ER overhaul hits snag
Registered nurses James Gibbons, Alan Warrington, Kathy Burgess, and union head James Murray, l-r, in front of the emergency department of Victoria Hospital. Photo taken on Monday Feb 22, 2016 (MORRIS LAMONT, The London Free Press)
London Health Sciences Centre had hoped by March to complete changes that would break an ER logjam that had been among the worst in Ontario — but that target now has been pushed back to later this year.
The delay isn’t the only challenge: The union that represents front-line registered nurses is accusing the hospital of funding the Toyota plans by downgrading the calibre of nurses who treat the mentally ill in ERs.
“We just spent millions of dollars to try to implement Toyota,” said James Murray, a registered nurse and president of Local 100 of the Ontario Nurses’ Association that represents 3,600 nurses in London. “It’s wasted money.”
Five registered nurses who care for those with mental illness in the emergency room will be replaced by cheaper, less educated registered practical nurses (RPNs), he said.
Though RPNs have valuable skills, they can’t replace RNs tasked with making tough calls about those with mental illness, including whether to restrain them through the use of medication or physical devices
“(RPNs are) not going to be able to pick up the subtle clues,” Murray said.
But hospital CEO Murray Glendining says the change won’t compromise safety and that the money saved had nothing to do with the Toyota plan.
As for the delay, that’s because the plan required changes to how care is provided in homes, the community and long-term care, and those changes aren’t complete.
“We are not abandoning the (Toyota plan),” Glendining told The Free Press.
In order to move patients through the ER more quickly, the hospital must speedily treat those who can be released while securing ward beds for those who will need to be admitted. The first part of that plan has gone well — Glendining says the December results were spectacular — but the second part is challenging,
When there is not enough support for people to be cared for in their homes, communities and nursing homes, patients who should be discharged are not — creating a bottleneck that backs up the ER with patients waiting for a bed on a ward.
“(The plan) is much bigger than just the emergency department,” Glendining said.
The percentage of patients waiting to be safely discharged from a ward has remained stubbornly high and recently spiked again, he said.
But Murray isn’t convinced Toyota changes help patients, pointing to a review of all previous studies on similar efficiency changes that found little evidence that such changes make a difference.
“While some may strongly believe (these) interventions lead to quality improvements in health care, the evidence to date simply does not support this claim. More rigorous, higher quality and better conducted scientific research is required,” researchers in Saskatchewan wrote in a study published in the International Journal for Quality in Health Care Advance Access.