For hospital administrator Michael McMillan, the emergency room at University Hospital of Northern B.C. is a canary in a coal mine.
When the flow of patients in and out of the ER grinds to halt and wait times sometimes become an excruciating test for the sick and wounded, its a sign to McMillan of problems elsewhere in the building.
"The emergency department is where all the bottlenecks and capacity issues become apparent," said McMillan, chief operating officer of the Northern Health Authority.
"Emergency is seen as a very procedurally-based system, there are so many things that affect it. If we're not dealing with patients appropriately and providing services in the community it will block beds in acute care and, ultimately, those things show up in emergency."
As part of the province's patient-focused funding program, which pays hospitals more money based on the number of procedures they do, Nanaimo General Hospital has found a way to cut wait times in its emergency ward by 50 per cent, and the hospital is reaping the rewards.
Nanaimo has a program in place that brings in as much as $600 in additional funding if they can move an emergency patient to an acute care bed within 10 hours. That money has allowed the hospital to hire a lab technician for the emergency department and set up a five-bed unit for emergency patients who need additional care but don't require admission to the hospital.
UHNBC is not one of the 14 emergency wards in the province that receives per patient money incentives as people are moved through the system. McMillan and his staff are examining Nanaimo's ER strategy and that of other hospitals across the country, but because emergency wards are so interconnected to other departments he says its difficult to pinpoint ways to relieve congestion.
"There is no single thing that every community is going to have the same results [in emergency wards] just because it's such a symptom of the entire system," McMillan said.
Patient-focused funding has been in place for a year in B.C., resulting in $53 million in new provincial government funding and 36,000 more procedures performed at B.C.'s 23 largest hospitals.
UHNBC has been able to increase the number of MRI exams it will conduct this year by 1,250 screenings, one-third above a baseline target number, which will bring in $343,750 to the hospital operating budget.
"For every MRI we do, we get a payment [of $275] and what that allows us to do is assign more staff to do more MRIs, and it allows us to pay a physician to read and interpret the results," said McMillan.
UHNBC is also on schedule to double the number of shoulder surgeries it performs, from 63 to 123. Each additional shoulder surgery will bring in $3,000. There are incentives for hospitals to do more outpatient work rather than admitting them, which will make more money available under the new funding formula.
The Prince George hospital also put more resources into increasing capacity for hip and knee surgeries, making more inpatient beds and support services available while taking advantage of a new seventh operating room to give surgeons five operating days per week instead of four. That helped increase the number of orthopedic surgeries from 920 in 2009 to 1,392 in 2010, with a similar number expected this year.
"We are trying to do the right thing for patients," said McMillan. "The whole orthopedic investment made it easier to do it, but we're doing it because the patients need the service, not because some money flowed for that specifically."
