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Criticall and Emergency Care Access in Ontario

Posted Feb 07 2010 8:23am

One of our regular contributors had posted an informative post on the previous journal entry regarding accessing beds in Ontario hospitals for emergency cases using Criticall, particularly neurosurgical cases. It  indicates a true lack of access in 2010. This is not something new but it is easy to be hoodwinked by the science of studying wait times and the systems designed to deal with lack of capacity in a system that is likely to get much worse before we come to our collective senses.

Of course, tens of millions were thrown at neurosurgical cases in the past couple years in an effort to create an improvement but in my own estimation, nothing has really changed. I still wait for months...a year in some cases...for a neurosurgical consult in cases with positive MRI findings. I still have referrals rejected because the fax back reads "due to focus on cancer cases, cervical and lumbosacral cases will not be seen".

I do note that what did change after some money flowed was that neurosurgeons were suddenly quiet.

Looking ahead to an aging population and a population with increasing obesity, diabetes and cardiovascular disease, with all the inherent cerebrovascular complications such as stroke and MIs, it doesn't take a rocket scientist, or even a LHIN administrator, to figure out that things are going to get nastier.

I have copied the post almost in its entirety and hope that it provides a deeper understanding of how poorly our system is equipped to meet the needs of the future, not to mention now.

I will also have a look for Mr. Smitherman's comment.

Here is the post from eklimek:

"I am grateful the discussion is in the press about the shortcoming and unsustainability in providing service.

As some of you probably know there is a telephone communication system called Criticall in Ontario. It is used when an emergency requires treatment not locally available.

In years gone by, when there was surge capacity, it was very helpful in connecting the sending and receiving clinicians and assisted in finding emergent care somewhere in the province. Now with no excess capacity pretty well anywhere clinicians begin to view it as becoming just one more hoop.

Here is how it works. Since Criticall does not know the actual provincial bed availability for the needs of the patient (e.g neurosurgery) , it literally telephonically hopscotchs across the province sequentially ringing up on call neurosurgical services.

Reflect for a second on this. Say you are on call as at the potential receiving end. You also know there is no ICU /NICU or surgical capacity on site because you just took the last bed with the last case. Nevertheless you get called. You are obliged to respond, listen to the story, may choose to give telephonic advice for which shared liability is engendered and still must refuse to accept the case because you lack the capacity to treat the problem. All this, let's say, at 3 or 4 in the morninng.

Meanwhile, on the sending end, typically after 3 or 4 refusals for "no beds" over a similar number of hours of repetition and telephone tag with serial oncall services, the conversation turns to out-of-province care. Of course the alternative is to start over from the beginning, just to see if the bed situation has changed in the last 6 hours.

The new wrinkle is interposition of a medical director near the outset of the process if the patient is to leave the home LHIN. Who knew we really needed another noncare provider in this process?"


Thanks for putting it so plainly, eklimek. As health care in Canada sinks, the band leaders play on....except of course when they are trying to enter the life-rafts destined for the US.

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