Essays

Essays October 2016

Healthcare is 24/7

Duncan Sinclair

 

For every professional, striking a balance between one’s responsibility to those who need the services you provide and that of your own and your family’s health is never easy. This is especially true in healthcare. Like fires, emergencies, and criminal activities, illnesses and injuries occur independently of the clock and calendar. They have to be dealt with 24/7, 365 days a year. Sadly, that fact seems to have been overtaken by nine to five-ism in too many parts of our so-called healthcare system.

My discharge from an acute care hospital was scheduled for a Friday morning not long ago. I was up and dressed before 9 am; my family was there with the car parked nearby. All that remained was to receive a pre-arranged ‘phone call from the Community Care Access Centre confirming my transfer to home care. Despite the hospital’s repeated enquiries, no call came. By late afternoon, counted by then as an additional $840 bed-day, I signed myself out and went home with my son as caregiver. Telephone calls to the CCAC’s switchboard yielded assurances that they had my file, coupled with what proved to be empty promises that somebody with decision-making authority would call that evening. It was not until late the next day that I finally got to speak to a nurse coordinator who offered me a choice between waiting for a home care provider to visit me or an appointment at a clinic the following day (Sunday) to have my dressings changed and drains flushed (they were supposed to be flushed daily). I chose the latter. While there I picked up sufficient supplies and my son received instruction so he could tend to the drains and dressings himself thereafter.

Mine is an all-too-common story illustrating the plain fact that people need healthcare services all hours of the day and night, every day of the year, including on weekends. As one hospital representative put it at a local forum a few days ago, people’s need for care is never “after hours,” or at least it shouldn’t be. If we are to make our so-called “system” people-centered, healthcare’s providers must organize themselves so care is as readily available at night and on weekends as it is now nine-to-five. In my case, it was clear that the CCAC’s care coordinators were getting ready on Friday and enjoying a provider’s weekend on Saturday and Sunday, even to the extent of not communicating with the people referred to them much less providing them with services. That is simply not good enough. The cart has got ahead of the horse!

On the same theme, I think the common practice of hospital nurses working 12 hour shifts is pushing the limit of what is good for their own health and, by association, that of their patients. When in hospital I did my own completely unscientific canvass of those who looked after me, all of whom responded that they liked working 12 hour shifts because doing so afforded them more consecutive days off after their work week; it is a practice that, as with home care, fits providers’ preferences and not necessarily the best interests of those to whom they are providing care. So, I suspect, does short-staffing of hospitals on weekends.

Like all of us, the providers of healthcare need time off to maintain and foster their own health and well-being and that of their families. Just like people in the police or fire services, no caregiver can or should be on duty all the time.

What’s the answer? Teamwork!

The Emergency Rooms of our acute care hospitals are very busy places precisely because they have organized themselves into very sophisticated (and expensive) teams of doctors, nurses, and other staff – all those needed to deal expeditiously with real emergencies, car crashes, heart attacks, and the like – and they are on duty 24/7. By contrast, very few providers of primary care services or home and community care are organized into teams that can provide services around the clock. As a consequence ER’s waiting rooms are crowded with people who may well have problems they consider to be urgent but that are far from life threatening; problems they would normally take during office hours to their family physician or nurse practitioner. Think about the trauma to a frail elderly person taken from her retirement or long-term care home by ambulance to a hospital’s ER only to be reassured that no ill consequence had followed the “turn” in the night that triggered the call to 911; far better that she stay in her bed and be seen by a family physician, nurse practitioner, or experienced nurse on call. Ironically, having to deal simultaneously with primary care, and home and community care issues as well, taxes the capacity of the ER’s highly specialized teams and facilities to deal with genuine emergencies. For many non-emergent patients it means hours of sitting in waiting rooms, unnecessary exposure to all kinds of infectious agents, and growing dissatisfaction with the ability of our costly healthcare services to meet their very legitimate needs.

Some initiatives, Health Links and Family Health Teams for example, are being taken to organize healthcare’s primary, home and community care providers into teams able to function 24/7. But we certainly need to pick up the scope and the pace!

About the Author

Duncan Sinclair, now retired, was Chair of Ontario's Health Services Restructuring Commission (1996-2000) and before that, Dean of the Queen's University Faculty of Medicine and Vice-Principal for Health Science.

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