A discusting waste exposed by Christina Blizzard
Patient transfers an area for savings
A recently released study on ambulance transfers provides an interesting glimpse into a shocking hidden cost of health care.
Fully-equipped ambulances, staffed by trained EMS paramedics, are increasingly being used as an expensive form of health buses to transport patients to non-urgent care.
That's according to a study by University of Toronto researchers, who found that of the approximately 400,000 patient transfers each year, just over 80% are non-urgent, routine patient transfers.
"Primarily, these are for physician appointments, dialysis or returning to the facility they came from or home," said lead researcher Victoria Robinson in an interview.
Large urban areas can sometimes control transfer costs by using private transportation companies.
Those simply don't exist everywhere, so smaller towns and cities, northern and rural areas depend on ambulances for transfers.
"This practice diverts resources from more emergent requests," the study finds.
One of the outcomes of hospital restructuring that occurred in the 1990s is that patients no longer get one-stop shopping when they're hospitalized. One in three patients admitted to hospital has to be transferred elsewhere for treatment.
"Every day in Ontario there are approximately 3,000 hospital admissions. It is now up to 1,375 patient transfers," Robinson said. She estimates the average cost of a transfer at a staggering $700.
Patient transfers overall are costing the health-care system more than $280 million annually.
"The results call into question the use of sophisticated, highly-trained, expensive patient transfer resources to provide routine medical services in Ontario," says the report.
EMS service is provincially mandated and regulated, but is administered locally.
The researchers were able to track statistics because of changes to the transfer system that happened during the SARS outbreak of 2003. In the GTA, SARS was in part transmitted by inter-facility patient transfer.
During SARS, the old way of one hospital calling another to set up a transfer ended and a new system that screens for infectious diseases was implemented. No transfer can take place without authorization. A transfer often occurs when a patient arrives at an ER suffering from a condition that hospital isn't equipped to handle. Or, frequently, patients are transferred between hospitals for services such as dialysis -- often as many as three times a week.
While 70% of all transfers are within a 25-kilometre distance, some are longer. Those involving pregnant women and newborn babies require travelling a median of 40.3 km for re.
"The problems with transfers in general is that they are lower priority," Robinson said.
"A 911 call will always take priority.
"An emergency transfer is going to take priority over a non-urgent transfer, and a non-urgent transfer could be that dialysis appointment.
"Even though that is non-urgent, to that patient, they have to get that care and if it is delayed it's going to have an impact on their care," she said.
Clearly any system that is costing taxpayers $700 for patient transportation that could easily be handled by a taxi is unsustainable.
Let's see now: An average trip of 25 km costs us around $700. That works out to around $28 per km. At least you don't have to tip the paramedics.
Still, there has to be a cheaper and more effective way.
As health care becomes more regionalized and hospitals start to specialize in cancer care, cardiac, pediatric care and so on, this province will have to find a cheaper, more sensible way to move patients around.
