Location, location, location.
It's a maxim most frequently used in real estate, but in the case of Royal Columbian Hospital's emergency ward, it's not too far off the mark.
"The emergency (ward) has to maintain a priority for emergency situations," said Dr. Adam Lund. "It's not the right place for in-patients."
Lund and his fellow ER doctors gave a letter to hospital administration earlier this week indicating that, as of next Wednesday, patients who have been seen, admitted and are effectively on hold for a spot in another area will no longer be housed in ER beds while they wait for a bed.
"Within the hospital culture, once you are admitted, you 'own a bed.' . We haven't challenged that dogma too much," said Lund.
Right now, incoming emergency patients often get shuffled into overflow spaces because the ER beds are filled with in-patients who are in limbo while waiting for a space to open up on a ward.
"There's a real cap on what the wards will tolerate - they're daily in an over-count position, for years now."
Lund said that, from an administrative perspective, he completely understands why the ER seems like the best spot for in-patients when wards are full.
"If I had to pick a place, I'd think of the ER, too. There are 24/7 doctors and nurses, there's equipment and good lighting. Everything is right there in the ER," he said.
But it's not an ideal situation for either the in-patient who is struggling to get some rest in a noisy environment or the incoming ER patient who has to wait or be temporarily housed in overflow areas.
Lund says the move is an attempt to force a change of mindset and hopefully find some longterm solutions for the issues.
"What we've seen over the last decade is a slow creep where care is marginalized to these ad-hoc spaces," he said, noting that a decision was made recently to set up a temporary space in the hospital lobby. "But how far can you go? The joke is the parking lot, but how far out can you really spread?"
In the past few years, RCH has made headlines several times for overflowing ER patients being cared for in the hospital's Tim Hortons or, more recently, in a temporary space in the general lobby.
"We need everyone in the public, the media, the (health-care) system, to understand the problem the same way, which is this: we don't really have a problem with emergency centre overcrowding, we have a problem with hospital overcrowding.
"We believe we have enough beds and doctors and staffing to do emergency medicine in our health authority. . It's our hope that by saying emergency medicine needs an equal place and that it's important to preserve emergency capacity, we look to a different solution."
Lund said that may include, in part, increased capacity in other areas, but it's a multifaceted question that needs to examine all components of the healthcare system, from home care to long-term care.
Roy Thorpe-Dorward with the Fraser Health Authority said they're "completely supportive" of the plan.
"It will be a change to the patient flow," he said, noting that will be an adjustment to current procedure.
However, he acknowledged that it's not ideal to have either ER patients or in-patients in overflow spaces.
"(Over-capacity) is absolutely what we're working on," he said.
Pointing to the recently released census details, he notes that growth in the region is a challenge that adds pressure to the system.
"It's about seven per cent (patient growth), year over year, and for RCH and Surrey (Memorial) it's probably a bit more, about 10 per cent growth."
In addition, the region - along with the entire country - is facing an increasing population of seniors as the baby boomer generation continues to age.
"It's a reality every day at RCH that all the beds are full," he said.
All of the hospital's in the region have in-patients in the ER waiting for a bed elsewhere in the hospital or region.
In response to those pressures, says Thorpe-Dorward, the authority is working on a few areas: increasing capacity at Surrey Memorial by 150 beds as well as a proposed but not-yet-approved plan to increase RCH's capacity by 300 beds.
However, those are both longer-term solutions that will take time to implement fully.
For shorter-term solutions, he notes they're looking at ways to improve efficiency in many different ways - such as speeding up the process for having a patient discharged once they're ready to leave.
"We have to focus on all the changes that can be made - small differences that will add up," he said.
To that end, he points to an expert panel that has been convened to look specifically at shortand mid-term changes at Royal Columbian Hospital and Surrey Memorial to improve the situation.
That group is expected to come back with some ideas no later than March 31.
As for patients at RCH, Lund says the doctors, nurses and staff are committed to giving the best care they can, even when the location makes things challenging.
"From a doctor's point of view, we do the best we can every day - but it just makes you feel run-down. I worry that it forces us to be more abbreviated when you're dealing with the logistics of working in nontraditional spaces," he said.
