Community Information

Questions and Answers on the Douglas Memorial Site and the Port Colborne Site

The following is a list of questions and corresponding responses. These questions are from members of the community and presented at Niagara Health System (NHS) open houses as well as through emails to hospital representatives

How many patients at NHS’ Port Colborne site have to pay a fee of over $50 per day for their accommodation? How many will have to pay by 2012/13?

There has been a co-payment fee in place for many years across Ontario for two types of hospital patients that qualify under certain conditions – Alternate Level of Care (ALC) patients and Complex Continuing Care (CCC) patients. If a patient in either of these categories is occupying a bed in a hospital while they wait for a long term care (LTC) bed to become available, they are required to pay a fee if applicable. This practice is province wide. The same thing happens in similar circumstances in communities across Ontario. The co-payment fee is income driven – depending on their income level not every patient pays the full fee. Some patients pay all of the fee, some pay a portion and some patients qualify not to pay the amount. The co-payment fee that is paid is the same fee they would pay in a long-term care facility – $53 per day.

The co-payment fee is charged for patients who have been determined by Community Care Access Centre (CCAC) – a community healthcare agency that helps coordinate and provide healthcare service in the home and in long term care settings – to be eligible for a bed in a long term care home.

Other patients that may pay a co-payment are those who become permanent in Complex Continuing Care, such as long-term ventilated patients, or those with chronic conditions that require more interventions than can be provided in a long term care home.

At January 26, 2010, 17 patients (ALC and CCC combined) at the Port Colborne site were paying all or some of the co-payment fee.

There is no way to predict how many patients would be paying the co-payment by 2012/13. It depends, as stated above, on their discharge destination. As of November 1, 2009 there were approximately 16 patients (ALC and CCC combined) paying a co-payment at the Port Colborne Site. Last year, there were approximately 12. Approximately 83 per cent at Port Colborne Site were paying the co-payment fee last year prior to the bed conversions. Since the bed conversion, 67 per cent at Port Colborne have been charged the co-payment fee.

How many patients at the Douglas Memorial site have to pay a daily ALC rate?

On average, approximately 33% of ALC patients have paid the co-payment and 25% of CCC patients have paid the co-payment. At January 26, 2010, there were 16 patients at the Douglas Memorial Site and 33 patients at the Port Colborne Site paying the co-payment fee.

Approximately 60 per cent of the patients at Douglas Memorial and 83 per cent at Port Colborne Site were paying the co-payment fee prior to the bed conversions. Since the bed conversion 43 per cent of patients at Douglas Memorial and 67 per cent at Port Colborne and have been charged the co-payment fee.

Right now the urgent care centre is open 24/7. The NHS originally proposed the Urgent Care Centre (UCC) be open 14 hours. How long before the NHS reduces the hours of the UCCs in Port Colborne and at Douglas Memorial site in Fort Erie?

On June 29, 2009, the NHS signed an agreement with the local physicians at the Port Colborne Site to maintain the services as outlined in the Hospital Improvement Plan (HIP) for the Port Colborne site for a period of two years. As did the local physicians from Fort Erie on September 30, 2009. Prior to considering or undertaking further changes, the NHS would undertake an independent third party review.

Other than Don Davis, how many more citizens of Port Colborne have died as the ambulance took too long to get them to an emergency department? How many have had poor health outcomes due to time delay to access a physician and life saving emergency services?

The NHS has a comprehensive quality assurance process in place to monitor the quality of care provided to patients and follow up occurs when required. Where unexpected incidents of death occur, the hospital notifies the Coroner. The Coroner decides based on the circumstances whether a review is necessary and the review is led by the Coroner. It should also be remembered that pre-hospital care starts when the paramedics first encounters the patient.

According to LHIN demographics, Port Colborne has the highest percentage of seniors and low income population in the entire region. Why are vital services being removed from this vulnerable group?

The Port Colborne site, prior to the Hospital Improvement Plan, was providing limited acute care services. The majority of acute care services, including surgical and medical care, was provided outside of the community of Port Colborne at other sites of the NHS and have been for years.

