I thought I would start this week's note with part of a letter my wife received from a friend who is in one of our hospitals…….edited a bit to protect privacy….

"We finally have a little more faith in the health system since coming to TGH. Honestly, the Emergency Department was phenomenal. So professional, so caring, asking questions we weren't asked at another hospital. Plus performing more and different tests.  You must tell Charlie about the incredible staff. Nothing is perfect as you always strive to improve systems, but in comparison to what we went through, we feel incredible relief. We are realistic and understand that XXXXX's condition is difficult to deal with and the C Diff he picked up at another hospital complicates matters, but at least we feel better that he's at TGH and they're doing the best they can to help him and us."

I want to thank everyone in our Emergency Departments and the teams on our General Internal Medicine/General Surgery units who are coping with volumes that increase each year by about 5%.  I've walked through the ED with Mike Nader and Joy Richards in recent weeks and we all saw the toll it is taking – on patients in the hallways and waiting rooms -- while staff are working in the ED and on the floors to admit patients who need our care.  From the note above, it is clear that we are keeping that strain to ourselves.  So the question is – what can we all do about it?  Some suggestions:

  • We need to focus on the foundational element of Operational Excellence led by Mike Nader and myself and in the effort to create an Overflow Capacity Protocol (OCP) that works – for patients, staff and physicians.  If you have ideas for the EDs or the units, please send them to Charlie.Chan@uhn.ca, Mike.Nader@uhn.ca, Janet.Newton@uhn.ca at Toronto Western and/or Scott.McIntaggart@uhn.ca at Toronto General.
  • Our physicians, working with the teams on the floors can begin discharge planning from the moment a patient arrives.  I know this happens already but we can get better at it and we can involve the Home and Community Care Coordinators who are here to help people return to their home – whether it is a family home, a long-term care facility or another healthcare facility.  In doing this work, please let Social Work and the Home and Community Care Coordinators determine where the patient's needs are best met.
  • The teams in labs and imaging are working to find ways to get test results more rapidly to the care teams.  With rapid results, decisions can be made and patients and their families can make plans for discharge.
  • We are talking to the Toronto Central Local Health Integration Network (TC-LHIN) and the Ministry of Health and Long-Term Care (MOHLTC) to ensure that they understand the pressures so that they can advocate for us – and for all Toronto-area hospitals.  In recent days, the announcement about the re-opening of the Humber River hospital for patients who are Alternate Level of Care (ALC) is an indication of a creative approach by the Ministry.  If we didn't have ALC patients in our beds, we would have more beds to care for patients who need acute services.  Mike Nader, Sue Jewell, Gaetan Tardif, Marnie Escaf, and Marnie Weber are leading an innovative proposal to convert our Hillcrest site to help address the TC-LHIN inpatient over-capacity challenge.  More to come in the next few months.

Last week was one that few of us will soon forget with the terrible events in Las Vegas and Edmonton.  As caregivers, we think about what the response must have been like and what those who survived will need after the event in terms of physical care and psychological support.  I hope you had the time over the Thanksgiving weekend to appreciate and give thanks for those around you.


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