What’s enough?

QHC administrator says 12 beds all PECMH needs

How many hospital beds are enough? QHC director Steve Blakely was hoping to turn the conversation away from bed cuts to a determination of what is the right number of beds.

“How many hospital beds do we need?” asked Blakely at QHC’s board meeting last week.

QHC’s chief physician Dick Zoutman didn’t answer the question but observed, rather vaguely, that the proposed solutions being considered go beyond discussions of beds but embrace a notion of improving overall hospital performance.

CEO Mary Clare Egberts believes 12 beds is the right number for Picton.

“I see this as the hospital moving to right size—the size it should have been all along,” Egberts said to the Times.

“A 12-bed hospital is a viable primary care hospital that can provide the level of services that are appropriate for it.”

County physicians don’t agree. According to Dr. Elizabeth Christie, head of the Prince Edward Family Health Team, there aren’t nearly enough hospital beds for a population of this size, even before the bed cuts come into effect—expected in April.

She points to data that show that there are on average 2.5 medical beds for every thousand people in Ontario—the lowest level of beds per capita than any province in the country. And if Ontario were a country, it would be ranked fourth from last in a list of OECD (developed) nations.

But it gets worse.

Christie says that when one applies Ontario’s average to QHC, the hospital corporation should have 325 beds. Yet it only has 260—shrinking to 234. Using this same average PECMH should have 45 beds. Even when deducting a third of these beds for more acute conditions that would not be treated in Picton in any event, PECMH would still need 30 beds just to meet Ontario’s meagre average.

“We are way under the average,” explains Dr. Christie. “If you cut Picton hospital down to 12 beds you are off the chart. This is one bit of evidence that shows that we are cutting beyond the norm.”

Christie has been critical of QHC for refusing to explain how it arrived at its proposed funding solutions. She says the disproportionate cuts to PECMH haven’t been justified, nor have they been shown to be driven by evidence or cost effectiveness.

Egberts counters that County physicians were given the opportunity to help QHC figure out how it could save $10 million back in October. Instead they wanted to see what QHC suggested and would comment on the proposals.

“They were invited on October 4 to help create the process to find these savings,” said Egberts. “It was the Picton Family Health Team who said ‘put out some ideas for us to respond to.’ That is what we did.”

Christie says PECMH can’t cut beds without affecting patient care. The community supports QHC is expecting the CCAC to provide aren’t in place—that its own capacity is already strained.

“Our beds are full,” explained Christie. “Across QHC we range between 95 and 104 per cent occupancy.” There is research from the Ontario Hospital Coalition published last year that shows that the ideal occupancy rate is about 85 per cent to ensure efficient patient flow and that safety is protected from risks associated with overcrowding.

“We are over capacity now. We see that. In Picton, Trenton and Belleville we often have people admitted to emergency departments because inpatient beds are full. That isn’t good for patients— because the focus of nursing resources is different.”

Egberts says that is why QHC has revised it proposals— staggering bed cuts over three years to ensure the Community Care Access Centre ramps up its services to match the declining role of the hospital.

“We did this to make sure the services are there when people leave the hospital,” said Egberts.