system, thousands more long term care beds, more community nursing, more help for caregivers, a dementia strategy, more hospital beds. And so much more.

The sickest patients: cancer, trauma, heart attack, asthma etc hardly ever complain. We see the fear in their eyes as they feel their body in distress. They know we are doing our best to help.

There are others though who get angry. Angry at the wait, angry at us. In flu season, they are angry when, after a careful history and physical, we conclude they have flu. “What do you mean there’s nothing you can give me? I feel awful”

Flu is a viral illness. It makes people feel like they were hit by a truck. For days. There is nothing, except Tylenol, Advil and fluids. Antibiotics don’t do anything except give you diarrhea. So if you want to avoid a lengthy illness and an ED visit, get a flu shot. Every year.

Keeping just the flu patients out of the ED would go a long way to decanting the pressure. It would also help keep our elderly and babies from getting sick because someone sitting in the waiting room gave them flu.

Congestive healthcare failure: this is what 🇨🇦 healthcare system looks like. Government doesn’t want to acknowledge it because seeing it means doing the hard work and not throwing tiny bandaids on a huge bleeding wound.

🇨🇦 strategy for almost 2 decades has been the same every winter.

Call it a ‘surge’. It implies that this is a temporary blip and things will go back to normal. But our population is growing, the silver tsunami is coming and ‘normal’ is a fantasy concept.

Calling it a surge falsely reassures the public that everything is actually ok. It’s not.

In order to change this, we need to get our collective head out of the sand. Stop resting on our laurels about Medicare. Look at what’s actually in front of us.

Have difficult conversations with the public about what the healthcare system can and can’t do. Tell them the truth. This is not a surge. This is a system in crisis. And it’s going to take everyone caring about it to save it from impending collapse.
#unsustainableisunstable