SMH 'code
violations and issues that constitute ever increasing risk factors'
Posted January
25, 2013
Stevenson Memorial Hospital (SMH) has become its own health hazard and
requires millions of dollars to fund an expansion of the 50-year-old
Fletcher Street building, which "fails to fully meet many regulatory
(fire, safety and other)
requirements as well as falling short of important health care
standards such as; patient privacy, infection control, and
accessibility."
That's one of the conclusions of the 368 page Pre Capital Schedule
A Submission from SMH to the Central Local Health Integration Network
(LHIN), signed by hospital board chair John Swindon, and SMH CEO
Annette Jones. It was presented Jan. 23 to the Central LHIN and lays
bare the initial overview of the proposed major capital project,
justifications for funding, and proof of community engagement. In that
sense there are 92 pages of support letters from every facet of the
community.
At its core, the submission's message is that the physical structure,
built in 1962 to serve about 7,000 people, is not much larger than
today, which sees it handling over 30,000 cases annually through its
emergency department, an area that is about 4,000 sq. ft in space, the
lowest ratio in the province. And with a catchment area currently
around 55,000 people, and projected to double within the next two
decades.
"This is well less than half
of documented hospital standard stated in the Hospital Service Needs
and Capacity Planning report and creates heightened risks for infection
control, patient and staff safety, patient privacy, mobility access,
falls prevention and ambulance off-loading protocols," according to the
submission's cover letter. "The fact that the
main lobby, hospital registration desk, coffee shop, gift shop and
entrance to the Hospital are now shared with the Emergency Department
triage area and waiting room is unacceptable. A recent Ministry of
Health review as well as a HIROC review of these facilities found code
violations and issues that constitute ever increasing risk factors for
both the Hospital and the Ministry."
The submission suggests that the hospital building is "no
longer capable of being renovated, will
not support the use of many of today's accepted practices for patient
care and environmental controls." And its improvements will deliver
"significant cost savings achieved in building management alone with a
new Emergency Department."
Highlighted below are two of the key components of the
submission report:
"Department Layout:
The current department layout creates serious operational
inefficiencies, which negatively impact patient care and staff and
physician satisfaction with their working environment. The department
is divided into two sections, with acutely ill patients (CTAS 1 to 3)
located at one end of the ER and the less acutely ill patients (CTAS 4
and 5) down a hallway in a small "fasttrack area." Nurses who are
caring for the acutely ill patients are restricted to staying within
that area and are unable to travel down the hall to monitor and care
for the less acute patients. This will only allow for 'fast-track'
space when there is an extra staff nurse on duty. During the night
shift, (10:00 pm to 7:00 am), the fast-track area has to be closed, as
it is unsafe to have patients at the end of a hallway and not visible
or easily accessible to the staff. This situation reduces the overall
capacity of the department during the night, often the busiest time
period in an ER for CTAS 4 and 5. The co-location of all patient
encounter spaces together would greatly assist in alleviating this
problem."
Patient Care Areas:
- Although SMH meets MOHLTC Wait Time Targets, the current department
is too small to promote operational and financial efficiency. To
facilitate a better flow of patients, and increased volumes with
decreased wait time, it is necessary to have more "patient areas" for
the patients to be seen and/or waiting within the
department;
- Wall-mounted oxygen is only available in 3 of the 4 acute rooms and
not available in the other 9 rooms including the fast-track area.
Wall-mounted oxygen must be available in all patient encounter spaces;
- The ER does not meet the requirements of the Ontarians with
Disabilities Act (2001), and as a result, accessibility for persons
with disabilities is compromised. As the population in the hospital's
catchment area increases, particularly the population aged 65+, this
will become an even greater issue, as incidence of disability increases
with age;
- There are only three washrooms in the ER, one of which is the public
washroom for the main entrance and main floor of the hospital.
Therefore, members of public must enter the ER to use a public
washroom, further compromising patient privacy and confidentiality and
the ability to maintain infection prevention and control standards; and
- A critical concern is that there is only one "dirty hopper" in the
entire ER and it is located in the Trauma room. This location was part
of the 1964 design of the ER department. Having the only "dirty hopper"
in the Trauma room poses a significant risk in that all potentially
infectious bodily fluids and bodily matter is being transported into a
Trauma room that is frequently occupied by an acutely ill patient and
their family. The current infrastructure exponentially increases the
risk of cross contamination from infectious disease. Without a major
redevelopment, there is currently no ability to relocate either the
Trauma room or the dirty hopper as there is no space within the current
infrastructure.
"The space that will be freed up by establishing a new add on
ER, OR, DI and Lab wing will be used to enhance and add other clinical
and rehab programs, in partnership with other providers, that are
currently not available within the community. The mental health
services that are currently operated from a separate on site older
building will be brought back into the hospital as will the executive
and administrative functions," according to the submission."