For the acute care beds that remained at Port Colborne, over 70% of those beds were occupied by patients that required care outside of the hospital (i.e. long term care, rehabilitation, at home with home care supports) but these services were not available. The goal of the HIP, working with the LHIN and other partners in the community, is to increase services for seniors and for those in our communities who have chronic health conditions. That’s why we’ve changed the bed type at Port Colborne Site to Complex Continuing Care, to serve people who need a different type of hospital care and to stay in longer to get rehabilitation and therapy services. We also want to bring in more outpatient clinics that would focus on chronic conditions like COPD and asthma.

We need timely access to life saving services….the ability to stabilize and transfer. When will Port Colborne hospital get these ER services and be assured they will be permanent?

The Urgent Care Centre at Port Colborne Site continues to have the ability to stabilize and begin life-saving treatment in some emergency cases. That is why it was so important during the public education phase to inform the public as to when to call 911 for certain medical emergencies. The paramedics would take the patient to the most appropriate emergency department for that specific medical emergency – and not necessarily the closest.

It is important to recognize that there are some conditions that cannot be stabilized and never could in Port Colborne- due to lack of medical specialists and /or enhanced diagnostics and the best chance for survival is to the closest emergency facility within or outside Niagara. The resuscitation room in the Urgent Care Centre contains the same equipment as prior to the conversion.

There is no intention to remove this life-saving equipment and the staff trained to use it. The Urgent Care Centres continue to be staffed with qualified ER nurses and physicians. In fact, emergency cases do still come to the Urgent Care Centre occasionally (not by ambulance but walk in or by family), where they are stabilized before being transferred by ambulance to the most appropriate ER, within or outside of Niagara.

Will our local physicians get the proper funding model to assure we are able to retain them at the UCC? When? Right now the agreement will only be in place until Dec. 19, 2009.

NHS does not have a role in physician funding arrangements for emergency or urgent care departments. Funding arrangements are negotiated between the Ontario Medical Association and the provincial government. The existing funding arrangement with the physicians in the UCC at the Port Colborne site was recently extended until new arrangements could be negotiated.

Currently the NHS will allow ambulances to take patients to Port Colborne hospital under certain determined guidelines. What are those guidelines and why hasn’t the NHS publicized this information?

The Non-Urgent Ambulance guidelines for transporting non-urgent patients to the Urgent Care Centres (UCC) in Port Colborne and Fort Erie were established jointly between NHS and Niagara Emergency Medical Services (NEMS) and is a first of its kind in the province of Ontario.

The information contained in the joint NEMS and NHS UCC guideline is intended for use by allied healthcare professionals – paramedics, doctors, nurses, to help guide them in the decisions they make in caring for patients with non-urgent medical conditions that may be safely treated at a UCC. The specific protocol is intended as a guide for healthcare professionals with specific training and is interpretive based on case by case patient conditions and history.

What is important for the public to know is that paramedics will provide care and transport them to the most appropriate health care facility that can deal with their medical condition.

The Ontario Nurses’ Association has censured the NHS since 2002 and recently has requested the NHS be investigated under the Public Health Act as their frontline staffing puts patients at risk. What is the NHS doing about this?

Many actions have been taken, working with the Ontario Nurses’ Association, to address concerns that resulted in the censure. There has been a dramatic reduction in nursing vacancies resulting in a lower rate of overtime costs and workload pressure on nursing. As well, there is an improved labour relations environment resulting in a reduction in both outstanding grievances and new grievances being filed. We have various mechanisms and structures in place to ensure ongoing dialogue with the members of the Ontario Nurses’ Association to address issues and concerns as they arise.

The NHS will be cutting 90 beds and eliminate 90 staff (many frontline workers) within five years. A number of cuts have already been made. How will this help ER wait times across Niagara, which are well above provincial average?

There are many reasons for higher-than-average wait times in the ER and we are implementing a number of initiatives to improve our wait times. They include improving our processes for patients, such as Medical Directives, which are now in place so that RNs can order lab and diagnostic tests for Emergency or Urgent Care patients before the patients see the doctor. Also new is having two physicians working in our ERs during peak times, so that both emergency and non-emergency patients can be seen more quickly. A third initiative is new rapid assessment areas, to fast-track non-emergency patients. All these initiatives are intended to improve the patients’ experiences in our ERs/Urgent Care Centres.

