Fraser Health strategy targets ER overuse
A seven-month review of Fraser Health has resulted in a new strategy that focuses on cutting unnecessary use of hospital emergency rooms in favour of improved primary and community care.
Health Minister Terry Lake said Wednesday too many patients in the region aren't getting the appropriate type of care and suffering worse outcomes, compared to other peer hospitals in Canada.
"When you provide that care in the community, you take the pressure off the acute care setting," Lake said. "That helps look after your budget problem as well."
Average lengths of hospital stays are longer in Fraser, Lake said, increasing risks of picking up infections in hospital or problems like bed sores.
The concept is far from new.
Fraser has been trying for years to clear its congested ERs with a shift to preventative or home health care.
Although Lake did not criticize past efforts, he said the time was right for a strategic "data-driven" re-examination of the issues for the region, whose staff had been too bogged down in "putting out fires."
The region will get a modest infusion of extra money – $40 million in 2014/15 and $20 million in 2015/16 – to assist with opening up community care beds during the transition.
Lake said the findings confirmed Fraser's budget of $3.1 billion has been appropriate in recent years, in light of its population of 1.7 million, rapid growth rate and demographics.
"It's not a matter of dollars," he said.
Funding for Fraser is slated to climb 4.3 per cent in 2014, 1.4 per cent in 2015 and 1.2 per cent to more than $3.3 billion in 2016.
The review was ordered by Lake last November, largely in response to the health authority's inability to avoid successive budget overruns.
The resulting strategic and operational plan sets out 10 priority actions for improvement.
Topping the list is the goal of reducing hospital readmission rates and lengths of stay to save money and reinvest savings in community and long-term care.
Other top priorities are continuing work to cut hospital-acquired infections and increasing immunization rates for measles, mumps and rubella.
The review also recommended cardiac and stroke programs be more efficiently coordinated across the Lower Mainland's health authorities.
Lake ruled out a full merger of the Fraser and Vancouver Coastal health authorities, but said the ministry will look further at carving off the Burnaby local health area and add it to Vancouver Coastal because of the number of Burnaby patients who go into Vancouver for treatment.
"We've got two large hospitals we're going to rebuild – St. Paul's and Royal Columbian," Lake said. "It's imperative the two health authorities work together to ensure those rebuilds provide the service and infrastructure necessary to serve the entire population of the Lower Mainland rather than take an isolated view of the two hospitals."
NDP health critic Judy Darcy said it's a "laudable goal" to take pressure off acute care hospitals but said she doubts the province is committing enough money to the required alternatives.
"I don't think there's the money there to make the enormous strategic investments to turn this ship around."
Darcy said she still hasn't seen an adequate explanation of why Fraser's per capita funding from the province is much lower than most other health authorities.
"Fraser has 36 per cent of the province's population and 28 per cent of the funding."
The full strategic and operational plan, along with summaries of the review team findings, can be found at http://fraserhealth.ca/about_us/strategic_plan.
A search is underway for a new president and CEO of Fraser Health to replace former top executive Dr. Nigel Murray, who resigned last month to return to New Zealand.
Fraser is also without a permanent board chair. Interim chair Wynne Powell has been filling in since Lake terminated former chair David Mitchell, saying fresh eyes were needed to finalize the review.
Review of health region runs up several red flags
The use of emergency departments at Fraser Health hospitals has been growing more than three times faster than the region's population.
That's one of the findings contained in the results of the provincially ordered review released Wednesday.
ER use has run at 6.4 per cent, compared to Fraser's population growth of 1.7 per cent, the review found, mainly due to frequent users who tend to be older, poor and lacking regular care.
Most patients at Abbotsford, Burnaby, Royal Columbian and Surrey Memorial hospitals could get their care through community clinics or family doctors, it suggests.
The region's acute care hospitalization rate has been highest of all B.C. health regions since 2008 and more than 35 per cent of admissions exceeded the expected length of stay, limiting bed capacity.
Fifty-seven per cent of Fraser's budget goes to acute care, leaving relatively small slices for residential care (18 per cent), community care (nine per cent) and mental health and substance use services (seven per cent.)
Patient safety also scored poorly, according to the report.
Burnaby had the second-worst rate of nursing-sensitive adverse events – such as infections, bed sores and fractures in hospital – in Canada for two straight years.
"Rates at Surrey Memorial, Burnaby and Ridge Meadows hospitals have been almost double the national average and with no demonstrated improvement over the past three years."
- A 3.6 per cent increase in the region's more than 8,000 residential care beds since 2010 has not kept pace with population growth.
- Nearly 300 new residential beds would be needed to reach the provincial average of 80 beds per 1,000 seniors over 75.
- Mental illness affects 17 per cent of Fraser's adult population and 14 per cent of children and youth.
- 11.5 per cent more adults are expected to be living with mental illness by 2020, while the number in need of withdrawal management/treatment services is to climb from 160,000 to 200,000.