COVER

Getting discharged earlier

MARK NICHOLS June 15 1998
COVER

Getting discharged earlier

MARK NICHOLS June 15 1998

Getting discharged earlier

Length of stay rates

For several decades, the length of time people spend in hospital for any reason has been in free fall. As a result, Canadian hospitals now have fewer than one-third as many beds per person in the population than they did 30 years ago.

Part of the change stems from the realization that keeping patients bedridden in hospitals can be a recipe for infections and problems brought on by immobilization. Technology is also hastening the process. For the past 50 years, the primary choice of treatment for an enlarged prostate has been a TURP (transurethral resection of the prostate), which uses a telescopic knife to remove tissue

and allow freer passage of urine. Most provinces keep patients in hospital for between three and six days after a TURP, while Alberta regularly allows just two days for the procedure. But now, men can undergo

less invasive methods of killing prostate

tissue as outpatient procedures. Minimally invasive “key-hole” surgery has sped up recovery time for many other procedures by sparing patients the debilitating surgical wounds of the past.

Since the early 1990s, a drive to shut down beds and close entire hospitals has put a premium on rapid patient turnover to free up bed space. “But there is a limit,” says Dr. Charles Wright, director of clinical epidemiology and evaluation at the Vancouver Hospital and Health Sciences Centre, “and we are approaching it. In many parts of the country, the number of acute-care beds is now under severe stress.”

Statistics have tracked the shortening lengths of stay

in recent years in the four provinces that reported acute-care data. In British Columbia, Alberta, Ontario and New Brunswick, patients spent on average at least half a day less in acute care in 1996-1997 than in 1992-1993. Hospital stays for specific procedures—for which more complete national data is accessible—can

vary dramatically among provinces, and between the regions. In the case of gallbladder removal—in which minimally invasive laparoscopic surgery is increasingly used—Prince Edward

The short-stay trends

Median number of days spent in hospital for four procedures, 1995-1996

Transurethral resection of Radical Total the prostate mastectomy hysterectomy (TURP) (females, (age 20+) f (age 50+) age 25+) NF 3 5 5 6 NS 2 4 4 5 PE 4 6 6 6 NB 2 5 5 5 QC 3 6 5 5 ON 1 4 4 3 MB 2 4 3 4 5K 2 5 5 4 AB 2 4 2 2 BC 2 4 3 3 Canada 2 5 4 4

Island still keeps patients in hospital about four days, while Ontario typically whisks them through in a single day.

The pressure to reduce lengths of stay is not likely to let up. And for the most part, the experts applaud the trend as a way to get more out of the health-care system—as long as the support services for convalescing patients are in place. Alberta has increased spending on home and community care by 300 per cent since the early ’90s, to $200 million this year. But in many provinces, the services are lacking. “The trend towards shorter lengths of stay can be a mixed blessing,” says Dr. David Naylor, a clinical epidemiologist who heads the Toronto-based Institute for Clinical Evaluative Sciences. “If the home-care services aren’t available, then you are dumping the load onto relatives and friends—it almost amounts to a user fee for families.” That prospect lends added urgency to federal Health Minister Allan Rock’s professed commitment to working with the provinces towards a national approach to home care. An infusion of federal money would help meet the immediate needs of patients whose time on a hospital bed is rapidly dwindling.

MARK NICHOLS