We also are concentrating efforts on improving the timeliness of patient admission from the Emergency departments into our inpatient beds. The availability of inpatient beds is also contingent upon the availability of community services, such as long term care, rehabilitation and home care supports, so that patients required these services do not occupy our acute care beds. The beds planned for closure by the NHS over the next five years are now housing patients who no longer require hospital care. These Alternate Level of Care patients require more home-care support or a different type of residential care, such as long-term care. New ‘Aging at Home’ funding has been announced by the province for these types of patients. This means that our inpatient beds can be utilized by patients who require hospital-based services.

How can cutting all these beds provide more accommodations and more healthcare?

Cutting acute care beds is not about cutting services to the community. The NHS is working with the LHIN and its partners to ensure access to the most appropriate bed type or healthcare service, which may not always mean a bed. Many of the beds within the NHS are currently occupied by patients who do not require access to acute care services but require access to long term care, rehabilitation and home care services, to name a few. As these services become available in the community, the NHS will not require all of the acute care beds it is currently operating.

If I understand correctly, an ambulance can take only non-emergency patients to Port Colborne even though the staff in the Port Colborne UCC are supposed to be able to stabilize emergency situations. Which means the travel time to further centres must mean you don’t get attention as quickly as if you got it in Port.

Patients do get attention quickly when they’re in an ambulance. It’s important to remember that medical treatment begins as soon as paramedics arrive at a 911 call. Ambulances are staffed with paramedics and in Niagara, many ambulance crews have an Advanced-Care Paramedic. Paramedics have the skills and onboard equipment to do a wide range of emergency procedures. In fact, they’re often referred to as an ‘emergency room on wheels’ because they are doing many procedures now that used to be started only when the patient arrived in ER. Depending on the condition of the patient when ambulance crews arrive at the scene, they assess the situation in consultation with their despatch and base hospital who provide medical expertise to the paramedics as to the most appropriate destination for the patient. Through this discussion, they may decide that the most appropriate destination is an UCC or an ER within Niagara (not necessarily the closest ER based on the condition, for example stroke patients are taken directly to the regional stroke centre in NF) or an ER outside of Niagara (i.e. trauma).

It is important to remember that while the ED physicians and staff are well qualified to deal in emergency situations they many times require the back up of surgeons or other specialities that are only available in sites with emergency departments. The changes in the HIP are all about getting the right patient, to the right place for the right care.

The person showing me your diagrams of the new healthcare complex being built in West St. Catharines repeatedly referred to “natural light” and I agree this is great. But so is family visiting beneficial to one’s recovering. If one can’t get to the other end of the region to visit family members (& friends), how can this be an improvement? It is hard on the patient as well as those who want to visit.

Transportation is a key issue in Niagara. NHS has been working closely with the Region of Niagara and local governments to improve public transit services.

In Dr. Kitts report he recommended Port Colborne and Fort Erie hospitals both have 24/7 urgent care centres and that each site should operate a 3-6 bed monitored holding unit adjacent to the Urgent Care Centre. The unit would be designed for patients requiring a 24-48 hr. observational length of stay. At Douglas Memorial Hospital in Fort Erie, they have these monitored beds. Port Colborne does not. Why doesn’t Port Colborne site have monitored beds and why has the NHS not enforced this requirement made by Dr. Kitts?

The NHS committed that during the implementation of the HIP, the NHS would work closely with the physicians in Niagara to understand their issues and concerns and make modifications as necessary to the HIP, without impacting negatively on quality of care and/or cost savings. The NHS worked closely with the physicians in Port Colborne, Fort Erie and Niagara-on-the-Lake regarding the care they thought most appropriate to retain in their communities and in their sites and came to consensus with them, which in some cases, resulted in slight modifications to the HIP, without impacting cost savings.

To operate acute observation beds, there must be physician coverage. In these three communities, the family physicians are involved in different ways in providing coverage for inpatients. In Fort Erie and Niagara-on-the-Lake, family physicians want to continue caring for patients in hospital and believed that the distance for these patients to travel to another site for such a short length of stay was not warranted. Therefore they wished to oversee the care of both Complex Continuing Care patients and those acute short-stay patients who are in an observation bed for up to 48 hours.

However, in Port Colborne, the family physicians chose not to continue with their hospital privileges to care for patients in hospital and believed the shorter distance to Welland for acute care services was not unreasonable. This way, if a patient’s stay was determined to require care beyond 48 hours, they would not need to be disrupted for a transfer to Welland.

