Great letter published in the Edmonton Journal today....... Opinion: Admitted to hospital? Take along a family friend EDMONTON - This year it is estimated that 22,000 Canadians will die or be maimed because of medical misadventure, nursing mistakes, abuse, neglect or just poor health system performance. It is not clear how many Albertans will die because of the same problems, and it seems difficult to obtain accurate information and numbers. I am concerned and Albertans should be as well. We can take a lesson from hospital experiences elsewhere. In England, the Mid-Staffordshire public inquiry into high mortality rates and scandalous conditions at the Stafford Hospital in the late 2000s concluded as many as 1,200 patients may have died needlessly after they were “routinely neglected” at the hospital. Alberta Health Services is charged with a significant responsibility as it relates to the organization and running of the health system to not only meet the needs of Albertans, but to help Albertans become healthier. As a family physician of 23 years in this province, I can bear witness to the strengths and weaknesses of the system within which I work. For several years now I have advised families of people in my practice that should any of their loved ones be admitted to hospital, any hospital, they ideally should have someone with them at all times, similar to a health aide. Sure, family members are unregulated, but they care. This is not because I distrust my health colleagues who work predominantly in the acute care sector, but because of my worry about policies and processes that compromise their abilities to deliver high quality and safe care. Alberta Health Services doesn’t seem to understand the distinction between “supplementary” and “substitutive” when considering health professionals. The lowest cost provider seems to trump scope of practice and skill level. The policy of substituting licensed practical nurses (LPNs) for registered nurses suggests Alberta Health Services does not understand that we need both. When physician colleagues express concern about the safety of admitting patients to a ward where many if not most of the nurses have been replaced by LPNs, we have a problem. Equally, if not more importantly, the modest investment Alberta Health Services makes in primary health care and community-based care is insufficient. In our own practice at the Royal Alexandra Family Medicine Centre, allowing for only three nurses for a practice population of 6,000 defies logic and represents a focus on cost without attention to the overall impact on people and the system. Effective management and access to services for long-term conditions (chronic illness) and acute illness, is what primary care is all about. Our nurses are responsible for practice lists/panels to the same degree that we are, in addition to the more conventional nursing practices. Calling on elderly people as part of a telephone visit and followup, triaging people phoning with illness concerns, and supporting health maintenance and illness prevention strategies are just a part of what our nurses do. We also need LPNs in the system, and unfortunately much of the debate of late has pitted one group of health professionals, registered nurses, against another — the licensed practical nurses. So much for the concept of teamwork. Alberta Health Services authorities suffer from a community health and illness blind spot. They seem to think their emergency rooms and hospitals reflect what goes on in the community. They rarely, if ever, see or understand what it is that community health professionals do and how, were it not for them, the system would shut down. Effective primary health care prevents the inappropriate use of emergency rooms. Hospital-based personnel have a great deal of difficulty understanding what truly goes on in the community and how essential primary health care is to the functioning of an overall system. Were it not for the physicians, nurses, LPNs, pharmacists and other health professionals grounded in the community and doing their good works, the system would be in even more trouble. It is distressing to see nurses and nursing assistants, in addition to their regular jobs, take on the responsibility of looking out for family who require the services of the acute care sector. How many Albertans will have to die, be maimed or otherwise suffer before a systems approach is applied to health care in this otherwise very wealthy province? I am getting a little sick and tired of how poorly our health professionals are being treated at the hands of well-intentioned but clearly inept system managers. I am sick and tired of having to witness my patients, myself, and other health professional colleagues, being told we all must wait six months before “we” can get an MRI. It is not only patients who depend on this diagnostic test, but also those of us who are involved with their diagnosis and management. It is distressing to have a radiologist colleague inform us of the wait times and also that they are pretty much at a loss to make it any better. What is it going to take for Alberta Health Services to recognize the essential and valuable role their nurses play, as well as that of their LPNs? When will they be able to look beyond the walls of the hospital to learn that their management approach is not only ill conceived and poorly executed, but is a danger to all Albertans? Will we have to witness a Mid-Staffordshire debacle here before anything improves? Is it already happening? Dr. David G. Moores is a family physician at Royal Alexandra Family Medicine Centre in Edmonton. © Copyright (c) The Edmonton Journal
Posted on: Wed, 07 Aug 2013 01:04:12 +0000
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