Saturday, February 8, 2014

Hospitals too full to be safe? Not in London, Ontario.

The front page headline warned: " Hospitals too full to be safe." A follow up online story delivered the second punch to the gut: Overloaded wards likely contributing to spread of dangerous superbugs, says head of infection control for London hospitals. On reading the story I was surprised to learn infection rates have not been on the rise generally in London hospitals and in some cases rates have actually declined. A concerted effort at infection control led by Dr. Michael John is credited for the surprisingly good numbers.

Maybe it's just me and my personal bias when it comes to London hospitals and health care in Canada but I thought the newspaper missed the story. Many experts believe hospital acquired infections (HAI) increase when bed occupancy rates climb above 85 percent. Rates in London have surpassed 100 percent at times, and yet there has not been a corresponding increase in HAI rates.

Dr. John revealed to the paper that "beds have been fitted with hygienic liners that can be disposed, new disinfectants kill spores and patients who can’t be isolated are given separate commodes." Chalk up a win for Dr. John and the health care staff in London.

For some reason, the reporter seemed intent on focusing on the shortage of hospital beds. By comparing the number of hospital beds per thousand in Ontario to the average number available in Europe, a huge mix of countries, the reporter made the shortage seem even more dire: A classic "comparing apples and oranges" error.

Let's try comparing apples to apples: countries to countries. According to the most recent numbers released by The World Bank, Canada has 3.2 beds per 1000 people. Both The United States and Britain had a smidgen less at 3.0 beds per 1000. Sweden fared even worse with only 2.7 beds.

There are more than 50 countries listed by The World Bank with fewer beds per 1000 than Canada. Admittedly, for the most part, having bed numbers that are better than these 50 is not a surprise. Still, Canada can take solace in the fact that Norway has only  3.3 beds per 1000 or a mere .1 more beds than Canada. Norway has some excellent health care numbers despite having a low bed number.

According to the newspaper article, Ontario has only 2.4 hospital beds per 1000. It sounds bad and it is bad but Ontario does not sport the worst numbers on the continent. For lower numbers look south. Ontario has more beds than almost 40% of the American states according to The Henry J. Kaiser Family Foundation. Oregon only has 1.8 beds per 1000 and California, Hawaii and Vermont have numbers that are little better.

A more telling number is the percentage of Americans reporting that in the past 12 months they failed to see a doctor despite needing one because of cost. In some regions of the States the number of people who have stopped seeking medical help despite needing it is more than 1 in 5. That is downright frightening. The link provided takes one to a page with some very conservative numbers.

Researchers with The Commonwealth Fund in the United States calculated a much higher number. 37 percent of Americans in the Commonwealth survey went without recommended health care, not seeing a doctor when ill, or failing to fill prescriptions because of costs.

The number of hospital beds per thousand has been dropping all over the globe for years. As can be seen by the number in London, the medical profession is trying to rise to the challenge, and it is a tough challenge.

Recently I had an ablation procedure performed at University Hospital in London. After being sedated by an anesthetist, a heart specialist threaded thin, flexible wires from my groin up through my body to my heart. The surgeon guided the wires into my heart where heat was used to destroy the heart muscle causing my cardiac problem.

Today this procedure is often done as day surgery. My procedure was done in the morning and I was home for dinner. One way to cut down on hospital acquired infections is to get the patient out of the hospital quickly. My recovery bed was my own.

Are more hospital beds needed? Of course, there's no argument there, and the shortage is neither new nor news. The big story is how well those in the health profession in Canada are delivering some damn fine health care despite facing some pretty daunting problems.

We may be short of beds and our ER departments may take far too long to see all patients, but in the end the important numbers are good. For instance, we live longer, healthier lives than our neighbours to the south.

I tip my hat to the fine Canadian doctors and nurses without whom I would not be here today. I truly owe them my life. Thank you.

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