Thread by @NeejaB

Thread on healthcare system collapse. Warning: it's long.

Just finished handover for the acute inpatient GIM service I take over tomorrow, and several observations that may help explain further why this crisis is not like anything we have seen before, and why cutting nursing renumeration makes literally zero sense.

An average GIM service will have a mix of patients awaiting long term care/subacute care with a number of medically acute patients. For many years, the flow out of the hospital has relied on numerous factors, including availability of community and alternate level of care spaces.

Not infrequently, there is a traffic jam at the hospital exit, and anywhere from 10-20% of acute GIM will be medically non-acute patients awaiting disposition. These patients remain in their bed, which subsequently reduces the total number of acute care beds remaining.

Pre-covid, this was a recurring theme, but generally we could predict the waves of high volumes and slow-downs, which allowed our teams to plan staffing accordingly. We were already in a crunch to keep up with aging population, & archaic infrastructure, but we were getting by.

Enter COVID, tidal waves, unprecedented amt of pressure on the healthcare system. Restricted inpt services, closed outpt resources, govt interference on addictions/MH infrastructure began..The resultant tidal wave of disease, unravelled wellness is just getting started.

No longer can we predict the waves of volume, acuity or despair. What was previously 20% medically non acute has now become 5-10%. With Incredibly ill patients with complex medical conditions.

The handover I took today required 3 pages of detailed notes, with only 2 of 24 patients deemed "medically non acute."

Add to this a burnt out medical team- allied health to pharmacy to Md to nursing. Nursing:patient ratios increasing to keep beds open. Vacancies causing unit& operations closures. Whispers heard in the hallways "I don't know how we provide any kind of standard of care like this."

And without our nursing colleagues, we cannot function in acute care. We cannot execute the treatment plans, we cannot care holistically for our patients, we cannot deliver the care we know our patients deserve.

And when you have a system that is bursting beyond its seams with the highest acuity we have seen in years, how....HOW... Does it make any sense to push our colleagues down even further?

Alberta, our healthcare system is in dire straits. And while our leadership dons cowboy hats and eats pancake breakfasts, I hope you know that those of us left standing will do our best with what we have.
#ableg #abpoli