There continues to be monitoring capability within the Urgent Care Centre at the Port Colborne site should a patient arrive that needs initial monitoring to make a diagnosis or support close observations until transfer can occur.

Out of the 46 beds at the Douglas Memorial site in Fort Erie, how many patients have been reassessed and made chronic?

Of the 46 beds at the Fort Erie site, 40 are designated complex continuing care and 6 are Acute Short-Stay beds, for patients requiring observation for up to 48 hours. Admission to either of these beds is made by a physician, with input from the health team members providing care.

How many patient admitted to the Douglas Memorial site are from Greater Fort Erie?

It is our goal to ensure to the extent possible access to the 46 beds at the Douglas Memorial site for Fort Erie residents. There may be times when this is not possible due to bed pressures at other sites. If there are empty beds, we certainly will transfer patients from other communities in Niagara to the Douglas Memorial site. Therefore, the split between Fort Erie residents and other residents of Niagara occupying these beds could change on a daily basis. For admissions between April and November, almost 60% of admissions were for Fort Erie residents.

Are patients admitted by emergency or local doctors to the six 48-hr beds at the Douglas Memorial Site asked to sign a document for charges if they remain after the 48 hours?

No, no such practice or form exists. If a patient requires care after 48 hours, depending on the type of care required, they may remain at the site or be transferred to the most appropriate acute care facility to receive additional services.

How many rooms are being used in the Douglas Memorial Site for medical purposes?

All rooms in the hospital are for medical purposes, whether they are patient treatment rooms, staff break areas, storage of medical equipment and supplies, or office space used by partner agencies such as Canadian Mental Health Association.

Where are the “clinics” by specialists being held at the Port Colborne Site , and are they in a private area or mixed in with the Urgent Care Centre?

The majority of the clinics are located on the 1st floor of the Port site predominantly within the Urgent Care Centre. There are physician referral clinics i.e. blood transfusions, lumps and bumps that are done in the UCC.

Are minor surgical procedures i.e. lumps and bumps removed at the Douglas Memorial site?

Minor procedures continue to be performed at the Douglas Memorial Site in the Urgent Care Centre. The family physicians have access to provide removal of minor lumps and bumps – these are planned and these doctors have scheduled time during the week to perform these procedures for their patients. There are also prescheduled times that surgeons come to the site to do consultant clinics in the following specialties orthopaedics, urology, gynaecology, general surgery and dental.

If minor surgical procedures, such as the above mentioned, are performed or patients are booked for assessment, what steps have been taken to ensure confidentiality?

Last year, we renovated to improve patient privacy and flow in the UCC area. Specific changes to the patient registration desks are wall dividers and a sound masking system installed in the ceiling, which adds white noise to improve privacy. This is an improvement over the old layout, which placed those registering directly in the waiting area. As well, the nurse triage area is now a separate room to provide patient confidentiality, rather than the open hallway where patients used to be triaged.

Why has the NHS installed parking meters at the Douglas Memorial site in the area where the privately-owned building housing Doctors’ offices is situated?

The property adjacent to the hospital is under the jurisdiction of the Medical Arts Building owner – not the NHS. The NHS initiated parking changes on its own property, consistent with parking rates charged on all other sites of the NHS. This is an example of revenue generation expected of all hospitals to assist towards balancing their budgets.

Are NHS members being paid a per diem for attending open house sessions?

No.

Of the 40 CCC beds at Douglas Memorial Site, how many are designated CCC and how many ALC?

The designation of the patients in these beds is made by the physician in consultation with other members of the healthcare team. On any one day, the number of CCC versus ALC will be different. On average, the NHS has been seeing 40% (or 16 patients) as CCC and 60% (or 24 patients) as ALC.

How many inpatient beds remain at the Port Colborne site? How many are from out of town?

There are 46 inpatient beds designated as complex continuing care at the Port Colborne Site. It is our goal to ensure to the extent possible access to the 46 beds at the Port Colborne site for Port Colborne residents. There may be times when this is not possible due to bed pressures at other sites. If there are empty beds, we certainly will transfer patients from other communities in Niagara to the Port Colborne site. Therefore, the split between Port Colborne residents and other residents of Niagara occupying these beds could change on a daily basis. For admissions between April and November, 2009 almost 68% of admissions were for Port Colborne residents.